The HIV & IS Literature Database Tool aims to compile recent, high-quality research articles that utilize implementation science methods to study some aspect of HIV/AIDS. The University of Washington/Fred Hutch CFAR IS Core has developed this tool to be used as a reference by students, faculty, and practitioners alike. Research articles are categorized based on author, year published, study design, key IS topic, IS model/framework, HIV topic, population and geography. The database includes 123 articles, ranging in publication year from 2007 to 2022. We hope this tool will help accelerate research progress by giving study investigators and practitioners a database that can jump start grant proposal writing and program design. PhD candidates Irene Mukui and Sarah Shaw led the development of this tool.
You can preview the tool by opening it below. However, for full functionality of the tool, please download the Excel file. We are allowing public access of this resource, but if shared with others, please do credit the University of Washington/Fred Hutch CFAR IS Core for this work.
HIV Implementation Science Literature Database
| Resource Title | Authors | Year published | Study Design see notes tab for categories & definitions |
Key Takeaway(s) & Excerpts | IS Theory/Model/Framework see notes tab for categories & definitions |
IS Strategies Included/Used data not abstracted for all articles |
Key IS Methodologies see notes tab for categories & definitions |
Implementation outcomes (Proctor et al) |
Key HIV Topic see notes tab for categories & definition |
Focus Population | Geographic Setting | Article URL | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A combination strategy for enhancing linkage to and retention in HIV care among adults newly diagnosed with HIV in Mozambique: study protocol for a site-randomized implementation science study | Elul, et al. | 2014 | Cluster RCT
Nested pre/post two sample design |
This is a study protocol publication.
This study will assess the effectiveness of a combination intervention strategy (CIS) compared to the standard of care in improving linkage to and retention in care following an HIV diagnosis. Additionally, a nested study will assess the incremental effectiveness of this approach plus financial incentives compared to just CIS. |
Not described | Not abstracted for this review | Costing/economic evaluation
Stakeholder & policy analysis |
Acceptability
Feasibility |
HIV treatment/ adherence
Re-engagement in care/retention |
Adults | Mozambique | https://doi.org/10.1186/s12879-014-0549-5 | |
| A Computational Future for Preventing HIV in Minority Communities: How Advanced Technology Can Improve Implementation of Effective Programs | Brown, et al. | 2013 | Not described | Overview of the application of computational science to strengthen HIV prevention interventions: Mobilyze (Behavioral intervention technology), Sisters informing Sisters about Topics on AIDS (SISTA), Familias Unidas, and Good Behavior Game
Suggest that the delivery of successful prevention approaches at the community level will require much more personalized interventions so they fit into people's lives rather than requiring large changes, as well as contextualized implementation to address complex social systems in which prevention efforts are situated. Computational approaches can help reach populations who have historically been marginalized and less involved in research as well as target messages based on certain audience characteristics and stages of behavioral change. These strategies may also help reduce response burden on individuals. Suggested approaches: 1) Use of sophisticated, computationally driven interventions to reduce risky sex behaviors,and 2) computational supports that increase effective implementation of behavioral interventions that have been shown to be effective in reducing HIV risk behaviors in minority populations. |
RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) | Not abstracted for this review | Systems engineering | Adoption
Fidelity Sustainability |
HIV prevention | Youth | USA | https://doi.org/10.1097/qai.0b013e31829372bd | |
| A Living Database of HIV Implementation Research (LIVE Project): Protocol for Rapid Living Reviews | Eshun-Wilson, et al. | 2022 | Systematic review and meta-analyses | HIV implementation research evolves rapidly and is often complex and poorly characterized, making the synthesis of data on HIV implementation strategies inherently difficult., which is further compounded by variability in interventions , outcomes, contexts and delays in publication. The LIVE project (A Living Database of HIV Implementation Research) aims to overcome these challenges by applying an implementation science lens to the conduct of rapid living systematic reviews and meta-analyses to inform HIV service delivery priorities and guideline development. |
Not described | Not described | Other | Not described | HIV testing
HIV treatment (ART) HIV prevention |
PLHIV | Global | https://doi.org/10.2196/37070 | |
| A Multi-Disciplinary Approach to Implementation Science: The NIH-PEPFAR PMTCT Implementation Science Alliance | Sturke et al. | 2014 | Not described | Outlines components of IS in relation to PMTCT
Implementation science (IS) holds promise as a scientific strategy to address current barriers to effective implementation of evidence-based interventions in PMTCT programs. Effective application of IS to PMTCT will require deliberate and strategic efforts to facilitate collaboration, communication, and relationship building among researchers, implementers, and policy-makers, leading to the establishment of this Alliance. The end goal of the Alliance is to contribute to essential advances in the fields of IS and PMTCT and inform current thinking on best practices for evidence-based program and policy development related to PMTCT. IS is defined as the study of methods to promote the integration of research findings and evidence into health care policy and practice to achieve their potential public health impact. |
Not described | Not abstracted for this review | Implementation/intervention mapping | Acceptability
Adoption Cost Feasibility Fidelity Sustainability |
PMTCT | Pregnant and breastfeeding women | Sub-Saharan Africa
USA |
https://doi.org/10.1097/qai.0000000000000323 | |
| A police education programme to Integrate occupational safety and HIV prevention: protocol for modified stepped-wedge study design with parallel prospective cohorts to assess behavioural outcomes | Strathdee, et al. | 2015 | Hybrid Type I
Stepped-wedge design |
Evaluation of the impact of a police education program (PEP) on uptake of occupational safety procedures, prevention and treatment of HIV and viral hepatitis, attitudes toward PWID, and adverse behaviors that interfere with HIV prevention and protective behaviors. The study also aims to assess potential mediating and moderating factors that influence PEP efficacy. Ultimately the goal is to reduce HIV/STI incidence among PWID. | Transcontextual Model (TCM)
Self Determination Theory (SDT) Theory of Planned Behavior (TPB) |
Not abstracted for this review | Costing/economic evaluation | Adoption
Cost Fidelity Sustainability |
HIV prevention | Persons who inject drugs (PWID) | Mexico | https://doi.org/10.1136/bmjopen-2015-008958 | |
| A pragmatic approach to identifying implementation barriers and facilitators for a novel pre-exposure prophylaxis (PrEP) delivery model at public facilities in urban Uganda | Thomas, et al. | 2022 | Stepped-wedge cluster randomized trial | Data from the Partners PrEP Program (PPP)—a stepped-wedge cluster randomized trial that launched PrEP delivery through an integrated model of oral PrEP and antiretroviral therapy (ART) delivery for HIV sero-different couples at public health facilities in Uganda was used. A standardized form structured using the CFIR was used to record barriers and facilitators. Conceptual content analysis approach was used to analyse the data. 11 CFIR constructs were identified including implementation facilitators and barriers. Facilitators included sensitizing and educating facility staff about PrEP (knowledge and beliefs about the innovation); establishing formal and informal feedback and accountability mechanisms (reflecting and evaluating); and empowering facility staff to address implementation challenges (self-efficacy).Key implementation barriers were related to ineffective recruitment and referral of sero-different couples to and from nearby facilities (cosmopolitanism) as well as stockouts of laboratory resources and testing supplies (available resources). | Consolidated Framework for Implementation Research (CFIR) | Not described | Qualitative research | Not described | PrEP | Sero-different couples | Uganda | https://doi.org/10.1186/s43058-022-00254-w | |
| A systematic review of early adoption of implementation science for HIV prevention or treatment in the United States | Shangani, et al. | 2021 | Not described | Systematic review of HIV prevention and treatment primary research studies conducted in the US which reported on at least one implementation outcome (as defined by Proctor).
