How to evaluate combination prevention - Marie Laga

For effective HIV prevention, we must address several levels at once. But are we using the best methods to understand if and how such combination programmes work?

To begin, Professor Marie Laga reviews the case for combination prevention, defined as:

The strategic, simultaneous use of different classes of prevention activities (biomedical, behavioral, social/structural) that operate on multiple levels (individual, relationship, community, societal), to respond to the specific needs of particular audiences and modes of HIV transmission, and to make efficient use of resources through prioritizing, partnership, and engagement of affected communities.

UNAIDS (2010)

How well do current approaches measure whether such interventions are effective? Randomised controlled trials, developed to evaluate biomedical results, are considered the 'gold standard'. But what happens when we apply these definitions of 'rigour' and 'evidence' to complex, multi-layered programming? What gaps result, with what implications for the field of HIV prevention?

Professor Laga proposes:

  • a set of approaches to evaluation, process documentation and plausibility design
  • a re-framing of expectations of evidence
  • a focus on analysing programme successes
  • collaboration between researchers, evaluators and programme implementers

In addition to watching the video of this Learning Lab, you can download a PDF of the presentation slides and read Evaluating HIV prevention effectiveness: the perfect as the enemy of the good.

Marie Laga (MD, MSc Epid, PhD) is a Professor at the Department of Public Health, Institute of Tropical Medicine in Antwerp, Belgium. She has been involved in HIV research since the start of the epidemic in the 1980s. Dr Laga and her team contributed significantly to HIV prevention science in the areas of

  • sexual transmission and its co-factors
  • prevention programmes for vulnerable groups such as female sex workers, youth and men who have sex with men
  • evaluation of female-controlled methods
  • linkages with the field of sexual and reproductive health

Professor Laga provides policy support and technical assistance to numerous international and local organizations to strengthen HIV prevention worldwide.

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