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Evaluating Structural Interventions

Evaluating Structural Interventions. Kelly Hallman “Pushing Forward with Structural Interventions for HIV Prevention – Where Are We Now and How Do We Move Forward” 26 July 2012, IAS Conference. The reality. We are hardwired for this. ..and WHY do you want my sex?.

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Evaluating Structural Interventions

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  1. Evaluating Structural Interventions Kelly Hallman “Pushing Forward with Structural Interventions for HIV Prevention – Where Are We Now and How Do We Move Forward” 26 July 2012, IAS Conference

  2. The reality We are hardwired for this

  3. ..and WHY do you want my sex? • Intimacy, pleasure • Evolution, childbearing • Challenge of HIV and STIs • How do we tackle? • How to measure intervention impact?

  4. Levels of “rigor”

  5. Common HIV prevention outcomes • HIV • HSV • Condom use • Sexual partnering • Abstinence, frequency

  6. What’s common to these outcomes? • Changes at individual-level

  7. …and the “enabling” environment?

  8. “Poverty isn’t created by poor people. It’s created by wrong systems. And we don’t notice it.” - M. Yunus

  9. Structural change • Transformation that alters flows in • authority • rights • resources • opportunities • information • responsibilities • Long-term process

  10. Are these amenable to study using an RCT?

  11. RCT • Randomized • Denial of benefits a concern • Phased-in approach • Control • All else held constant • Learning, mid-course correction? • Narrow intervention • or single bundled package • or expensive multi-arm • Trial • Limited time to measure change

  12. Perhaps a middle ground

  13. Structural factors likely to impact HIV, health, well-being • What is the theory of change? • Clear conceptual framework • Causal impact hypothesis • Identify “proximate determinants” • Outcomes along path to desired change

  14. Theory Study outcomes, Study design • Did it work? • Structural level • Organizational theory • Systems analysis • Timeline • Individual level • Outcomes: Factors along pathway to desired change • Design: e.g., case-control with careful matching (PSM) • Timeline

  15. Methods • Why did it work (or not)? • Monitoring • Operations research • Institutional change theory • Qualitative approaches • Seasonality analysis • Time use patterns • etc.

  16. Let us move creatively beyond…. Your study was not an RCT! Be gone with you!

  17. “The first rule of social change: Maximize your impact without being a jerk. If you maximize impact while being a jerk, it is not worth it.” - Jacob Harold, Hewlett Foundation

  18. The Population Council conducts biomedical, social science, and public health research. We deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world.

  19. Few girls under age 15 in Burkina Faso reached by peer educators

  20. Yet younger girls much lower levels of HIV and SRH knowledge than older girls

  21. Few girls with little schooling reached by a peer educators

  22. And …most girls in Burkina Faso have never been to school

  23. And their levels of preventive knowledge are much lower than those who ever attended school

  24. Siyakha Nentsha impact on self-reported sexual behaviors Boys Girls (Yt2 - Yt1) - (Yc2 - Yc1) + * + p<0.10; * p<0.05; ** p<0.01

  25. Siyakha Nentsha impact on social and economic Boys Girls (Yt2 - Yt1) - (Yc2 - Yc1) * * * + p<0.10; * p<0.05; ** p<0.01

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