Used the Template for Intervention Description and Replication (TIDieR) to evaluate the comprehensiveness of intervention description and specifications. Acceptability and feasibility implementation outcomes were most commonly assessed across both prevention and treatment programs. The authors identified four key gaps in the literature: 1) no use of established conceptual frameworks for implementation science, 2) none of the studies used a type 3 hybrid study design, 3) few studies assessed adoption, penetration, cost, and sustainability and none reported on appropriateness and fidelity, 4) inconsistent level of details related to the interventions used. Implementation science can support HIV prevention and treatment interventions in the US and there is a need to ensure detailed and clear descriptions of interventions to facilitate replication and comparability. |
Proctor's Implementation Outcomes Framework | Not abstracted for this review | Qualitative research | Acceptability
Adoption Cost Feasibility Fidelity Penetration Sustainability |
HIV care cascade | Not described | USA | https://doi.org/10.1097/qad.0000000000002713 | |
| A type II implementation-effectiveness hybrid quasi-experimental pilot study of a clinical intervention to re-engage people living with HIV into care, 'Lost & Found': an implementation science protocol | Cox, et al. | 2020 | Hybrid: Type II Implementation-Effectiveness
Quasi-experimental Mixed methods |
Protocol to assess effectiveness and implementation outcomes of an intervention to improve re-engagement in HIV care, specifically looking at the utility of two specific implementation strategies. | Enhanced Replicating Effective Programs
Expert Recommendations for Implementing Change (ERIC) Proctor's Implementation Outcomes Framework Tailored Implementation for Chronic Diseases |
Not abstracted for this review | Adaptive designs/strategies
Qualitative research |
Feasibility
Acceptability Adoption Fidelity Sustainability |
Re-engagement in care | PLHIV | Canada | https://doi-org.off/10.1186/s40814-020-0559-6 | |
| A type III effectiveness-implementation hybrid evaluation of a multicomponent patient navigation strategy for advanced-stage Kaposi's sarcoma: protocol | Collier, et al. | 2022 | Hybrid type III study using a non-randomized, pre- post-design nested within a longitudinal cohort. | This is a hybrid type III effectiveness-implementation study using a non-randomized, pre- post-design nested within a longitudinal cohort. The study will compare delivery of evidence-based chemotherapy for advanced-stage Kaposi’s Sarcoma during the period before (2016-2020) to the period after (2021-2024), the rollout of a multicomponent patient navigation strategy-navigation period will be compared with the post-navigation period to assess the impact of this multicomponent patient navigation strategy on (1) implementation outcomes (2) service and client outcomes using the Proctor et al.’s taxonomy. Study will also describe the implementation process and the determinants of implementation success for the multicomponent patient navigation strategy. By using a clearly specified, theory-based implementation strategy and validated frameworks, this study will contribute to a more comprehensive understanding of how to improve cancer treatment in advanced-stage KS. | Proctor's Implementation Outcomes Framework
Theoretical Domains Framework (TDF) |
Not described | Implementation/intervention mapping | IS Outcomes Fidelity Service Penetration Feasibility Appropriateness Client outcomes Satisfaction |
HIV-associated Kaposi's Sarcoma | PLHIV | Kenya | https://doi.org/10.1186/s43058-022-00281-7 | |
| A world of choices: preference elicitation methods for improving the delivery and uptake of HIV prevention and treatment | Kerkhoff, et al. | 2023 | Scoping Review | Despite the growing availability of effective HIV prevention and treatment interventions, there are large gaps in their uptake and sustained use across settings. Preference elicitation methods (PEM) and can be applied to improve the delivery and uptake of HIV prevention and treatment interventions. PEM are increasingly applied in HIV implementation research, where discrete choice experiments (DCEs) have previously predominated. Beyond DCEs, there are other underutilized PEM that may improve the reach and effectiveness of HIV prevention and treatment interventions among individuals by prioritizing their barriers to engagement and determining which attributes of interventions and delivery strategies are most valued. PEM can also enhance the adoption and sustained implementation of strategies to deliver HIV prevention and treatment interventions by assessing which attributes are the most acceptable and appropriate to key stakeholders. This review summarizes the utility of PEMs in enhancing RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework as it relates to implementation of HIV prevention and treatment interventions and better understanding reasons underlying stakeholders’ preferences identified from preference elicitation studies. | Preference elicitation
RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) |
Not described | Stakeholder & policy analysis | Appropriateness
Adoption Fidelity Sustainability |
HIV prevention
HIV treatment |
Not described | Global | https://doi.org/10.1097/coh.0000000000000776 | |
| Acceptability and Appropriateness of Digital PrEP Interventions for Black and Latina Cisgender Women:Perspectives From Service Providers in Los Angeles County | Uskup, et al. | 2022 | Not described | A formative implementation research project to explore service providers' perspectives on the perceived acceptability and appropriateness of technology products to improve PrEP uptake and access for BLCW. | Proctor's Implementation Outcomes Framework | Tailor strategies (adapt and tailor strategies) |
Implementation/intervention mapping
Qualitative research |
Acceptability
Appropriateness |
PrEP | Cisgender women | USA (Los Angeles) | https://doi.org/10.1097/qai.0000000000002973 | |
| Acceptability, Appropriateness, and Preliminary Effects of the PrEP Diffusion Training for Lay HIV Workers: Increased PrEP Knowledge, Decreased Stigma, and Diffusion of Innovation | Wu, et al. | 2021 | Multi-time-point cross-sectional study | The goal of this study was to evaluate the effect of a training intervention on knowledge, PrEP stigma, and implementation behavior among lay HIV workers in China.
Overall trainings were delivered with high fidelity across sites and participants reported that the training was highly acceptable and appropriate. The authors also observed an increase in PrEP knowledge, decrease in PrEP stigma, and increase in determinants of implementation behavior following the training. |
Diffusion of Innovation
Information-Motivation-Behavioral Skills Model Proctor's Implementation Outcomes Framework Social Learning Theory Theoretical Domain Framework (TDF) Training Evaluation Framework and Tools |
Not abstracted for this review | Dissemination research | Acceptability
Appropriateness |
PrEP | Lay HIV workers | China | https://doi.org/10.1007/s10461-021-03248-2 | |
| Accounting for variations in ART program sustainability outcomes in health facilities in Uganda: a comparative case study analysis | Zakumumpa, et al. | 2016 | Case Study
Mixed methods |
The goal of this study was to identify facilitators and barriers to the long-term sustainability of ART programs in Uganda. The research team compared health facilities with different levels of ART sustainability (high, low, and non sustainers). The internal organizational context was the most distinguishing factor across cases, with high sustainers reported having an internal program champion, stable program leadership of at least 7 years, robust ART program reporting systems and long-standing external champions. Donor support was important for sustainment except in the case of for-profit providers. Strategies to increase ART program sustainability are also distinguished by the size of the health facility with the larger and more well established hospitals being able to receive multiple grants compared to small, less-established health facilities. Moreover, the barriers/facilitators to long-term sustainability often interacted with one another making it difficult to establish the direction of causality between them and the status of ART program sustainability. | Shediac-Rizkallah and Bone framework | Not abstracted for this review | Organizational readiness/ assessment
Qualitative research |
Penetration
Sustainability |
HIV treatment & adherence | PLHIV | Uganda | https://doi.org/10.1186/s12913-016-1833-4 | |
| Adapting a tobacco cessation treatment intervention and implementation strategies to enhance implementation effectiveness and clinical outcomes in the context of HIV care in Vietnam: a case study | Shelley, et al. | 2022 | Mixed method formative Evaluation | Smoking rates remain high in Vietnam, particularly among people living with HIV/AIDS (PLWH), but tobacco cessation services are not available in outpatient HIV clinics (OPCs). This paper describes the systematic, theory driven process of adapting intervention components and implementation strategies with demonstrated effectiveness in high income countries, and more recently in Vietnam, to a new population (i.e., PLWH) and new clinical setting, as a formative research prior to conduct of hybrid type III RCT. Qualitative data collection and analyses were guided by the socio ecological model, CFIR and Theoretical Domains Framework. Based on findings, components of the intervention and implementation strategies were adapted, followed by a 3 month pilot study in one OPC and adaptations made. |
Consolidated Framework for Implementation Research (CFIR)
Theoretical Domains Framework Socio-ecological model |
Training and clinical decision support Workflow mapping and redesign Referral system |
Implementation/intervention mapping | None described | HIV treatment | PLHIV | Vietnam | https://doi.org/10.1186/s43058-022-00361-8 | |
| Adapting and Implementing a Community Program to Improve Retention in Care among Patients with HIV in Southern Haiti: "Group of 6" | Naslund, et al. | 2014 | Not described | This paper describe the adaptation and implementation of a patient-led community ART group model developed by Medecins San Frontieres in Mozambique for the Haitian context. The intervention was called "Group 6" in Haiti and this unique name demonstrated local ownership of the program. Engaging stakeholders in the adaptation process to ensure local ownership was a key factor in successful implementation of the intervention. Additional institutional characteristics may have contributed to successful implementation including: support from hospital director and providers and CHWs who were implementation leaders/local champions.
However, key limitations with no control group nor baseline retention in care data. |
Not described | Not abstracted for this review | Stakeholder & policy analysis | Fidelity | HIV treatment & adherence | PLHIV | Haiti | https://doi.org/10.1155/2014/137545 | |
| Adapting and pilot testing an HIV and intersectional stigma reducing intervention for Dominican Republic healthcare contexts: Protocol for translational research | Budhwani, et al. | 2022 | Cluster randomized stepped wedge trial | A study protocol detailing the adaptation and pilot testing of the Finding Respect and Ending Stigma around HIV (FRESH) intervention in Dominican Republic. FRESH is a healthcare setting stigma-reduction intervention designed to reduce stigmas affecting people living with HIV (People Living with HIV (PLHIV)), focusing on HIV and inter-sectional stigmas experienced by sexual and gender minority (SGM) people living with HIV. After the successful adaptation of the FRESH intervention, it will be pilot-tested through the conduct of a pilot stepped wedge cluster randomized controlled trial. | ADAPT-ITT | Not described | Organizational readiness/assessment | Acceptability
Adoption |
HIV-related stigma | PLHIV | Dominican Republic | https://doi.org/10.1016/j.conctc.2022.100980 | |
| Adolescent Trials Network for HIV-AIDS Scale It Up Program: Protocol for a Rational and Overview | Naar, et al. | 2019 | Hybrid Type I, Type II, Type III | Scale It Up (SIU) U19 funded as a NIH cooperative agreement as part of ATN and has an implementation science core (ISC). The ISC provides core measures for understanding contextual factors and assessing intervention fidelity and maintains a library of categorized research papers, in additional to other activities.
