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

Christopher Bonell, James Hargreaves, Vicki Strange, Paul Pronyk, John Porter Social Science & Medicine , 2006; Vol. 63, Issue 5 Download publication

Do issues of ethics, feasibility and utility preclude the use of randomised controlled trials (RCTs) in evaluations of structural interventions for HIV prevention?

This paper, including a contribution from STRIVE researcher James Hargreaves, debates the appropriateness of applying RCTs to structural interventions. The authors are broadly supportive of RCTs as one of the most rigorous methods for evaluating the effects of biomedical and behavioural interventions. However, the paper considers a range of circumstances where RCTs may prove unacceptable, unfeasible or less useful. These include: 


  • 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;
  • Where the period required to trial interventions extends beyond practical decision-making time-scales. 


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