National Alliance of State and Territorial AIDS Directors (NASTAD), 444 North Capitol St NW, Suite 339, Washington, DC, USA.
Int J Equity Health. 2022 Dec 21;21(1):185. doi: 10.1186/s12939-022-01801-6.
The use of evidence-based (EB) and evidence-informed (EI) criteria in determining the effectiveness of health interventions has been widely adopted by national and international agencies in their attempt to address health gaps, particularly around Ending the HIV Epidemic (EHE) initiatives. Utilization of these rigorous standards has proven critical in making progress towards achieving EHE goals, yet many communities remain unreached and underserved despite widespread adoption of EB/EI standards in public health research and practice. Although a crucial tool for innovative healthcare delivery, emphasis on the use of EB/EI parameters has created bias within the cycle of knowledge creation that favors well-resourced institutions given their capacity to meet the rigorous evaluation standards required of EB/EI science. This bias can systematically exclude institutions more aligned with community needs, such as community-based organizations and other grass-roots initiatives, which may have long-standing interventions that more effectively engage marginalized groups but do not have the capacity to meet EB/EI standards.
This paper will explore the manifestation of systematic bias and research inequity in the process of identifying and assessing EB/EI HIV care interventions through the lens of a Health Resources and Services Administration funded initiative, coined the Center for Innovation and Engagement, which supports people living with HIV in the United States. An overview of the initiative is provided along with examples of how promising interventions with positive outcomes for members of marginalized communities are excluded in place of interventions that meet traditional standards of scientific rigor but are not novel or particularly innovative. Themes around academic imperialism and power hierarchies will be considered along with key barriers, lessons learned, and recommendations for promoting more equitable EB/EI research practice.
It is crucial for entities supporting public health interventions to prioritize equity and inclusion in all stages of funding, design, and implementation. This is particularly true for conditions, such as HIV, that disproportionally impact the most marginalized. This will require approaching EB/EI research with a critical lens towards power and a willingness to dismantle historical dynamics that perpetuate inequities as a way of encouraging truly innovative solutions to support those who need it most.
在确定卫生干预措施的有效性时，采用基于证据（EB）和循证（EI）标准已被国家和国际机构广泛采用，以努力解决卫生差距问题，特别是在终结艾滋病流行（EHE）倡议方面。这些严格标准的使用对于实现 EHE 目标的进展至关重要，但尽管在公共卫生研究和实践中广泛采用了 EB/EI 标准，许多社区仍然无法获得服务。虽然这是创新医疗保健服务的重要工具，但对 EB/EI 参数的强调在知识创造周期内造成了偏见，因为资源充足的机构有能力满足 EB/EI 科学所需的严格评估标准。这种偏见可能会系统地排除与社区需求更一致的机构，例如社区组织和其他基层倡议，这些机构可能具有更有效地吸引边缘群体的长期干预措施，但没有能力满足 EB/EI 标准。
本文将通过美国卫生资源和服务管理局资助的一项名为“创新与参与中心”的倡议，从识别和评估基于 EB/EI 的艾滋病毒护理干预措施的过程中，探讨系统偏见和研究不公平现象的表现。该倡议概述以及一些例子将说明，如何将具有积极成果的边缘社区成员的有前途的干预措施排除在外，而代之以符合传统科学严谨性标准但不新颖或特别创新的干预措施。本文还将考虑学术帝国主义和权力等级制度等主题，以及主要障碍、经验教训和促进更公平的 EB/EI 研究实践的建议。
支持公共卫生干预措施的实体必须在资金、设计和实施的所有阶段优先考虑公平性和包容性。对于艾滋病毒等不成比例地影响最边缘化人群的情况尤其如此。这将需要以批判的眼光看待 EB/EI 研究中的权力，并愿意打破延续不公平现象的历史动态，以此鼓励支持最需要的人的真正创新解决方案。
