Behavioral and biomedical interventions tend to focus
on decreasing individual and network level risks of HIV.
However, the effectiveness of these interventions as measured
by reductions of HIV incidence will ultimately be
limited by the community, public policy, and epidemic
stages in which they are operationalized. To date, the
majority of evaluations of biomedical and behavioral
interventions have focused on efficacy rather than realworld
effectiveness. Moving forward, there has been arenewed emphasis on implementation science to assess
the effectiveness of interventions. There appears to be
consensus that translating efficacious interventions to
effective programs necessitates addressing higher order
risk factors. However, to date there remains a limited
evidence base in the peer-reviewed literature supporting
structural interventions. Moreover, the interventions or
programs attempting to change community dynamics
such as stigma or public policy are more difficult to implement
and evaluate than individual-level interventions
amenable to rapid scale-up and blinded randomized trials
[51]. Similarly, new approaches are needed for the
evaluation of evidence supporting such interventions
transcending randomized controlled trials [52].