Outlines 4 individual effectiveness implementation hybrid trial protocols and 2 center-wide protocols that assess contextual implementation factors and cascade outcomes for self management interventions aimed to increase the likelihood that youth are adherent across the HIV prevention and care cascades. |
Exploration, Preparation, Implementation, Sustainment (EPIS)
Five Components Model for self-management |
Not abstracted for this review | Qualitative research
Costing/economic evaluation Mathematical modeling |
Cost
Fidelity Sustainability |
Self-management across HIV prevention and treatment cascades | Youth | USA | https://doi.org/10.2196/11204 | |
| Application of the Consolidated Framework for Implementation Research to community pharmacy: A framework for implementation research on pharmacy services | Shoemaker, et al. | 2017 | Not described | This review provides an implementation framework for community pharmacy services based on literature from medication therapy management (MTM), immunizations and Rapid HIV testing.
Aim of the review was to identify the CFIR constructs most pertinent for implementing professional services in community pharmacy settings. Although the intervention characteristics depend on the specific intervention, the authors found that relative advantage, adaptability, complexity, and cost were particularly relevant to community pharmacy settings. Multiple CFIR constructs were interrelated for either promotion or barring successful implementation in community pharmacy settings. CFAR constructs in the process domain were not addressed in HIV testing articles. Variety of HIV testing kits (over the counter and those to be used at home) was a facilitator and provision of HIV testing in pharmacies has the potential to increase health care access to high need areas (could also be incorporated into existing services). However, community norms around HIV could be a disincentive to implementing testing and stigma of HIV was a barrier to uptake of HIV testing among pharmacies. This review lead to the development of a framework for implementation research on pharmacy services (adapted from CFIR). |
Consolidated Framework for Implementation Research (CFIR) | Not abstracted for this review | Costing/economic evaluation
Qualitative research |
Acceptability
Adoption Feasibility Sustainability |
HIV testing & diagnostics | Pharmacies | USA | https://doi.org/10.1016/j.sapharm.2017.06.001 | |
| Applying Chronic Illness Care, Implementation Science, and Self-Management Support to HIV | ElZarrad, et al. | 2013 | Not described | This paper provides recommendations for HIV prevention programs (in particular PrEP) based on the ECCM and implementation science models. Additionally, the authors present the expanded chronic care model for HIV/AIDS and the evidence integration triangle for HIV/AIDS.
A system of ongoing, multilevel feedback from practical measures of progress is important for HIV/AIDS prevention and treatment programs. |
Expanded Chronic Care Model (ECCM)
Evidence Integration Triangle RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) |
Not abstracted for this review | Stakeholder & policy analysis | Adoption
Sustainability |
HIV prevention
PrEP |
Not described | Global | https://doi.org/10.1016/j.amepre.2012.09.046 | |
| Applying implementation science frameworks to identify factors that influence the intention of healthcare providers to offer PrEP care and advocate for PrEP in HIV clinics in Colombia: a cross-sectional study | Martinez-Cajas, et al. | 2022 | Cross sectional | Cross sectional study to assess barriers and facilitators for the provision of PrEP care and advocacy for PrEP by Health care providers which based on the CFIR and TDF domains in Colombia. Study also examined the relationship between the CFIR/TDF domains or subdomains with the providers’ intention to offer PrEP care and advocate for PrEP implementation. Study found support for nine indices with good internal consistency, reflecting PrEP characteristics, attitudes towards population needs, concerns about the use of PrEP, concerns about the role of the healthcare systems, knowledge, beliefs about capabilities, professional role, social influence, and beliefs about consequences. Findings suggested the importance of multilevel strategies to increase the provision of PrEP care by healthcare providers including acquisition of new skills, training of PrEP champions, and strength the capacity of the health system. | Consolidated Framework for Implementation Research (CFIR) & Theoretical Domains Framework (TDF) |
Not described | Qualitative research | Not described | PrEP | HIV care providers | Colombia | https://doi.org/10.1186/s43058-022-00278-2 | |
| Applying the Exploration Preparation Implementation Sustainment (EPIS) Framework to the Kigali Imbereheza Project for Rwandan Adolescents Living With HIV | Donenberg, et al. | 2019 | Randomized clinical trial | Adolescents living with HIV face challenges to antiretroviral therapy (ART) adherence. Poor mental health drives nonadherence but can be improved with cognitive behavioural therapy (CBT). CBT delivered by peers may strengthen effects while building capacity for sustainment in low-income countries. This study retrospectively applied the Exploration Preparation Implementation Sustainment framework to characterize the execution a project in Kigali Rwanda. 2-Arm individually randomized group-controlled trial of Trauma-Informed Adherence-Enhanced CBT (TI-CBTe) delivered by Rwandan youth leaders (YLs) to adolescents living with HIV was implemented (TI-CBTe or usual care). The study evaluated feasibility, acceptability, uptake, and fidelity. Findings revealed strong feasibility, acceptability, uptake, and fidelity , increasing the likelihood of sustainment. | Exploration, Preparation, Implementation, Sustainment Framework (EPIS) | Not described | Implementation/intervention mapping | Feasibility
Acceptability Uptake Fidelity Sustainment |
HIV treatment adherence | Adolescents living with HIV | Rwanda | http://dx.doi.org/10.1097/QAI.0000000000002204 | |
| Assessment of contextual factors shaping delivery and uptake of isoniazid preventive therapy among people living with HIV in Dar es salaam, Tanzania | Nyarubamba, et al. | 2022 | Exploratory qualitative case study | TB is a leading cause of death among people living with HIV (People Living with HIV (PLHIV)) globally. IPT is the recommended strategy by WHO to prevent TB disease and related deaths among People Living with HIV (PLHIV). Delivery and uptake of IPT has remained suboptimal. The study assessed contextual factors that shape delivery and uptake of IPT in Dar es Salaam region, Tanzania guided by CFIR through exploratory qualitative design and used thematic analysis. Characteristics of IPT such as aligning the therapy to individual patient schedules and its relatively low cost facilitated its delivery and uptake. Perceived adverse side effects negatively affected the delivery and uptake of IPT. Characteristics of individuals delivering the therapy including their knowledge, good attitudes, and commitment to meeting set targets facilitated the delivery and uptake of IPT. Organisational characteristics including communication among units and supportive leadership facilitated the delivery and uptake of IPT. External system factors including HIV stigma, negative cultural and religious values, limited funding as well as shortage of skilled healthcare workers presented as barriers to the delivery and uptake of IPT. | Consolidated Framework for Implementation Research (CFIR) | Not described | Implementation/intervention mapping | Not described | IPT for TB among people living with HIV (PLHIV) | PLHIV | Tanzania | https://doi.org/10.1186/s12879-022-07867-5 | |
| Barriers and facilitators to implementing a motivational interviewing-based intervention: a multi-site study of organizations caring for youth living with HIV | Nagy, et al. | 2021 | Type III, hybrid implementation-effectiveness trial |
Presents qualitative interview data collected during the early phase implementation of a motivational interviewing (MI) based intervention at 10 HIV care clinics in the United States providing services to youth. Using the Exploration-Preparation-Implementation-Sustainment (EPIS) framework to understand the implementation and the dynamic adaptation process (DAP) model to balance notions of intervention fidelity and flexibility, providers and stakeholders at each site were interviewed prior to implementation to gather their perspectives onorganizational readiness for the intervention, as well as provider and client characteristics. Study findings included the inner and outer contextual factors that affect implementation and denote the points at which the MI-based intervention may be tailored to fit the unique context of a clinic while remaining faithful to the intervention’s original design. |
Exploration-Preparation-Implementation-Sustainment (EPIS) Dynamic adaptation pro- |
Not described | Organizational readiness/assessment | Not described | HIV care | Youth living with HIV | USA | https://doi.org/10.1080/09540121.2021.1950604 | |
| Barriers and facilitators to implementing the HEADSS psychosocial screening tool for adolescents living with HIV/AIDS in teen club program in Malawi: health care providers perspectives | Kip, et al. | 2022 | Cross-sectional descriptive | Home, Education, Activities, Drugs, Sexuality, Suicide/Depression (HEADSS) tool is used to screen ALHIV for common mental health problems. A qualitative study conducted in Malawi assessed for barriers and facilitators to use of HEADSS approach using semi-structured guides following the Consolidated Framework for Implementation Research (CFIR) and for analysis of results. Barriers included inadequate planning for integration of the HEADSS approach; concerns that the HEADSS tool was too long, time consuming, lacked appropriate cultural context, and increased workload; and reports by participants that they did not have knowledge and skills to screen ALHIV using this tool. Facilitators to implementing the screening were that health care providers viewed screening as a guide to better systematic counselling, believed that screening could build better client provider relationship, and thought that it could fit into the existing work practice since it is not complex. | Consolidated Framework for Implementation Research (CFIR) | Not described | Qualitative research | Not described | Psychosocial screening among ALHIV | Adolescents living with HIV | Malawi, | https://doi.org/10.1186/s13033-022-00520-3 | |
| Barriers to Implementation of Rapid and Point-of-Care Tests for Human Immunodeficiency Virus Infection Findings From a Systematic Review (1996-2014) | Pai, et al. | 2015 | Systematic review | This systematic review documents, explores, and classifies all the barriers reported at different levels of the health system related to HIV rapid and point-of-care testing. The discussion outlines conditions which need to be present to successfully integrate these diagnostic tools into clinical workflow.
