Evidence Strategies and Practical tools for inclusion of social and structural interventions such as housing, employment, and food security in plans to end the epidemic
Policy, Program, Intervention or other types of research evaluation
Issues : The use of high-quality research evidence is necessary to support the use of effective HIV-related programs, services and drugs and to support the implementation of structural interventions. However, few stand-alone research studies are sufficiently persuasive to drive policy change, and only the strongest study designs (e.g., meta-analyses, systematic reviews, and large randomized controlled trials) can yield strong recommendations. Unfortunately, individuals and community organizations often lack the capacity to navigate research databases (which are often inaccessible to those outside research institutions) and efficiently locate the evidence needed to support their advocacy initiatives. This can create difficulty with rapidly identifying relevant research evidence to inform programs and policies to address pressing priorities. Effectively connecting community organizations, researchers, and policymakers to high-quality and relevant research evidence is imperative in the development of relevant, evidence-informed programs, and policy change towards the end of the HIV epidemic.
Description : In 2010, the Ontario HIV Treatment Network (OHTN) began the development of the Synthesized HIV/AIDS Research Evidence (SHARE) database to facilitate timely access to research evidence about HIV and AIDS. SHARE is a searchable online repository of HIV-related research syntheses (systematic reviews, scoping reviews, meta-analyses, and other types of systematic reviews) available at www.hivevidence.ca. Searches of MEDLINE/PubMed and the Cochrane Library are conducted by the Knowledge Synthesis team at the OHTN every three months to locate articles for the database. Titles and abstracts are screened, and relevant articles are included. To facilitate searches within the database, reviewers categorize included articles according to HIV-relevant topics. This taxonomy of topics is organized into four domains: population(s) of interest (e.g. men who have sex with men); prevention, engagement and treatment cascade (e.g. retention in care); health systems (e.g. governance, financial and delivery arrangements); and syndemics and determinants of health (e.g. housing). Links to the abstract or full paper (when publicly available) are provided for all included articles. The database is also searchable using key words in titles or abstracts, and by authors’ names.
Lessons learned : As of March 6th, 2018, searches have yielded over 36,000 titles and abstracts that have been reviewed by the Knowledge Synthesis team. After reviewing, 2354 peer-reviewed systematic reviews have been categorized using the taxonomy and included on the SHARE database. Articles have been included that relate to 15 population groups, such as general HIV-positive population (n=1198; 51%), children or youth under 18 years (n=377; 16%), women (n=370; 16%), men who have sex with men (n=245; 10%), people who use drugs (n= 162; 7%), etc. A total of 71% of articles (n=1,675) relate to the prevention, engagement, and treatment cascade; and 15% (n=360) relate to health systems. Articles were also categorized according to 29 different syndemic and social determinant categories, such as hepatitis B or C coinfection (n=132; 6%), nonmedicinal drug use (n=132; 6%), stigma and discrimination (n=89; 4%), food security (n=19; 0.8%), housing (n=19; 0.8%), etc.
It is clear from the large number of articles found, that the SHARE database has the potential to greatly streamline the dissemination of synthesized HIV-relevant research. Health system stakeholders addressing topics related to HIV/AIDS can now easily identify relevant research and use it to inform decision-making and advocacy.
Recommendations : The Knowledge Synthesis team will continue to update SHARE by identifying and categorizing new systematic reviews. Analytic data will continue to be analyzed to enhance its content and functionality (e.g., providing quality appraisals). In the future, it may be beneficial to investigate the ease and utility of the SHARE database for its users through controlled trials. In the meantime, efforts to promote the SHARE database will be strengthened to expand its reach and ensure it remains useful for HIV/AIDS researchers, policymakers, and community organizations.