Consequences of HIV prevention interventions and programs: spectrum, selection, and quality of outcome measures

The outcome measures employed in an HIV prevention intervention study shoul d match the research and policy questions at hand. Ii the question is 'did the intervention work to prevent HIV infection?', then seroincidence data m ay be insufficient. However, if the question is 'why did the intervention w ork?', then more detailed behavioral data are necessary (and sometimes beha vior change itself is the real goal of an intervention study). Given the wi de range of questions asked by HIV prevention policy makers, funders and re searchers, a spectrum of outcome measures is needed across HIV prevention i ntervention studies. These include measures of behavioral determinants, HIV -related risk behaviors, HIV incidence (and other biologic markers), morbid ity, mortality, and cost-effectiveness factors (such as cost per quality-ad justed life year saved). In this paper, we review the range of outcome meas ures used and needed in these intervention studies. Particular attention is paid to the psychometric properties of self-reported behavior change measu res of sexual behavior and substance use. Additional emphasis is placed on the role of cost-effectiveness measures in intervention studies. A general framework is proposed for conceptualizing the array of outcome measure poss ible for any given HIV prevention intervention study. (C) 2000 Lippincott W illiams & Wilkins.