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When is an HIV infection prevented and when is it merely delayed?
Evaluation Review 2000;24(3):251-271.
Pinkerton SD, Chesson HW, Holtgrave DR, Kassler WJ, Layde PM.
Abstract
HIV prevention programs are typically evaluated using behavioral outcomes.
Mathematical models of HIV transmission can be used to translate these behavioral
outcomes into estimates of the number of HIV infections averted. Usually,
intervention effectiveness is evaluated over a brief assessment period and
an infection is considered to be prevented if it does not occur during this
period. This approach may overestimate intervention effectiveness if participants
continue to engage in risk behaviors. Conversely, this strategy underestimates
the true impact of interventions by assuming that behavioral changes persist
only until the end of the intervention assessment period. In this article,
the authors (a) suggest a simple framework for distinguishing between HIV
infections that are truly prevented and those that are merely delayed, (b)
illustrate how these outcomes can be estimated, (c) discuss strategies for
extrapolating intervention effects beyond the assessment period, and (d)
highlight the implications of these findings for HIV prevention decision
making.