The need for ongoing, prompt, cost-efficient and comprehensive monitoring and evaluation of drug treatment is well recognised_.  The scientific literature supports the use of randomised controlled trials (RCTs) as the ‘gold standard’ research design for evaluating interventions and treatment outcomes. However, in community substance-use treatment settings, the use of RCTs is not always possible or appropriate. There are ethical issues and questions about relevance, feasibility and costs.

The 2014 Annual epidemiological report from the Health Protection Surveillance Centre,¹ published in December 2015, reports 377 new diagnoses of HIV, of which almost half (n=183) were among men who had had sex with men (MSM).  This reflects a growing trend with the number of new diagnoses among MSM increasing threefold in the ten years since 2005 (from 60 to 183).  Moreover, the median age of diagnosis has decreased from 37 to 31 years. Increased access to testing explains some of the increase.