Test device barriers: primarily related to diagnostic accuracy followed by difficulties in test conduct/implementation, among others. Country economic status seems to affect the use of RDTs/POCTs in practice. Setting up quality assurance, improving turnaround time taken to test protocols, reducing costs, and setting up clear screening, diagnostic clinical pathways protocols, and clinical management action plans with RDT/POCT were key for successful implementation of RDT/POCTs. |
Not described | Not abstracted for this review | Operations research | None described | HIV testing & diagnostics | Not described | Global | https://doi.org/10.1097/poc.0000000000000056 | |
| Beyond Surveillance: A Role for Respondent-driven Sampling in Implementation Science | Solomon, et al. | 2013 | Cluster RCT | The authors suggest that the application of respondent-driven sampling, which has generally been used for surveillance, can be used to recruit participants for cluster randomized trials of community interventions within implementation science research. The article outlines an example of the use of this strategy within a cRCT to assess the effectiveness of men's wellness centers in improving utilization of HCT among MSM in India.
RDS uses systematically collected data about the relationships between recruiters and recruits to adjust for recruitment bias in the analysis. Additionally, to strengthen generalizability, the personal network size of each respondent is collected to allow weighted analysis through "post stratification". However the reliability of RDS samples over time is not yet established - this can be strengthened through ethnographic approaches and strategic selection of seeds. |
Not described | Not abstracted for this review | Impact evaluation | Adoption
Cost Feasibility |
HIV testing & diagnostics | MSM | India | https://doi.org/10.1093/aje/kws432 | |
| Cascade Analysis: An Adaptable Implementation Strategy Across HIV and Non-HIV Delivery Platforms |
Wagner, et al. | 2019 | Not described | Cascades have been used to characterize sequential steps in diverse disease areas and across prevention, testing, and treatment, using routine data, but are often inaccessible to frontline health care workers (HCWs) who may have the greatest opportunity to innovate health system improvement.
The cascade analysis tool (CAT) which is an excel-based, simple simulation model with an optimization function, and used originally with the Systems Analysis and Improvement Approach (SAIA) has been adapted 7 times: for prevention of mother-to-child transmission; for hypertension screening and management and for mental health outpatient services in Mozambique; for pediatric and adolescent HIV testing and treatment, HIV testing in family planning, and cervical cancer screening and treatment in Kenya; and for naloxone distribution and opioid overdose reversal in the United States. CAT has high acceptability and feasibility across resource-limited and high-income settings and with various HCW cadres. CAT integrates well with CQI and process mapping, two evidence-based implementation strategies, and may be a low-cost addition to enhance their effectiveness. |
Not described | Cascade analysis Tool (Audit and provide feedback & Develop and implement tools for quality monitoring) |
Systems Analysis and Improvement Approach (SAIA) | None described | HIV and non-HIV care cascades | Paediatric, adolescent, and adult populations | Sub-Saharan Africa | http://dx.doi.org/10.1097/QAI.0000000000002220 | |
| Central Implementation Strategies Outperform Local Ones in Improving HIV Testing in Veterans Healthcare Administration Facilities | Goetz, et al. | 2013 | Quasi-experimental
3 arms |
Focused on scale up of a multimodal program to promote HIV testing in Veterans Health Administration facilities in geographic regions with varying rates of HIV prevalence. The study assessed the effectiveness of promotion of routine and risk-based HIV testing, as well as the effect of providing differing levels of organizational support on the magnitude of the impact of the intervention on testing rates.
Observed immediate and sustained increases in risk-based and routine testing rates. Results also suggest that changes in testing policy without advocacy or other interventions are insufficient to change clinical practice. |
Not described | Not abstracted for this review | Impact evaluation | None described | HIV testing & diagnostics | Veterans | USA | https://doi.org/10.1007/s11606-013-2420-6 | |
| Cost analysis of implementing HIV drug resistance testing in Kenya: a case study of a service delivery site at a tertiary level hospital in Kenya | Gachogo, et al. | 2020 | Mixed costing approach
Time and motion study |
Estimation of the cost of HIVDR testing (micro and gross costing from provider's perspective) and identification of major cost drivers. Capital expenditure and reagents are the most expensive components of HIVDR testing - cost saving is possible through reagent volume reduction without compromising the quality of test results. | Not described | Not abstracted for this review | Costing/economic evaluation
Qualitative research Mathematical modeling |
Cost | HIV drug resistance testing | Not described | Kenya | https://doi.org/10.12688%2Ff1000research.23379.1 | |
| Decentralizing PrEP delivery: Implementation and dissemination strategies to increase PrEP uptake among MSM in Toronto, Canada | Charest, et al. | 2021 | Not described | A feasibility evaluation of two decentralization strategies for PrEP delivery: patient initiated continuing medical education (PICME) and nurse-led PrEP delivery and sexual health clinics.
Factors associated with participants' intentions to access PrEP through family physicians rather than sexual health clinics included: being out to that doctor, the physician having good/excellent communication skills, and the physician having very good or excellent engagement in participatory decision-making. A greater proportion of participants accessing care at the sexual health clinics were born outside of Canada and did not have health insurance. The nurse-led PrEP delivery model may be a beneficial task shifting approach but comes with potential challenges including longitudinal follow-up of PrEP patients (departure from usual model of care at sexual health clinics). The engagement of primary care providers in PrEP delivery is also important and the PICME strategy may help facilitate this. |
MacLean, Rabin and others' Dissemination and Implementation Framework adapted from Proctor and Brownson, 2012 | Not abstracted for this review | Dissemination research | Feasibility
Fidelity |
PrEP | Gay, bisexual, and other MSM | Canada | https://doi.org/10.1371/journal.pone.0248626 | |
| Decentralizing the delivery of HIV pre-exposure prophylaxis (PrEP) through family physicians and sexual health clinic nurses: a dissemination and implementation study protocol | Sharma, et al. | 2018 | Mixed methods | This study will assess two strategies to meet the projected demand for PrEP among gay, bisexual and other MSM in Canada by incorporating PrEP into services provided by family physicians and sexual health clinic nurses. The first strategy is a patient-initiated continuing medical education program (dissemination intervention). The second strategy consists of nurse-led PrEP (implementation intervention). | MacLean, Rabin and others' Dissemination and Implementation Framework adapted from Proctor and Brownson, 2012 | Not abstracted for this review | Costing/economic evaluation
Dissemination research Mathematical modeling Qualitative research |
Adoption
Cost Feasibility Fidelity Penetration |
PrEP | Gay, bisexual, and other MSM | Canada | https://doi.org/10.1186/s12913-018-3324-2 | |
| Definitions of implementation science in HIV/AIDS | Odeny, et al. | 2015 | Systematic review | Review of definitions of implementation science and research in the HIV/AIDS scientific literature to identify a synthetic working definition: majority referred to the gap between knowledge/evidence and use, delivery and application but were poorly linked. Tension between seeking knowledge that is generalizable across contexts and knowledge that is adapted to specific contexts.
