The Highest Attainable Standard of Evidence (HASTE) for HIV/AIDS Interventions: Toward a Public Health Approach to Defining Evidence

Stefan D. Baral, Andrea Wirtz, Frangiscos Sifakis, Benjamin Johns, Damian Walker, Chris Beyrer

Research output: Contribution to journalReview articlepeer-review

12 Scopus citations


Objectives. Evidence-driven decisions have become a standard for health interventions, policy, and programs. While randomized controlled trials (RCTs) are encouraged for public health interventions, there are limitations with RCTs as the gold standard of evidence for HIV interventions. We developed a novel system of evaluating evidence for assessing HIV preventive interventions termed the Highest Attainable Standard of Evidence (HASTE). Methods. The HASTE system focuses on triangulation of three distinct categories of evidence: efficacy data, implementation data, and plausibility. We conducted systematic reviews, including experimental and observational data, to assess all available interventions for men who have sex with men (MSM). We collected implementation and programmatic data using a global electronic consultation, Internet searches, and in-person consultations. We assessed plausibility with expert analyses of both biological and public health evidence. Results. HASTE includes four grades of evidence: Strong (Grade 1), Conditional (Grade 2), Insufficient (Grade 3), and Inappropriate (Grade 4). We used the HASTE system to evaluate the evidence for HIV interventions for MSM in low- and middle-income countries. Several differences emerged in the strength of recommendation with the use of the HASTE system, including strong recommendations for voluntary counseling and testing and for structural interventions. Conclusions. The HASTE system addresses a need for an evidence evaluation tool that is specific for HIV interventions and facilitates an evaluation of biomedical, behavioral, and structural approaches using the highest standard of attainable evidence. HASTE represents a tool that balances scientific integrity and practicality in assessing the quality of evidence of preventive interventions targeting the most-at-risk populations for HIV.

Original languageEnglish (US)
Pages (from-to)572-584
Number of pages13
JournalPublic health reports
Issue number6
StatePublished - 2012

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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