title: Evaluation of the effect of human immunodeficiency virus-related structural interventions: the connect to protect project.
abstract: OBJECTIVE
  With the emphasis on structural-level interventions that target social determinants of human immunodeficiency virus (HIV) transmission to curb the HIV epidemic, there is a need to develop evaluation models that can detect changes in individual factors associated with HIV-related structural changes.
  
  
  OBJECTIVE
  To describe whether structural changes developed and achieved by community coalitions are associated with an effect on individual factors associated with the risk of contracting HIV.
  
  
  METHODS
  In this serial cross-sectional survey design, data were collected from 8 cities during 4 rounds of annual surveys from March 13, 2007, through July 29, 2010. Study recruitment took place at venues where the population of focus was known to congregate, such as clubs, bars, community centers, and low-income housing. The convenience sample of at-risk youth (persons aged 12-24 years) included 5337 individuals approached about the survey and 3142 (58.9%) who were screened for eligibility. Of the 2607 eligible participants, 2559 (98.2%) ultimately agreed to participate.
  
  
  METHODS
  Achievement of locally identified structural changes that targeted public and private entities (eg, federal agencies, homeless shelters, and school systems) with the goal of fostering changes in policy and practice to ultimately facilitate positive behavioral changes aimed at preventing HIV.
  
  
  METHODS
  Number of sexual partners, partner characteristics, condom use, and history of sexually transmitted infections and HIV testing.
  
  
  RESULTS
  Exposure to structural changes was not statistically significantly associated with any of the outcome measures, although some results were in the direction of a positive structural change effect (eg, a 10-unit increase in a structural change score had an odds ratio of 0.88 [95% CI, 0.76-1.03; P = .11] for having an older sexual partner and an odds ratio of 0.91 [95% CI, 0.60-1.39; P = .39] for using a condom half the time or less with a casual partner).
  
  
  CONCLUSIONS
  This study evaluated a broad representation of at-risk individuals and assessed the effect of numerous structural changes related to various HIV risk factors. No structural changes as measured in this study were associated with a statistically significant reduction in risk behaviors. These null findings underscore the need for a long-term approach in evaluating structural interventions and the development of more nuanced methods of quantifying and comparing structural-change initiatives and determining the appropriate strategies for evaluating effect.
authors.affiliation: Department of Pediatrics, School of Medicine, All Children's Hospital, Johns Hopkins Medicine, St Petersburg, Florida.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Ellen
authors.affiliation: Health Studies Sector, Westat, Rockville, Maryland.
authors.forename: Lauren
authors.initials: L
authors.lastname: Greenberg
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Nancy
authors.initials: N
authors.lastname: Willard
authors.affiliation: Health Studies Sector, Westat, Rockville, Maryland.
authors.forename: James
authors.initials: J
authors.lastname: Korelitz
authors.affiliation: National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Bill G
authors.initials: BG
authors.lastname: Kapogiannis
authors.affiliation: Health Studies Sector, Westat, Rockville, Maryland.
authors.forename: Dina
authors.initials: D
authors.lastname: Monte
authors.affiliation: Division of Adolescent Medicine, Department of Pediatrics, University of California, San Francisco.
authors.forename: Cherrie B
authors.initials: CB
authors.lastname: Boyer
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Harper
authors.affiliation: Department of Pediatrics, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Henry-Reid
authors.affiliation: Division of Adolescent Medicine, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Friedman
authors.affiliation: Health Studies Sector, Westat, Rockville, Maryland.
authors.forename: René
authors.initials: R
authors.lastname: Gonin
mesh_terms: D000293:Adolescent; D002648:Child; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006293:Health Promotion / Q000458:organization & administration*; D006306:Health Surveys; D006801:Humans; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012725:Sexual Behavior; D015229:Sexually Transmitted Diseases, Viral / Q000517:prevention & control* / Q000635:transmission; D014481:United States; D055815:Young Adult