Proposed definition for the use in HIV scientific literature: Implementation science is a multidisciplinary specialty that seeks generalisable knowledge about the behaviour of stakeholders, organisations, communities, and individuals in order to understand the scale of, reasons for, and strategies to close the gap between evidence and routine practice for health in real-world contexts. |
Not described | Not abstracted for this review | Other | None described | HIV/AIDS overview | Not described | Global | https://doi.org/10.1016/s2352-3018(15)00061-2 | |
| Determinants of Implementation for HIV Pre-exposure Prophylaxis Based on an Updated Consolidated Framework for Implementation Research: A Systematic Review | Li, et al. | 2022 | Systematic Review | Systematic review conducted in 2021, through search in Ovid MEDLINE, PsycINFO, and Web of Science related to HIV/AIDS, interventions, implementation, and determinants or strategies for PrEP implementation based on CFIR 2.0 construct.Two-thirds of measured determinants were of PrEP use by patients as opposed to delivery by providers. Articles contained few determinants in the inner setting or process domains (ie, related to the delivery context), even among studies of specific settings. Determinants across priority populations also focused on individual patients and providers rather than structural or logistical factors. Future research should prioritize identifying determinants, especially facilitators, unique to understudied populations and focus on structural and logistical features within current and promising settings (eg, pharmacies) that support integration of PrEP into clinical practice. | Consolidated Framework for Implementation Research (CFIR) | Not described | Intervetion/implementation mapping
Qualitative research |
Not described | PrEP | General population | Global | https://doi.org/10.1097/qai.0000000000002984 | |
| Development of a Blended Learning Approach to Delivering HIV-Assisted Contact Tracing in Malawi: Applied Theory and Formative Research | Rosenberg, et al. | 2022 | Not described | Study used formative research and frameworks to develop and digitize an implementation package to bridge the gap between assisted contact testing for HIV research and practice. Semi structured qualitative research was conducted in 2019 in Malawi ,with barriers and facilitators to intervention delivery were identified using the Consolidated Framework for Implementation Research. Approaches to digitization were examined using human-centred design principles. Limited clinic coordination and health worker capacity to address the complexities of ACT were identified as barriers. Ongoing individual training consisting of learning, observing, practicing, and receiving feedback, as well as group problem-solving were identified as facilitators. | Consolidated Framework for Implementation Research (CFIR)
Human Centered Design (HCD) |
Enhanced health worker training (including modeling, role plays, feeback) Group problem-solving |
Qualitative research | None described | Assisted contact tracing | Health care workers | Malawi | https://doi.org/10.2196/32899 | |
| Development of an Implementation Facilitation Strategy to Link Mental Health Screening and eHealth Intervention for Clients in Ryan White-Funded Clinics in Chicago | Stump, et al. | 2022 | Sequential mixed-methods | Sequential mixed-methods study with medical case managers and supervisors was conducted prior to implementation of a clinic-based behavioural health screener and referral to Optimizing Resilience and Coping with HIV through Internet Delivery, an evidenced-based intervention, in order reduce depression among People Living with HIV (PLHIV), an evidenced-based intervention. The CFIR was used to identify contextual barriers and facilitators in advance of implementation. Potential barriers included intervention complexity, needed human resources. Qualitative component identified low advantage for clinics with robust behavioural health systems but strong advantage in clinics without these services. Respondents identified system-wide training and monitoring strategies to facilitate implementation. | Consolidated Framework for Implementation Research (CFIR)
Implementation Research Logic Model (IRLM) |
Assess local needs, barriers & facilitators Share information Develop/distribute educational materials Trainings Identify/prepare champions Audit & feedback mechanisms Implement quality monitoring tools & systems |
Organizational readiness/assessment | Not described | Mental health screening in HIV clinics
eHealth interventions |
PLHIV | USA | https://doi.org/10.1097/qai.0000000000002980 | |
| Economic evaluation of mobile phone text message interventions to improve adherence to HIV therapy in Kenya | Patel, et al. | 2017 | Individual micro-simulation model | The objective of this study was to evaluate the cost-effectiveness of a weekly SMS-based adherence intervention and explore the added value of retention benefits. Developed an individual level micro-simulation model.
Findings suggest that SMS interventions are cost-effective to improve ART outcomes including in test and treat scenarios by WHO standards in Kenya. SMS interventions could be scaled up using infrastructure that has been developed as a part of an ongoing cellphone boom. Intervention cost effectiveness sensitive to intervention costs, effectiveness, and average cohort CD4 count at ART initiation. |
Not described | Not abstracted for this review | Costing/economic evaluation
Mathematical modeling |
Cost | HIV treatment & adherence | PLHIV | Kenya | https://doi.org/10.1097/md.0000000000006078 | |
| Enhancing Reporting of Behavior Change Intervention Evaluations | Abraham, et al. | 2014 | Not described | *note, not HIV specific
WIDER Recommendations: Guidelines to improve the reporting of behavior change interventions to better reflect implementation mechanisms which lead to change/impact and to facilitate replication. The authors report that improved reporting standards would facilitate and accelerate the development of the science of behavior change and its application in implementation science to improve public health. |
Not described | Not abstracted for this review | Implementation/intervention mapping | None described | NA | Not described | Global | https://doi.org/10.1097/qai.0000000000000231 | |
| Evaluating Respondent-Driven Sampling as an Implementation Tool for Universal Coverage of Antiretroviral Studies Among Men Who Have Sex With Men Living With HIV | Baral, et al. | 2016 | Prospective cohort study | Evaluation of RDS-based recruitment of gay men and other MSM into a comprehensive model of HIV prevention, treatment, and care services (TRUST service delivery model). RDS was found to be a feasible implementation tool for reaching key populations in need of ART-based prevention and treatment approaches. | Not described | Not abstracted for this review | Impact evaluation | Feasibility | HIV care cascade | MSM | Nigeria | https://doi.org/10.1097/qai.0000000000000438 | |
| Evaluation of a Systems Analysis and Improvement Approach to Optimize Prevention of Mother-To-Child Transmission of HIV Using the Consolidated Framework for Implementation Research | Gimbel, et al. | 2016 | Qualitative study nested within an cRCT | The Consolidated Framework for Implementation Research (CFIR) constructs was used to guided focus group discussions and interviews with health facilities; to determine core and adaptable components of Systems Analysis and Improvement Approach (SAIA) , implemented in a cluster RCT to address persistent implementation challenges in PMTCT, and to identify contextual influences that explain the heterogeneity in SAIA’s implementation success across country settings. Results: Flow mapping and continuous quality improvement were the core to the SAIA in all settings, whereas the PMTCT cascade analysis tool was the core in high HIV prevalence settings. Five CFIR constructs distinguished strongly between high and low performers: 2 in inner setting (networks and communication, available resources) and 3 in process (external change agents, executing, reflecting, and evaluating). The CFIR was a valuable tool to categorize elements of an intervention as core versus adaptable, and to understand heterogeneity in study implementation. | Consolidated Framework for Implementation Research (CFIR) |
Not described |
Systems Analysis and Improvement Approach |
Not described | PMTCT | Not described | Cote d'Ivoire
Kenya Mozambique |
http://dx.doi.org/10.1097/QAI.0000000000001055 | |
| Examining the Implementation of Conditional Financial Incentives Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance)) Framework to Improve HIV Outcomes among Persons Living with HIV (PLWH) in Louisian | Chrestman, et al. | 2022 | Mixed methods | Economic strengthening interventions are needed to support HIV outcomes among persons living with HIV (PLWH). A mixed method implementation science study was conducted to assess key RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) components tied to the provision of conditional financial incentives among PLWH in Baton Rouge, Louisiana. Over time, the proportion of participants engaged in care and retained in care significantly increased. However, the proportion of virally suppressed participants decreased over time. | RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Framework | Not described | Impact evaluation | Reach
Effectiveness Adoption Sustaibanility Penetration Acceptability Cost Feasibility |
Financial incentives for HIV treatment | PLHIV | USA | https://doi.org/10.3389%2Ffpubh.2022.872746 | |
| Experiences from a community advisory Board in the Implementation of early access to ART for all in Eswatini: a qualitative study | Mlambo, et al. | 2019 | Stepped-wedge cRCT (parent study) | Assessment of the perspectives, experiences, and practices of the first Community Advisory Board (CAB) and the application of strategies for community engagement as a part of the MaxART Early Access to ART for All study in eSwatini.
The paper outlines several roles of the CAB and the authors were particularly interested in understanding the CAB's role in addressing ethical issues that arise in the community and during the study. Implementation study teams should have reflective consultations during the design phase about the potential for and mechanisms of community representatives to monitor ethical conduct. Challenges to implementation of the different roles of the CAB included: lack of adequate funding and dependence of the CAB on the study team for finances; structure of CAB meetings; dealing with emotional issues from community members; concerns about CAB sustainability and lack of community awareness of the CAB’s role in some places. It is important to provide adequate guidance to the CAB about their roles and purpose so that they can represent and interact with communities effectively, as well as provide opportunities to review the scope of work and progress throughout implementation. |
Not described | Not abstracted for this review | Qualitative research | Cost
Sustainability |
HIV treatment & adherence | Community advisory board members | Eswatini | https://doi.org/10.1186/s12910-019-0384-8 | |
| Facilitators and barriers to effective scale-up of an evidence-based multilevel HIV prevention intervention | Kegeles, et al. | 2015 | Longitudinal study | The goal of the Translating Research Into Practice (TRIP) study was to determine if providing innovation-specific capacity building assistance (MPTES) improved the implementation of the Mpowerment Project across multiple CBOs and to identify barriers and facilitators to effective implementation.
