title: Bridging the gap between individual-level risk for HIV and structural determinants: using root cause analysis in strategic planning.
abstract: HIV prevention efforts have expanded beyond individual-level interventions to address structural determinants of risk. Coalitions have been an important vehicle for addressing similar intractable and deeply rooted health-related issues. A root cause analysis process may aid coalitions in identifying fundamental, structural-level contributors to risk and in identifying appropriate solutions. For this article, strategic plans for 13 coalitions were analyzed both before and after a root cause analysis approach was applied to determine the coalitions' strategic plans potential impact and comprehensiveness. After root cause analysis, strategic plans trended toward targeting policies and practices rather than on single agency programmatic changes. Plans expanded to target multiple sectors and several changes within sectors to penetrate deeply into a sector or system. Findings suggest that root cause analysis may be a viable tool to assist coalitions in identifying structural determinants and possible solutions for HIV risk.
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Willard
authors.forename: Kate
authors.initials: K
authors.lastname: Chutuape
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stines
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Ellen
mesh_terms: D000293:Adolescent; D019058:Community Networks / Q000458:organization & administration*; D055812:Community-Based Participatory Research / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D010934:Planning Techniques; D011647:Puerto Rico; D012307:Risk Factors; D060891:Root Cause Analysis; D014481:United States