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Should structural interventions be evaluated using RCTs? The case of HIV prevention.

Publication ,  Journal Article
Bonell, C; Hargreaves, J; Strange, V; Pronyk, P; Porter, J
Published in: Social science & medicine (1982)
September 2006

Structural interventions addressing macro-social determinants of risk have been suggested as potentially important adjuncts to biomedical and behavioural interventions for the prevention of HIV and other diseases. A few interventions of this type have been evaluated using randomised controlled trials (RCTs), the most rigorous design to evaluate the effects of biomedical and behavioural interventions. The appropriateness of applying RCTs to structural interventions is however debated. This paper considers whether issues of ethics, feasibility and utility preclude the use of RCTs in evaluations of structural interventions for HIV prevention. We conclude there is nothing particular to this category of interventions prohibiting use of RCTs. However, we suggest that RCTs may prove unacceptable, unfeasible or not useful in certain circumstances, such as where an intervention brings important benefits other than HIV prevention (such as increased income); where leaders of clusters do not allow decisions about macro-social policies to be determined randomly; where the unit of social organization addressed by an intervention is so large that recruitment of adequate numbers of clusters is impossible; and where the period required to trial interventions extends beyond practical decision-making time-scales. In such cases, alternative evaluative designs must be assessed for their ability to provide evidence of intervention effectiveness.

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Published In

Social science & medicine (1982)

DOI

EISSN

1873-5347

ISSN

0277-9536

Publication Date

September 2006

Volume

63

Issue

5

Start / End Page

1135 / 1142

Related Subject Headings

  • Sociology, Medical
  • Research Design
  • Randomized Controlled Trials as Topic
  • Public Health
  • Humans
  • HIV Infections
  • 44 Human society
  • 42 Health sciences
  • 38 Economics
  • 16 Studies in Human Society
 

Citation

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Bonell, C., Hargreaves, J., Strange, V., Pronyk, P., & Porter, J. (2006). Should structural interventions be evaluated using RCTs? The case of HIV prevention. Social Science & Medicine (1982), 63(5), 1135–1142. https://doi.org/10.1016/j.socscimed.2006.03.026
Bonell, Christopher, James Hargreaves, Vicki Strange, Paul Pronyk, and John Porter. “Should structural interventions be evaluated using RCTs? The case of HIV prevention.Social Science & Medicine (1982) 63, no. 5 (September 2006): 1135–42. https://doi.org/10.1016/j.socscimed.2006.03.026.
Bonell C, Hargreaves J, Strange V, Pronyk P, Porter J. Should structural interventions be evaluated using RCTs? The case of HIV prevention. Social science & medicine (1982). 2006 Sep;63(5):1135–42.
Bonell, Christopher, et al. “Should structural interventions be evaluated using RCTs? The case of HIV prevention.Social Science & Medicine (1982), vol. 63, no. 5, Sept. 2006, pp. 1135–42. Epmc, doi:10.1016/j.socscimed.2006.03.026.
Bonell C, Hargreaves J, Strange V, Pronyk P, Porter J. Should structural interventions be evaluated using RCTs? The case of HIV prevention. Social science & medicine (1982). 2006 Sep;63(5):1135–1142.
Journal cover image

Published In

Social science & medicine (1982)

DOI

EISSN

1873-5347

ISSN

0277-9536

Publication Date

September 2006

Volume

63

Issue

5

Start / End Page

1135 / 1142

Related Subject Headings

  • Sociology, Medical
  • Research Design
  • Randomized Controlled Trials as Topic
  • Public Health
  • Humans
  • HIV Infections
  • 44 Human society
  • 42 Health sciences
  • 38 Economics
  • 16 Studies in Human Society