Funders played a strong role in implementation, either facilitating or impeding effective implementation. Results suggest that TA should be provided proactively (before it is requested) and to supervisors, executive directors, and funders in addition to the CBOs to improve fidelity and implementation effectiveness. National HIV prevention policies, social determinants, and the community in which the program was implemented also impacted implementation. The two most important factors affecting implementation with fidelity seemed to be resources/funding (outer setting CFIR domains) and having effective frontline staff. TA should also include feedback on fidelity, especially if CBOs are not evaluating themselves. Therefore capacity building assistance is necessary not just at the start but also during implementation. Capacity building should focus on bringing individuals at different levels of the implementation system into alignment regarding understanding the program’s goals and methods. Findings aligned with the CFIR and the authors adapted CFIR constructs to specifically speak to HIV prevention support systems. |
Capacity building strategy based on: Diffusion of Innovations & Social Learning Theory Interactive Systems Framework for Dissemination and Implementation |
Not abstracted for this review | Qualitative research | Fidelity | HIV prevention | Young gay and bisexual men | USA | https://doi.org/10.1186/s13012-015-0216-2 | |
| Factors influencing the integration of evidence-based task-strengthening strategies for hypertension control within HIV clinics in Nigeria | Iwelunmor, et al. | 2022 | Cross-sectional Mixed methods study using explanatory sequential (Quantitative → Qualitative) approach | A formative assessment conducted to identify factors that may influence the integration of task strengthening strategies for hypertension (HTN) control (TASSH) within HIV clinics in Nigeria. A mixed methods study was conducted with purposively selected healthcare providers at 29 HIV clinics, using (a) an adapted Service Availability and Readiness Assessment (SARA) tool to assess the capacity of the clinic to manage NCDs and (b) Implementation Climate Scale to assess the degree to which there is a strategic organizational climate supportive of the evidence based practice implementation and C) qualitative assessment guided by CFIR to determine barriers and facilitators. Major facilitators of the intervention included relative advantage of TASSH, compatibility with clinic organizational structures, support of patients’ needs, and intervention alignment with national guidelines. Barriers included perceived complexity of TASSH, weak referral network and patient tracking mechanism within the clinics, and limited resources and diagnostic equipment for HTN. | Consolidated Framework for Implementation Research (CFIR)
Implementation Climate Scale (ICS) Service Availability and Readiness |
Task-strengthening strategy for HTN control (includes task-shifting of a package of interventions defined by WHO for HTN Control including CV risk assessment, medication titration, lifestyle counseling, and patient referral) |
Organizational readiness/assessment | Not described | Hypertension care integration into HIV care | PLHIV | Nigeria | https://doi.org/10.1186/s43058-022-00289-z | |
| Feasibility and Acceptability of Health Communication Interventions Within a Combination Intervention Strategy for Improving Linkage and Retention in HIV Care in Mozambique | Sutton, et al. | 2017 | Cluster RCT
Nested pre/post two sample design |
*Linked to Elul et al., 2014 protocol
This paper presents the results from the summative process evaluation to assess dose delivered and dose received for the structural versus health communication interventions. There was overall acceptability of both the communication (SMS reminders) and structural (financial incentives) interventions to support linkage to care. However, for retention in care, there was higher acceptability for the communication interventions. Dose delivered of the communication intervention was higher and improved over time. There were more barriers to the structural intervention (ex. significant additional training of healthcare workers, new patient flow). |
Steckler and Linnan framework
Saunders, Evans, and Joshi framework |
Not abstracted for this review | Impact evaluation | Acceptability
Feasibility |
HIV treatment & adherence | Adults | Mozambique | https://doi.org/10.1097/qai.0000000000001208 | |
| Feasibility of supervised self-testing using an oral fluid-based HIV rapid testing method: a cross-sectional, mixed method study among pregnant women in rural India | Sarkar, et al. | 2016 | Cross-sectional study
Mixed methods |
Self-testing for HIV status using an oral fluid-based rapid test under the supervision of a community health worker was acceptable and feasible among pregnant women in rural India. Factors increasing acceptability of the self tests included the ease of use, the ability to receive quick results, and that the test was not intrusive. Feasibility was assessed at three main steps: 1) preparing the test kit, 2) taking the sample and doing the test, 3) reading and interpreting the result. Overall women were confident in their ability to properly conduct the test with the biggest challenge being collecting the saliva sample. The supervised self-testing approach in this study overcome potential barriers related to literacy of a minority of participants and enabled all participants to be linked directly to both pre- and post-test counselling, as well as to immediate referral for confirmation. Important to assess the role of confirmatory testing outside of study settings.
This study found 100% sensitivity and 100% specificity of OraQuick HIV kits. |
Not described | Not abstracted for this review | Qualitative research | Acceptability
Feasibility |
HIV testing & diagnostics | Pregnant women | India | https://doi.org/10.7448/ias.19.1.20993 | |
| HIV self-testing among key populations: an implementation science approach to evaluating self-testing | Tucker, et al. | 2015 | Not described | This paper outlines an implementation science research agenda to improve monitoring and evaluation of HIVST programs and their impact across the HIV care continuum among key populations.
Applying an implementation science approaches involves examining the following steps in HIVST delivery: identifying gaps in existing HTC service provision, developing new HIVST interventions, implementing and disseminating interventions, measuring effectiveness and efficiency, and reviewing data to inform improved service provision. |
Not described | Not abstracted for this review | Mathematical modeling
Social marketing |
Fidelity
Sustainability |
HIV testing & diagnostics | Key populations | Global | https://doi.org/10.1016/S2055-6640(20)31145-6 | |
| HIV-Related Implementation Research for Key Populations: Designing for Individuals, Evaluating Across Populations, and Integrating Context | Schwartz, et al. | 2019 | Not described | Application of CFIR to discuss specific implementation research challenges among key populations (ex. related to epidemiologic inference, multiple intersecting stigmas and the effect on selection/information bias, absence of probabilistic sampling frames, etc.) and suggested approaches to address such challenges. The authors identify particular sub-constructs which are particularly relevant for programming for key populations. The article includes a CFIR framework specifically applied for key populations.
Implementation research specifically for HIV programming among key populations important to ensure they are reached by efficacious interventions. Comprehensive consideration of representation in research and programs across the IR process includes attention to population engagement, epidemiologic design, sampling, recruitment, retention, implementation outcomes, individual outcomes, dissemination, and the interplay of marginalization with each of these elements. This is an important step to understanding generalizability of findings. |
Consolidated Framework for Implementation Research (CFIR) | Not abstracted for this review | Implementation/intervention mapping | Adoption
Appropriateness Cost Feasibility Fidelity Penetration Sustainability |
HIV care cascade | Key populations | Global | https://doi.org/10.1097/qai.0000000000002191 | |
| HIV-related stigma and universal testing and treatment for HIV prevention and care: design of an implementation science evaluation nested in the HPTN 071 (PopART) cluster-randomized trial in Zambia and South Africa | Hargreaves, et al. | 2016 | Mixed-methods evaluation nested within Cluster RCT | Evaluation of the extent to which HIV related stigma affects and is affected by the implementation of a comprehensive combination HIV prevention intervention including a universal test and treatment approach.
Hypotheses: Stigma may pose challenges to many aspects of the PopART intervention including the acceptability of several HIV testing and treatment services as they are scaled up; PopART activities may also impact and shift experiences of stigma. |
Reducing HIV stigma and discrimination: Stangl et al., 2012 framework for programme implementation and measurement | Not abstracted for this review | Qualitative research
Stakeholder & policy analysis |
Acceptability
Appropriateness |
HIV-related stigma & discrimination
HIV care cascade |
Adult clients
Health care workers |
South Africa
Zambia |
https://doi.org/10.1093/heapol/czw071 | |
| Identification of Determinants and Implementation Strategies to Increase PrEP Uptake Among Black Same Gender–Loving Men in Mecklenburg County, North Carolina: The PrEP-MECK Study | Corneli, et al. | 2022 | Not described | Study implemented by a collaboration between community group , health providers and researchers to identify determinants of PrEP use among Black same gender–loving men (BSGLM) in North Carolina. Multiple frameworks were used including the PRECEDE-PROCEED’s educational/ecological assessment phase, and conducted Consolidated Framework for Implementation Research–informed organizational assessments with community-based organizations and clinics to assess readiness to pilot the implementation strategies. Awareness of how to access PrEP was lacking, and clinic scheduling barriers and provider mistrust limited access. Client -level implementation strategies, focusing on engaging the consumer and clinic-level implementation strategies focusing on changing clinic infrastructure, to make PrEP access easier were identified. | Consolidated Framework for Implementation Research (CFIR)
PRECED -PROCEED Expert Recommendations for Implementing Change taxonomy (ERIC) |
Financial strategies Change infrastructructure Involve/engage consumers (social media campaign) Provide interactive assistance |
Qualitative research | None described | PrEP | Black same gender loving men | USA | https://doi.org/10.1097/qai.0000000000002975 | |
| Identifying and Prioritizing Implementation Barriers, Gaps, and Strategies Through the Nigeria Implementation Science Alliance: Getting to Zero in the Prevention of Mother-to-Child Transmission of HIV | Ezeanolue, et al. | 2016 | Not described | This article presents 20 barriers and research gaps related to PMTCT and 25 unique interventions and implementation strategies generated from stakeholder exercises during the Nigeria Implementation Science Alliance Conference. Although some of the barriers and strategies have been previously identified in the literature (ex. lack of quality data, use of quality improvement methods), novel suggestions were also provided (ex. leveraging Nigeria Postal Service to support more efficient early infant diagnostic testing, forming cooperatives to aid transportation in hard to reach areas). | Not described | Not abstracted for this review | Qualitative research
Stakeholder & policy analysis |
None described | PMTCT | Pregnant women living with HIV | Nigeria | https://doi.org/10.1097/qai.0000000000001066 | |
| Impact of community health worker intervention on PrEP knowledge and use in Rakai, Uganda: A mixed methods, implementation science evaluation | Edwards, et al. | 2022 | Mixed methods | In a hyperendemic Ugandan fishing community, PrEP counselling was provided through a situated Information, Motivation, and Behavioral Skills (sIMB)-based community health worker (CHW) intervention and the implementation evaluated the intervention using a mixed- methods, implementation science design. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) conceptual framework was used to guide mixed data analysis to provide a structured approach to understanding of the experience with community providers and PrEP in this community. For each domain of the framework, we considered how the Health Scouts influenced knowledge and use of PrEP through the intervention design and accompanying counselling strategies. While data were collected concurrently, study utilized sequential (i.e., the qualitative data were used to better understand the quantitative findings) and convergent (i.e. qualitative and quantitative analyses were conducted independently of each other) designs for data analysis . Overall, Health Scouts appeared to positively influence clients’ PrEP knowledge, adherence, and retention across RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) domains. | RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Framework | Not described |
Impact evaluation |
Reach
Effectiveness Adoption Implementation Maintenance |
PrEP | Youth and adults using PrEP | Uganda | https://doi.org/10.1177/09564624221121208 | |
| Impact of early initiation versus national standard of care of antiretroviral therapy in Swaziland's public sector health system: study protocol for a stepped-wedge randomized trial | Walsh, et al. | 2017 | Stepped-wedge Cluster RCT
Mixed methods |
This study aims to more fully understand what is required to successfully implement an Early Access to ART for All (EAAA) strategy in a public health system in sub-Saharan Africa.
