EFFICACY AND EFFECTIVENESS ISSUES IN THE NIDA COOPERATIVE AGREEMENT -INTERVENTIONS FOR OUT-OF-TREATMENT DRUG-USERS

This paper examines the Cooperative Agreement (CA) HIV intervention st udies for active drug users, sponsored by the National Institute on Dr ug Abuse, in terms of the constructs of prevention efficacy and effect iveness. A rationale is presented for conservatively interpreting outc ome findings of these studies as indicative of intervention efficacy, as opposed to effectiveness. It is argued that the CA studies fall mor e within the domain of efficacy owing to the high degree of control an d optimization that occurred with respect to intervention recruitment, participation, process monitoring, and staff training. Because the in terventions were implemented and evaluated in community-based, noninst itutional settings with many real-world constraints, it is suggested t hat minimal shrinkage of their effects would occur if they were implem ented in uncontrolled community settings. The relationship of interven tion structure, content, process, dose, and participant characteristic s to intervention efficacy is reviewed and discussed, both in general terms and with reference to the CA studies.