Landscape of HIV Implementation Research Funded by the National Institutes of Health: A Mapping Review of Project Abstracts

Abstract

In 2019, the requisite biomedical and behavioral interventions to eliminate new HIV infections exist. "Ending the HIV Epidemic" now becomes primarily a challenge of will and implementation. This review maps the extent to which implementation research (IR) has been integrated into HIV research by reviewing the recent funding portfolio of the NIH. We searched NIH RePORTER for HIV and IR-related research projects funded from January 2013 to March 2018. The 4629 unique studies identified were screened using machine learning and manual methods. 216 abstracts met the eligibility criteria of HIV and IR. Key study characteristics were then abstracted. NIH currently funds HIV studies that are either formally IR (n = 109) or preparatory for IR (n = 107). Few (13%) projects mentioned a guiding implementation model, theory, or framework, and only 56% of all studies explicitly mentioned measuring an implementation outcome. Considering the study aims along an IR continuum, 18 (8%) studies examined barriers and facilitators, 43 (20%) developed implementation strategies, 46 (21%) piloted strategies, 73 (34%) tested a single strategy, and 35 (16%) compared strategies. A higher proportion of formal IR projects involved established interventions (e.g., integrated services) compared to newer interventions (e.g., pre-exposure prophylaxis). Prioritizing HIV-related IR in NIH and other federal funding opportunity announcements and expanded training in implementation science could have a substantial impact on ending the HIV pandemic. This review serves as a baseline by which to compare funding patterns and the sophistication of IR in HIV research over time.

Designs and methods for implementation research: Advancing the mission of the CTSA program

“…Some implementation studies are designed to test, evaluate, or observe the impact of one or more implementation strategies. Others seek to understand implementation context, determinants, barriers, and facilitators that will inform the study design [12].…”

“…They performed restricted randomization, which involved retaining balance between treatment and control arms on key covariates including geographic location and monthly pneumonia admissions. The study used random intercept multilevel models to account for any residual imbalances in performance at baseline so that the findings could be attributed to the audit and feedback, the implementation strategy of interest [12].…”

The HIV Treat Pillar: An Update and Summary of Promising Approaches

“…To date, HIV prevention research has focused on the effectiveness of HIV interventions, but relatively few studies evaluate implementation strategies needed to effectively bring them to scale in multiple settings and populations. 54 Federal agency funding for implementation research collaborations among academic institutions, HDs, clinics, and community-based organizations, such as the NIH-funded EHE initiatives, 55 facilitate the exploration of these questions and can further contribute to the design, evaluation, and effective implementation of interventions that are most relevant for public health practice and local HIV priorities.…”

Implementing culturally competent transplant care and implications for reducing health disparities: A prospective qualitative study

“…‘Implementation preparation’ (or ‘pre‐implementation’) research occurs after an organization's leadership has decided to adopt an intervention but before it is carried out 22 . The preparation phase also includes undertaking ‘implementation strategies’, which are ‘methods or techniques used to enhance the adoption, implementation and sustainability of a clinical programme or practice’, 23 such as training stakeholders about the intervention and further assessing organizational needs for adaptation. The preparation phase is valuable for increasing intervention adoption and fidelity 24,25 …”