Goal is to understand the program's acceptability and feasibility, as well as clinical outcomes (VLS, mortality, drug resistance, TB), affordability, and scalability of offering early ART treatment to all HIV positive individuals. The study also includes a community engagement component to determine how best to engage communities to support this intervention. |
Not described | Not abstracted for this review | Costing/economic evaluation
Mathematical modeling Qualitative research Stakeholder & policy analysis |
Acceptability
Feasibility |
HIV treatment & adherence
Viral suppression/ monitoring |
Adults living with HIV who are ART naive | Eswatini | https://doi.org/10.1186/s13063-017-2128-8 | |
| Impact of Mother–Infant Pair Clinics and Short-Text Messaging Service (SMS) Reminders on Retention of HIV-Infected Women and HIV-Exposed Infants in eMTCT Care in Malawi: A Cluster Randomized Trial | Mwapasa, et al. | 2017 | Cluster randomized trial (cRCT) |
Cluster RCT conducted to determine compliance to prescheduled visits and impact on retention in care of HIV positive pregnant women and HIV exposed infants when exposed to 3 service delivery models; namely integrated HIV and maternal, neonatal, and child health services [mother–infant pair (MIP) clinics], MIP clinics plus short-text messaging service (SMS) reminders to prevent default (MIP + SMS), and standard of care (SOC). Study found low retention rates and compliance to clinic visits across the 3 study arms .Study interventions did not improve infant or maternal retention and there was suboptimal exposure of the enrolled women and infants to the trial interventions, which may have blunted the effect of the interventions on retention. | Not described | Not described | Impact evaluation | Fidelity | PMTCT | Pregnant women living with HIV
HIV-exposed Infants |
Malawi
Nigeria Zimbabwe |
http://dx.doi.org/10.1097/QAI.0000000000001340 | |
| Implementation mapping to plan for a hybrid trial testing the effectiveness and implementation of a behavioral intervention for HIV medication adherence and care retention | Hoskins, et al. | 2022 | Not described | Implementation mapping is a systematic, collaborative, and contextually attentive method for developing implementation strategies. This method was used for Managed Problem Solving Plus (MAPS+), an adapted evidence-based intervention for HIV medication adherence and care retention that will be delivered by community health workers and tested in an upcoming trial. Needs assessment , assessment of determinants guided by CFIR and finally mapping of strategies to determinants were done (based on ERIC’s compilation) . Strategies were operationalized in clinics with several iterations for stakeholder feedback. The process of implementation mapping generated key challenges for implementation strategy development: lack of implementation strategies targeting the outer setting , tension between a one-size-fits-all and individualized approach for all clinics; conceptual confusion between facilitators and strategies; and challenges in translating the implementation science lexicon for partners. | Consolidated Framework for Implementation Research (CFIR)
Expert Recommendations for Implementing Change taxonomy (ERIC) CFIR-ERIC Implementation Strategy Matching Tool |
Revise professional roles Identify and prepare champions Use warm handoffs Change record systems |
Intervention/implementation mapping | Not described | HIV treatment adherence
Retention in care |
PLHIV | USA | https://doi.org/10.3389/fpubh.2022.872746 | |
| Implementation of a campus-based and peer-delivered HIV self-testing intervention to improve the uptake of HIV testing services among university students in Zimbabwe: the SAYS initiative | Mukora-Mutseyekwa, et al. | 2022 | Exploratory sequential mixed method study | The uptake of HIV testing services among adolescents and young adults in Zimbabwe is low due to stigma associated with the risk of mental and social harm. A mixed methods study was conducted guided by the Exploration, Preparation, Implementation, and Sustainment Framework. The formative evaluation showed that 66% of students intended to test and 44% of the enrolled students collected HIVST test kits. Giving comprehensive and tailored information about the intervention was imperative to dispel the initial skepticism among students. Youth-friendly and language-specific packaging of program materials accommodated the students. Peer-delivered HIVST using trained personnel was acceptable among adolescents and young adults offered the intervention at a campus setting. HIVST could increase the uptake of HIV testing for this population given the stigma associated with facility-based HTS and the need for routine HIV testing for this age group who may not otherwise test. An off-site post-test counseling option is likely to improve the implementation of a campus-based HIVST and close the linkage to treatment and care gap. | Exploration, Preparation, Implementation, and Sustainment Framework (EPIS) | Not described | Implementation/intervention mapping | Not described | HIV self testing | Youth | Zimbabwe | https://doi.org/10.1186/s12913-022-07622-1 | |
| Implementation of an HIV Pre-exposure Prophylaxis Strategy Into Abortion and Early Pregnancy Loss Care | Sonalkar, et al. | 2022 | Not described | Implementation outcomes study of an HIV pre-exposure prophylaxis (PrEP) care strategy for patients seeking management of induced abortion and pregnancy loss. Study used multifaceted implementation strategy directed toward family planning providers comprised of educational sessions, an electronic medical record-prompted verbal assessment of HIV risk, electronic medical record shortcuts for PrEP prescription, and support of a PrEP navigator. Assessed penetration of the PrEP , evaluated feasibility, acceptability, and appropriateness of the intervention using belief elicitation interviews with providers. Study found high uptake among eligible clients. Intervention was acceptable and appropriate, but reported barriers including time constraints, and disappointment if patients did not adhere to PrEP. Providers found intervention setting innovative. | Logic model of implementation | Care restructuring (introduction of new tools , electronic record systems) Provider education |
Impact evaluation | Reach/Penetration Acceptability Feasibility |
PrEP | Women seeking abortion and early pregnancy loss care | USA | https://doi.org/10.1097/qai.0000000000002972 | |
| Implementation of eHealth Interventions Across the HIV Care Cascade: a Review of Recent Research | Kemp and Velloza | 2018 | Not described | This article provides a review of recent implementation research on eHealth interventions targeting the HIV care cascade and the authors provide recommendations for future research.
Acceptability of eHealth interventions for HIV care and treatment relates to convenience and confidentiality from the patient perspective and ease of use and ability to be integrated into current workflow from the provider perspective. Adaptability of an intervention is important for scale-up and feasibility. Application of implementation research theoretical frameworks and validated measures of implementation outcomes was limited across the 17 studies identified. |
RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance)
Technology Acceptance Model |
Not abstracted for this review | Costing/economic evaluation
Mathematical modeling Qualitative research Quality improvement Process mapping |
Acceptability
Adoption Cost Feasibility Fidelity Penetration |
HIV care cascade | Not described | North America
Europe Sub-Saharan Africa |
https://doi.org/10.1007/s11904-018-0415-y | |
| Implementation of pre-exposure prophylaxis for human immunodeficiency virus infection: progress and emerging issues in research and policy | Caceres, et al. | 2016 | Not described | Overview of research on the cost-effectiveness, feasibility, and impact of PrEP programs and under what conditions one might observe the largest impact or cost effectiveness.
