Research – PRS Efficacy Review Process
Program – Selecting an Intervention
Program – Implementation
Further Questions

Research – PRS Efficacy Review Process

• What is the HIV/AIDS Prevention Research Synthesis (PRS) Project?

  The HIV/AIDS Prevention Research Synthesis (PRS) project was initiated by the Prevention Research Branch, Division of HIV/AIDS Prevention (DHAP) at CDC in 1996 to systematically review and summarize HIV behavioral prevention research literature. The goal of PRS is to translate scientific evidence from the research literature into practical information that can be used by prevention providers, state and local health departments throughout the United States, and HIV prevention researchers. PRS activities consist of systematic reviews, including qualitative, quantitative, and meta-analytical reviews, as well as the PRS efficacy review. For a list of all PRS-related publications, go to PRS Publications.

• How are the interventions in the current Compendium of Evidence-based HIV Prevention Interventions identified?

  The current Compendium lists two types of evidence-based behavioral interventions: HIV risk reduction interventions and HIV medication adherence interventions. For the HIV risk reduction efficacy review, PRS conducted a comprehensive systematic search of the HIV literature that included both automated and manual searches to identify relevant reports of HIV behavioral interventions published or in press from January 1988 onward. For the HIV medication adherence efficacy review, PRS conducted a similar comprehensive supplemental systematic search of the HIV literature to identify reports of behavioral medication adherence interventions published or in press from January 1996 onwards. Citations were screened for inclusion according to the study eligibility criteria. Eligible citations were then reviewed using the current PRS efficacy criteria to identify HIV behavioral interventions with scientifically proven evidence of efficacy. More information about the search strategy, eligibility criteria, and efficacy criteria for the risk reduction efficacy review can be found here. More information for the medication adherence efficacy review can be found here.

• What are the PRS efficacy criteria?

  The PRS efficacy criteria are used to determine if an HIV behavioral intervention is evidence-based. For HIV risk reduction interventions, that means determining if there is sufficient evidence that the intervention reduced HIV risk, by either reducing HIV or STD incidence, eliminating or reducing sex- or drug-risk behaviors, or promoting safer behaviors. For HIV medication adherence interventions, that means determining if there is sufficient evidence that the intervention increased HIV medication adherence behaviors or decreased HIV RNA viral load levels. The efficacy criteria were developed as the result of comprehensive literature reviews by CDC staff in the Prevention Research Branch at the Division of HIV/AIDS Prevention and with multiple consultations with external HIV researchers and methodologists. The criteria focus on quality of study design, quality of study implementation, quality of analysis, and strength of findings. More information about the risk reduction efficacy criteria can be found here and the medication adherence efficacy criteria can be found here.

• Why do the efficacy criteria for individual- and group-level interventions differ from the efficacy criteria for community-level interventions?

  Because most community-level interventions (CLIs) have study and design characteristics that differ from individual- and group-level interventions (ILIs/GLIs), they require efficacy criteria that differ somewhat from those for evaluating ILIs and GLIs. PRS developed efficacy criteria specific for identifying evidence-based HIV risk reduction CLIs after multiple consultations with methodologists and HIV researchers. The efficacy criteria for best-evidence CLIs and efficacy criteria for good-evidence CLIs reflect the current state of community-level HIV behavioral intervention research published to date. Compared to ILIs and GLIs, CLI research is still in an early stage of development. Future CLI evaluation studies are strongly encouraged to include a larger number of communities per study arm, have more rigorous design features, and provide transparent reporting of issues related to evaluation of internal and external validity (e.g., refusal rate at each assessment wave). We currently do not have medication adherence CLI criteria or any identified evidence-based medication adherence CLIs.

• Why do the efficacy criteria for medication adherence interventions differ from the efficacy criteria for risk reduction interventions?

  The criteria for evaluating both the HIV risk reduction interventions and the HIV medication adherence interventions were each developed in consultation with methodologists and HIV researchers in the respective fields. The process of developing the HIV medication adherence criteria included using the HIV risk reduction criteria as a base, identifying issues unique to medication adherence interventions, and modifying the criteria for HIV medication adherences to reflect the state of science and recommendations from the methodologists and HIV researchers.

• How do the original 1999 Compendium and the current Compendium differ?

