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Investigating combination HIV prevention: isolated interventions or complex system

Brown, Graham, Reeders, Daniel, Dowsett, Gary W., Ellard, Jeanne, Carman, Marina, Hendry, Natalie and Wallace, Jack 2015, Investigating combination HIV prevention: isolated interventions or complex system, Journal of the International AIDS Society, vol. 18, no. 1, pp. 1-6, doi: 10.7448/IAS.18.1.20499.

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Title Investigating combination HIV prevention: isolated interventions or complex system
Author(s) Brown, Graham
Reeders, Daniel
Dowsett, Gary W.
Ellard, Jeanne
Carman, Marina
Hendry, NatalieORCID iD for Hendry, Natalie orcid.org/0000-0002-2591-420X
Wallace, Jack
Journal name Journal of the International AIDS Society
Volume number 18
Issue number 1
Article ID 20499
Start page 1
End page 6
Total pages 6
Publisher International AIDS Society
Place of publication Geneva, Switzerland
Publication date 2015-12-14
ISSN 1758-2652
Keyword(s) combination HIV prevention
evaluation
evidence
complex systems
intervention research
treatment as prevention
Summary Treatment as prevention has mobilized new opportunities in preventing HIV transmission and has led to bold new UNAIDS targets in testing, treatment coverage and transmission reduction. These will require not only an increase in investment but also a deeper understanding of the dynamics of combining behavioural, biomedical and structural HIV prevention interventions. High-income countries are making substantial investments in combination HIV prevention, but is this investment leading to a deeper understanding of how to combine interventions? The combining of interventions involves complexity, with many strategies interacting with non-linear and multiplying rather than additive effects. Discussion: Drawing on a recent scoping study of the published research evidence in HIV prevention in high-income countries, this paper argues that there is a gap between the evidence currently available and the evidence needed to guide the achieving of these bold targets. The emphasis of HIV prevention intervention research continues to look at one intervention at a time in isolation from its interactions with other interventions, the community and the socio-political context of their implementation. To understand and evaluate the role of a combination of interventions, we need to understand not only what works, but in what circumstances, what role the parts need to play in their relationship with each other, when the combination needs to adapt and identify emergent effects of any resulting synergies. There is little development of evidence-based indicators on how interventions in combination should achieve that strategic advantage and synergy. This commentary discusses the implications of this ongoing situation for future research and the required investment in partnership. We suggest that systems science approaches, which are being increasingly applied in other areas of public health, could provide an expanded vocabulary and analytic tools for understanding these complex interactions, relationships and emergent effects. Conclusions: Relying on the current linear but disconnected approaches to intervention research and evidence we will miss the potential to achieve and understand system-level synergies. Given the challenges in sustaining public health and HIV prevention investment, meeting the bold UNAIDS targets that have been set is likely to be dependent on achieving systems level synergies.
Language eng
DOI 10.7448/IAS.18.1.20499
Field of Research 111799 Public Health and Health Services not elsewhere classified
1199 Other Medical And Health Sciences
Socio Economic Objective 920499 Public Health (excl. Specific Population Health) not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2015, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30082145

Document type: Journal Article
Collections: School of Education
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.