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The impact of Community Mobilisation on HIV Prevention in Middle and Low Income Countries: A Systematic Review and Critique

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      Abstract

      While community mobilisation (CM) is increasingly advocated for HIV prevention, its impact on measurable outcomes has not been established. We performed a systematic review of the impact of CM within HIV prevention interventions (N = 20), on biomedical, behavioural and social outcomes. Among most at risk groups (particularly sex workers), the evidence is somewhat consistent, indicating a tendency for positive impact, with stronger results for behavioural and social outcomes than for biomedical ones. Among youth and general communities, the evidence remains inconclusive. Success appears to be enhanced by engaging groups with a strong collective identity and by simultaneously addressing the socio-political context. We suggest that the inconclusiveness of the findings reflects problems with the evidence, rather than indicating that CM is ineffective. We discuss weaknesses in the operationalization of CM, neglect of social context, and incompatibility between context-specific CM processes and the aspiration of review methodologies to provide simple, context-transcending answers.

      Electronic supplementary material

      The online version of this article (doi:10.1007/s10461-014-0748-5) contains supplementary material, which is available to authorized users.

      Resumen

      Mientras que la movilización de la comunidad (MC) es cada vez más recomendada para la prevención del VIH, su impacto en resultados mensurables no se ha establecido. Realizamos una revisión sistemática del impacto de la MC en intervenciones para la prevención del VIH (N = 20), en resultados biomédicos, conductuales y sociales. En grupos de riesgo (particularmente trabajadoras sexuales) la evidencia es más bien consistente, indicando una tendencia general de impacto positivo, siendo los resultados conductuales y sociales más robustos que los biomédicos. En los jóvenes y comunidades en general la evidencia no es concluyente. Resultados favorables parecen ser mejorados al involucrar grupos con una fuerte identidad colectiva y, simultáneamente, atender al contexto socio-político. Proponemos que la naturaleza poco concluyente de los hallazgos refleja problemas con la evidencia, en lugar de sugerir que la MC es inefectiva. Discutimos las debilidades en la operacionalización de la MC, la desatención al contexto social y la incompatibilidad entre procesos contextualmente específicos en la MC y la pretensión de las metodologías de revisión de proveer respuestas simples y que trasciendan el contexto.

      Electronic supplementary material

      The online version of this article (doi:10.1007/s10461-014-0748-5) contains supplementary material, which is available to authorized users.

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      Most cited references 96

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      Developing and evaluating complex interventions: the new Medical Research Council guidance

      Evaluating complex interventions is complicated. The Medical Research Council's evaluation framework (2000) brought welcome clarity to the task. Now the council has updated its guidance
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        A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions.

        Several groups have outlined methodologies for systematic literature reviews of the effectiveness of interventions. The Effective Public Health Practice Project (EPHPP) began in 1998. Its mandate is to provide research evidence to guide and support the Ontario Ministry of Health in outlining minimum requirements for public health services in the province. Also, the project is expected to disseminate the results provincially, nationally, and internationally. Most of the reviews are relevant to public health nursing practice. This article describes four issues related to the systematic literature reviews of the effectiveness of public health nursing interventions: (1) the process of systematically reviewing the literature, (2) the development of a quality assessment instrument, (3) the results of the EPHPP to date, and (4) some results of the dissemination strategies used. The eight steps of the systematic review process including question formulation, searching and retrieving the literature, establishing relevance criteria, assessing studies for relevance, assessing relevant studies for methodological quality, data extraction and synthesis, writing the report, and dissemination are outlined. Also, the development and assessment of content and construct validity and intrarater reliability of the quality assessment questionnaire used in the process are described. More than 20 systematic reviews have been completed. Content validity was ascertained by the use of a number of experts to review the questionnaire during its development. Construct validity was demonstrated through comparisons with another highly rated instrument. Intrarater reliability was established using Cohen's Kappa. Dissemination strategies used appear to be effective in that professionals report being aware of the reviews and using them in program planning/policymaking decisions. The EPHPP has demonstrated the ability to adapt the most current methods of systematic literature reviews of effectiveness to questions related to public health nursing. Other positive outcomes from the process include the development of a critical mass of public health researchers and practitioners who can actively participate in the process, and the work on dissemination has been successful in attracting external funds. A program of research in this area is being developed.
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          Evidence-based public health: moving beyond randomized trials.

          Randomized controlled trials (RCTs) are essential for evaluating the efficacy of clinical interventions, where the causal chain between the agent and the outcome is relatively short and simple and where results may be safely extrapolated to other settings. However, causal chains in public health interventions are complex, making RCT results subject to effect modification in different populations. Both the internal and external validity of RCT findings can be greatly enhanced by observational studies using adequacy or plausibility designs. For evaluating large-scale interventions, studies with plausibility designs are often the only feasible option and may provide valid evidence of impact. There is an urgent need to develop evaluation standards and protocols for use in circumstances where RCTs are not appropriate.
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            Author and article information

            Affiliations
            [ ]Department of Methodology, The London School of Economics and Political Science, London, UK
            [ ]Department of Social Psychology, The London School of Economics and Political Science, 3rd Floor St Clements Building, Houghton Street, London, WC2A 2AE UK
            [ ]International HIV/AIDS Alliance, Brighton, UK
            [ ]Division of Health Research, Lancaster University, Lancaster, UK
            Contributors
            +44-020-7852-3713 , +44-020-7955-7565 , j.priego-hernandez@lse.ac.uk
            Journal
            AIDS Behav
            AIDS Behav
            AIDS and Behavior
            Springer US (Boston )
            1090-7165
            1573-3254
            23 March 2014
            23 March 2014
            2014
            : 18
            : 11
            : 2110-2134
            24659360 4196137 748 10.1007/s10461-014-0748-5
            © The Author(s) 2014

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

            Categories
            Substantive Review
            Custom metadata
            © Springer Science+Business Media New York 2014

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