title: The highest attainable standard of evidence (HASTE) for HIV/AIDS interventions: toward a public health approach to defining evidence.
abstract: OBJECTIVE
  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.
authors.affiliation: Johns Hopkins School of Public Health, Department of Epidemiology, Center for Public Health and Human Rights, Baltimore, MD 21205, USA. sbaral@jhsph.edu
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Baral
authors.forename: Andrea
authors.initials: A
authors.lastname: Wirtz
authors.forename: Frangiscos
authors.initials: F
authors.lastname: Sifakis
authors.forename: Benjamin
authors.initials: B
authors.lastname: Johns
authors.forename: Damian
authors.initials: D
authors.lastname: Walker
authors.forename: Chris
authors.initials: C
authors.lastname: Beyrer
mesh_terms: D003906:Developing Countries; D019317:Evidence-Based Medicine / Q000592:standards*; D006678:HIV; D015658:HIV Infections / Q000517:prevention & control*; D006287:Health Planning Guidelines; D006293:Health Promotion; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D015397:Program Evaluation / Q000379:methods*; D011634:Public Health