The Highest Attainable Standard of Evidence (HASTE) for HIV/AIDS Interventions: Toward a Public Health Approach to Defining Evidence

Abstract

Objectives. Evidence-driven decisions have become a standard for health interventions, policy, and programs. While randomized controlled trials (RCTs) are encouraged for public health interventions, there are limitations with RCTs as the gold standard of evidence for HIV interventions. We developed a novel system of evaluating evidence for assessing HIV preventive interventions termed the Highest Attainable Standard of Evidence (HASTE).Methods. The HASTE system focuses on triangulation of three distinct categories of evidence: efficacy data, implementation data, and plausibility. We conducted systematic reviews, including experimental and observational data, to assess all available interventions for men who have sex with men (MSM). We collected implementation and programmatic data using a global electronic consultation, Internet searches, and in-person consultations. We assessed plausibility with expert analyses of both biological and public health evidence.results. HASTE includes four grades of evidence: Strong (Grade 1), Conditional (Grade 2), Insufficient (Grade 3), and Inappropriate (Grade 4). We used the HASTE system to evaluate the evidence for HIV interventions for MSM in low-and middle-income countries. Several differences emerged in the strength of recommendation with the use of the HASTE system, including strong recommendations for voluntary counseling and testing and for structural interventions.conclusions. The HASTE system addresses a need for an evidence evaluation tool that is specific for HIV interventions and facilitates an evaluation of biomedical, behavioral, and structural approaches using the highest standard of attainable evidence. HASTE represents a tool that balances scientific integrity and practicality in assessing the quality of evidence of preventive interventions targeting the most-at-risk populations for HIV.

Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics

“…Moreover, the interventions or programs attempting to change community dynamics such as stigma or public policy are more difficult to implement and evaluate than individual-level interventions amenable to rapid scale-up and blinded randomized trials [51]. Similarly, new approaches are needed for the evaluation of evidence supporting such interventions transcending randomized controlled trials [52]. …”

Successes and challenges of HIV prevention in men who have sex with men

“… HASTE criteria comparisons are reproduced from Baral et al 5 ↓ = outcome is decreased by intervention. A = consistent conclusions across meta-analyses, high-quality systematic reviews, or several randomised controlled trials.…”

“…3,4 We review HIV prevention interventions for MSM, emphasise the importance of the development and assessment of combination prevention packages, and address challenges. The World Bank used the highest attainable standard of evidence (HASTE) system (which also includes data for implementation science) in its 2011 review 5 of published work, whereas WHO used the grading of recommendations assessment, development and evaluation (GRADE) system. 6 We combine these reviews and our own comprehensive review of work and suggest a conceptual framework for packaging of interventions and modelling of the potential effect of scale-up of HIV prevention interventions for MSM.…”

HIV epidemic among key populations in west Africa

“…There is ample evidence that targeted HIV prevention programs aimed at reducing transmission of HIV and STIs are feasible and effective among FSW [21,54–56] and to a lesser extent among MSM [57,58]. However, major challenges hamper the delivery of effective prevention programs in these populations in west Africa.…”