Bridging the Gap Between Individual-Level Risk for HIV and Structural Determinants: Using Root Cause Analysis in Strategic Planning

Abstract

HIV prevention efforts have expanded beyond individual-level interventions to address structural determinants of risk. Coalitions have been an important vehicle for addressing similar intractable and deeply rooted health-related issues. A root cause analysis process may aid coalitions in identifying fundamental, structural-level contributors to risk and in identifying appropriate solutions. For this article, strategic plans for 13 coalitions were analyzed both before and after a root cause analysis approach was applied to determine the coalitions' strategic plans potential impact and comprehensiveness. After root cause analysis, strategic plans trended toward targeting policies and practices rather than on single agency programmatic changes. Plans expanded to target multiple sectors and several changes within sectors to penetrate deeply into a sector or system. Findings suggest that root cause analysis may be a viable tool to assist coalitions in identifying structural determinants and possible solutions for HIV risk.

KEYWORDS:

• HIV prevention
• HIV risk factors
• structural factors
• structural interventions

Additional information

Notes on contributors

The Adolescent Medicine Trials Network for HIV/AIDS Interventions

The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) and Connect to Protect® were supported by grants U01 HD040533 and U01 HD040474 from the National Institutes of Health through the National Institute of Child Health and Human Development with supplemental funding from the National Institutes on Drug Abuse and Mental Health. Additional grants that supported this work at the ATN sites include: Children's Diagnostic and Treatment Center: U01 HD040476; Children's Hospital of Los Angeles: U01 HD040463; Children's National Medical Center: U01 HD040562; John H. Stroger Jr. Hospital of Cook County and the CORE Center: U01 HD040515; Montefiore Medical Center: U01 HD040499; Mount Sinai Medical Center: U01 HD040505; Tulane University Health Sciences Center: U01 HD040470; University of California at San Francisco: U01 HD040506; University of Maryland: U01 HD040584; University of Miami School of Medicine: U01 HD040494; University of Pennsylvania and the Children's Hospital of Philadelphia: U01 HD040481; University of Puerto Rico: U01 HD040490; and University of South Florida: U01 HD040497. The authors thank the investigators and staff of the ATN listed in Harper, Willard, and Ellen's (2012 [this issue]) “Connect to Protect®: Utilizing Community Mobilization and Structural Change to Prevent HIV Infection Among Youth” for their valuable contributions to this project.