  The main differences between the 1999 Compendium of HIV Prevention Interventions with Evidence of Effectiveness and the current Compendium are the set of criteria used for determining evidence of efficacy, the time periods covered, and the quality of the search. Because the HIV behavioral intervention research field has progressed, matured, and become more rigorous since the first Compendium was published in 1999, PRS strengthened its efficacy criteria for evaluating HIV risk reduction interventions in 2004 to reflect the scientific progress of the field and to focus on those interventions with the strongest evidence for efficacy. Those interventions with the strongest evidence of efficacy have the greatest chances of reducing HIV risk within communities. More information on the rationale for the revised HIV risk reduction criteria is provided in Lyles, Crepaz, Herbst, et al. Evidence-based HIV behavioral prevention from the perspective of CDC’s HIV/AIDS Prevention Research Synthesis Team. AIDS Educ Prev. 2006;18(suppl A):21-31. Regarding the time periods, the 1999 Compendium covers interventions identified from 1988 to 1998. The current Compendium covers interventions published or in press from 1988 to May 2008. Lastly, the search strategy implemented for identifying relevant literature for the 1999 Compendium was mostly based on key word searching of electronic databases, manual searching of reference lists and contacting of scientists. PRS developed a completely new and more comprehensive search strategy that was utilized in the PRS efficacy review of the literature for the current Compendium. More information about the efficacy criteria and the search strategy can be found here.

• Can I request PRS to review my intervention for evidence of efficacy?

  If you have an intervention that you would like to be reviewed by the PRS project, please first review the study eligibility criteria to make sure that your intervention is eligible for the PRS efficacy review. If you believe that your intervention meets the eligibility criteria, please send a copy of the published or in press manuscript that reports on the evaluation of your intervention and intervention materials to PRSProject@cdc.gov. In writing up your results, it might be useful to refer to CONSORT (for randomized control trials) or TREND (for non–randomized control trials). These are two groups that provide recommendations for reporting intervention evaluation findings, to ensure that all critical information is included in the manuscript.

• If my intervention meets the PRS efficacy criteria for best or good evidence, what happens next?

  If PRS has determined that your intervention meets the efficacy criteria for best or good evidence, you will be notified by PRS, and information about your intervention will be posted on the PRS website to inform HIV prevention planners, providers, and researchers about this evidence-based HIV behavioral intervention. To move the research into practice, researchers often work to get their intervention packaged for prevention providers using a variety of potential mechanisms, both private and federal. For its part, CDC periodically announces a request for applications to translate the science-based protocols of interventions meeting PRS’s efficacy criteria into intervention packages for use by prevention providers. These announcements are made by CDC’s Replicating Effective Programs (REP) project and will continue in the future pending funding. Researchers with efficacious interventions may apply for competitive funding to convert their research protocols into intervention packages.

  For HIV medication adherence interventions, we are currently considering different options for dissemination: packaging complete interventions using the current REP process; packaging adherence “tools”, or intervention components, that can be used by clinics/clinicians as part of comprehensive adherence counseling; or summarizing effective strategies as guidance. Our next step is to work with Federal partners and stakeholders to determine which option works best and discuss who will do it, and how it will be done.

Program – Selecting an Intervention

• How do I use the current Compendium to select an intervention for my community?

  The current Compendium posted on the PRS website provides you with a catalogue of all HIV behavioral interventions from 1988 onward identified by PRS as having sufficient evidence of efficacy. The website provides you with a complete listing of all best- and good-evidence interventions and a tool for searching the catalogue for interventions for certain populations or with certain intervention characteristics. You can review each intervention in more detail by clicking on the intervention name which directs you to the intervention fact sheet. The intervention fact sheet provides you with more detailed information about the intervention, the study participants, the evaluation study, the findings, and whether the intervention has been packaged for prevention providers. You may choose to consider any of these characteristics as important elements for matching an intervention to your community’s needs. Please note that CDC recommends that interventions with packages and available training, especially interventions disseminated by CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project, be considered first by agencies conducting HIV prevention interventions.

Program – Implementation

• Are community-based organizations (CBOs) going to be expected to adopt and implement one of these evidence-based interventions listed under the current Compendium?

  There is no expectation that CBOs should adopt and implement any of these best- and good-evidence interventions listed in the current Compendium immediately. In fact, these interventions should be considered within existing contexts, including such factors as community planning and existing funding requirements.

  CBOs directly funded by CDC are currently operating under a cooperative agreement that specifies the interventions and strategies to be implemented. CBOs not directly funded by CDC but funded by health departments under a cooperative agreement with CDC are expected to implement interventions based on scientific theory or with evidence of demonstrated or probable outcome efficacy. The health departments funded by CDC may want to fund CBOs to implement one or more of the best- and good-evidence interventions listed on the PRS website in the future.

  For CBOs that have the flexibility to consider the newly identified evidence-based interventions, the following steps should be considered:

  1. Consult your jurisdiction-wide comprehensive HIV prevention plan for priority populations and services and interventions.
  2. Identify target populations in need of best- or good-evidence interventions.
  3. Read the intervention fact sheet(s) on the PRS website to identify and learn more about the various interventions for the identified target population.
  4. Of those interventions that are most relevant for your target population, determine whether an intervention package and training are available through CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project. This information is also provided in the intervention fact sheet on the PRS website.
  5. If an intervention is not available through DEBI, a package may have been developed by CDC’s Replicating Effective Programs (REP) project. On REP’s website, you can find information about intervention materials that may be available for purchase from the original researcher.
  6. There also may be packages available from non-CDC sources. In some cases, these interventions will only be available for a fee from the private distributor. Information about these sources, if available, is provided in the intervention fact sheet on the PRS website.
  7. If there is no package available from any of these sources, the original investigator may have materials available. Their contact information is also provided in the intervention fact sheet on the PRS website.

