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Evaluation Review, Vol. 24, No. 3, 251-271 (2000)

When Is an HIV Infection Prevented and When Is It Merely Delayed?

Steven D. Pinkerton

Center for AIDS Intervention Research, Medical College of Wisconsin

Harrell W. Chesson

National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention

David R. Holtgrave

National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention

William Kassler

National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention

Peter M. Layde

Department of Family and Community Medicine, Medical College of Wisconsin

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.

Key Words: HIV prevention • Bernoulli model • transmission • cost-effectiveness


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