  Please note that CDC recommends that interventions with packages and available training, especially DEBIs, be considered first by agencies conducting HIV prevention interventions.

• What kind of guidance should health departments be providing to grantees regarding these newly identified evidence-based interventions that are regularly added to the PRS website?

  Health department grantees are currently providing HIV programmatic activities based on existing funding obligations and pre-approved plans. CBOs funded by health departments under a cooperative agreement with CDC are expected to implement interventions based on scientific theory or with evidence of demonstrated or probable outcome effectiveness. Health departments may want to fund CBOs to implement one or more of the best- and good-evidence interventions listed on the PRS website in the near future. Health departments should discuss this with their community planning groups (CPGs) and consider these interventions in future funding cycles as soon as packages and trainings are made available. If the health department and CPGs decide that implementation of some of these new interventions should proceed, then the following steps should be considered:

  1. Consult your jurisdiction-wide comprehensive HIV prevention plan for priority populations and services and interventions
  2. Identify target populations in need of best- and good-evidence interventions
  3. Read the intervention fact sheet(s) on the PRS website to identify and learn more about the various interventions for the identified target population.
  4. Of those interventions that are most relevant for your target population, determine whether an intervention package and training are available through CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project. This information is also provided in the intervention fact sheet on the PRS website.
  5. If an intervention is not available through DEBI, a package may have been developed by CDC’s Replicating Effective Programs (REP) project. On REP’s website, you can find information about intervention materials that may be available for purchase from the original researcher.
  6. There also may be packages available from non-CDC sources. In some cases, these interventions will only be available for a fee from the private distributor. Information about these sources, if available, is provided in the intervention fact sheet on the PRS website.
  7. If there is no package available from any of these sources, the original investigator may have materials available. Their contact information is also provided in the intervention’s fact sheet on the PRS website.

  Please note that CDC recommends that interventions with packages and available training, especially interventions disseminated by CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project, be considered first by agencies conducting HIV prevention interventions. CDC hopes that health departments will work with their grantees and the jurisdiction’s community planning group to consider these interventions in future funding cycles as soon as the packages and trainings are made available.

• How do I request intervention materials?

  If you have identified an intervention appropriate for your community's needs, first view the intervention fact sheet presented on the PRS website which provides intervention package information. If an intervention package is available, that information will lead you to the source from which the package is available. For interventions currently disseminated by CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project, the packages are available with training and technical assistance on how to implement the intervention. For other interventions packaged by Replicating Effective Programs (REP) project but not available through DEBI, you can contact the researcher to make arrangements for purchasing. If the intervention package is not available through CDC’s REP or DEBI projects, but instead only available through some other source, that information is available in the intervention fact sheet on the PRS website. Some interventions may not have available packages. For those, we suggest you contact the intervention developer (or principal investigator) as listed in the contact information in the intervention fact sheet on the PRS website. Please note that CDC recommends that interventions that have packages and training available, especially interventions disseminated by CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project, be considered first by agencies conducting HIV prevention interventions.

• How do I obtain training on how to implement an intervention?

  CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project offers training and technical assistance on how to implement some of the best-evidence interventions identified in the PRS efficacy review. To sign up for a DEBI training course for a particular intervention, go to the DEBI website, click on the Apply for Training tab at the top of the page, view the training schedule for the intervention of interest, and complete a training application for the training you want to attend. If the training is full or there is not a training date/location that works for you, beneath the training schedule there is a "click here" link where you can request to be alerted by email of other course dates and locations for that intervention. For information on other training or technical assistance made available by CDC, please visit the National Network of STD/HIV Prevention Training Centers (PTCs) or the DEBI website for other technical assistance programs.

• How can I implement an intervention without an available intervention package or training?

  Please note that CDC recommends that interventions with packages and available training, especially DEBIs, be considered first by agencies conducting HIV prevention interventions. It may be difficult to implement one of these evidence-based interventions without an available package and training. There may be intervention manuals or protocols available directly from the intervention developer (or principal investigator). Please refer to the contact information in the intervention fact sheet on the PRS website.

Further Questions

• What if I have further questions?

  If you have any further questions about evidence-based interventions after reviewing the PRS website, please contact the PRS staff in CDC’s Prevention Research Branch by email: PRSProject@cdc.gov. If you have questions about funding or programmatic requirement from CDC under cooperative agreements with community based organizations or health departments, please contact your CDC project officer.