Literature suggests that to increase the cost-effectiveness of PrEP there is a need for strategic implementation and budget impact analyses to inform scale-up. Integration of PrEP with relevant services will increase sustainability and foster comprehensive care. Meaningful and effective community involvement is a key factor in PrEP scale up. Implementation science can be applied to address challenges such as dynamic stakeholders' attitudes and information needs, PrEP awareness/demand creation, best options for the target drug, refinement of target populations, program organization, modes of delivery and integration with other services, health provider training, and strategies to manage STIs and tackle structural barriers to programmatic success. |
Not described | Not abstracted for this review | Costing/economic evaluation
Mathematical modeling Qualitative research Stakeholder & policy analysis |
Acceptability
Cost Feasibility Sustainability |
PrEP | Not described | Global | https://doi.org/10.7448/ias.19.7.21108 | |
| Implementation of South Africa's Central Chronic Medicine Dispensing and Distribution Program for HIV Treatment: A Qualitative Evaluation | Bogart, et al. | 2022 | Not described | South Africa Department of Health has been implementing the Central Chronic Medicine Dispensing and Distribution(CCMDD) since 2014, which allows clinically stable clients to obtain ART, as well as medication for chronic non-communicable diseases, at either external community pick-up points or clinic-based pick-up points (in designated queues), and to visit clinic providers less frequently (1–2 times annually vs. monthly). Pick-up points retail pharmacies and churches as an example. Study team used the Practical, Robust Implementation and Sustainability Model(PRISM) to evaluate implementation of CCMDD program. Participants had highly favourable attitudes towards CCMDD including decreased stigma concerns. Patient-level barriers included inadequate education about CCMDD and inability to get refills on designated dates. Organizational-level barriers included challenges with communication and transportation, errors in medication packaging and tracking, rigid CCMDD rules, and inadequate infrastructure. | Practical, Robust Implementation and Sustainability Model (PRISM) | Not described | Qualitative research | None described | HIV treatment (medicine dispensing) | Adults living with HIV on ART | South Africa | https://doi.org/10.1007/s10461-022-03602-y | |
| Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review | Rivera, et al. | 2021 | Not described | This scoping review describes the existing literature on implementation outcomes of HIV self testing in LMICs and includes key considerations across each outcome (see Table 2 for summary of key findings and gaps per outcome).
Acceptability and Adoption were the most frequently assessed outcomes. Evidence supports the acceptability, appropriateness, and feasibility of HIV-ST in the LMIC context. Costs and user error rates are threats to successful implementation and there is less evidence regarding later implementation outcomes such as sustainability and penetration. |
Proctor model | Not abstracted for this review | Adaptive design/strategies
Mathematical modeling Qualitative research Stakeholder & policy analysis |
Acceptability
Adoption Appropriateness Cost Feasibility Fidelity Penetration Sustainability |
HIV testing & diagnostics | Not described | LMICs | https://doi.org/10.1371/journal.pone.0250434 | |
| Implementation Planning for Integrating Depression Screening in Diabetes Mellitus and HIV Clinics in Botswana | Molebatsi, et al. | 2022 | Not described | The study evaluated patient and clinician perspectives on implementing depression screening within HIV and diabetes clinics using a guide informed by the Consolidated Framework for Implementation Research (CFIR) to understand barriers and facilitators to depression screening in medical clinics in Botswana.Three general themes emerged: (1) Appropriateness and Acceptability: attitudes and beliefs from clinicians and patients about whether depression screening should occur in this setting; (2) Stigma as an important barrier: the need to address the negative associations with depression to facilitate screening; and (3) Recommendations made basedon ERIC Stragety compilatiion , to facilitate screening . The results can help design implementation strategies to increase depression screening in clinics, which can be tested in future studies. | Consolidated Framework for Implementation Research (CFIR)
Expert Recommendations |
Revise professional roles Conduct educational meetings Identify and prepare champions Tailor strategies Alter incentive/allowance structures Use mass media Prepare patients/consumers to be active participants Change service sites Involve executive boards Audit and provide feedback |
Qualitative research | Acceptability
Appropriateness Feasibility |
Integration of depression screening in HIV clinics | Not described | Bostwana | https://doi.org/10.1007%2Fs43477-022-00062-3 | |
| Implementation science and stigma reduction interventions in low- and middle-income countries: a systematic review | Kemp, et al. | 2019 | Not described | Although not specific to stigma related to HIV, 69% of the studies included in this review focused on stigma related to HIV/AIDS. The application of implementation science to support the dissemination of stigma reduction interventions in LMICs has been limited and focused primarily on assessing acceptability and feasibility. No study in the sample explicitly incorporated a conceptual framework for implementation research, evaluated implementation strategies using a type 2 or 3 hybrid study design, nor used validated measures of implementation outcomes.
To strengthen the evidence base for delivery and scale-up of effective stigma reduction interventions there is an urgent need for rigorous stigma implementation research. |
Not described | Not abstracted for this review | Costing/economic evaluation
Qualitative research Quality improvement Process mapping Stakeholder & policy analysis |
Acceptability
Adoption Appropriateness Cost Feasibility Fidelity Penetration Sustainability |
HIV-related stigma & discrimination | Not described | LMICs | https://doi.org/10.1186/s12916-018-1237-x | |
| Implementation science for integration of HIV and non-communicable disease services in sub-Saharan Africa: a systematic review | Kemp, et al. | 2018 | Not described | The majority of implementation science studies regarding HIV/NCD integration applied qualitative, economic, and impact evaluation methods and focused on pre-implementation, formative efforts. Overall findings across studies suggest that the integration of HIV/NCD services is acceptable and feasible.
IS conceptual frameworks were rarely applied and there are major gaps in methodological coverage. Increased use of standardized measures of implementation outcomes will strengthen the field. All of the research was conducted in SSA, despite eligibility criteria being open to LMICs, and specific efforts to expand IS capacity in SSA can help address key research questions to inform decisions to scale up integrated services and refine them over the long term. Includes an HIV/NCD implementation science research agenda. |
RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) | Not abstracted for this review | Qualitative research
Social marketing Stakeholder & policy analysis |
Acceptability
Adoption Appropriateness Cost Feasibility Fidelity Penetration |
HIV/NCD integration | Not described | Sub-Saharan Africa | https://doi.org/10.1097/qad.0000000000001897 | |
| Implementation Science for the Prevention and Treatment of HIV among Adolescents and Young Adults in Sub-Saharan Africa: A Scoping Review | Vorkoper, et al. | 2022 | Scoping review | The scoping review examined the use of implementation research in AYA HIV studies conducted in SSA. The team searched five databases and included articles which focused on AYA (10–24 years old), addressed HIV prevention or treatment, were conducted exclusively in SSA countries, and included an implementation science outcome. Review included 44 articles in 13 SSA countries. Most were in East (52.3%) and South Africa (27.3%), and half focused exclusively on HIV prevention components of the care continuum. Acceptability and feasibility were the most cited implementation science outcomes. Only four articles used an established implementation science framework. The findings informed our recommendations to guide the design, implementation, and dissemination of further studies and health policymaking. | Approach for Adapting Evidence-Based Behavioral Interventions Guidelines (ADAPT)
Diffusion of Innovations PRECEDE– PROCEED model Exploration, Preparation, Implementation and Sustainment (EPIS) |
Multiple strategies included in different studies (scoping review) | Other | Acceptability
Feasibility Fidelity Adoption |
HIV prevention
HIV treatment |
Adolescents and young adults | Sub-Saharan Africa | https://doi.org/10.1007/s10461-022-03770-x | |
| Implementation Science for the Prevention and Treatment of HIV/AIDS | Schackman | 2010 | Not described | This article provides examples of the use of implementation science in HIV prevention and drug use programming.
Implementation science is critical to improving the effectiveness of program interventions to prevent and treat HIV. Given the interdisciplinary nature of implementation science, there is a lack of consensus on optimal scientific research approaches in the field - "For implementation science to become an established field in HIV/AIDS research, there needs to be better coordination between funders of research and funders of program delivery and greater consensus on scientific research approaches and standards of evidence." |
Not described | Not abstracted for this review | Quality Improvement
Process mapping Costing/economic evaluation |
Acceptability
Adoption Cost Feasibility |
HIV prevention
HIV and drug use |
Not described | Global | https://doi.org/10.1097/qai.0b013e3181f9c1da | |
| Implementation science of pre-exposure prophylaxis: preparing for public use | Underhill, et al. | 2010 | Not described | PrEP scale-up requires an understanding of a broad range of factors including physical infrastructure, monitoring and surveillance infrastructure, human resources, PrEP financing, provider training, outreach activities, education, regulatory approval, and support of potential PrEP users.
This article provides an overview of the implementation challenges and considerations related to PrEP scale-up. Local stakeholders need to be involved at early stages of implementation and scale-up. Building public awareness of PrEP is key and should also involve strategies to reduce HIV-related stigma. |
Not described | Not abstracted for this review | Costing/economic evaluation
Mathematical modeling Stakeholder & policy analysis Surveillance & data systems |
Acceptability
Cost |
PrEP | Not described | Global | https://doi.org/10.1007/s11904-010-0062-4 | |
| Implementation Science Perspectives and Opportunities for HIV/AIDS Research: Integrating Science, Practice, and Policy | Glasgow, et al. | 2013 | Not described | Provides an overview of how IS frameworks/ tools/strategies can inform the response to HIV/AIDS. Implementation science supports efforts to assess multiple levels of intervention and influence beyond the individual level, including policy, history, health systems, organizations, and economic and cultural factors.
Implementation lends itself to adaptive trial designs (endorsed for HIV vaccine development) and this design may also be useful for the implementation of behavioral interventions. Participatory approaches are essential in implementation science research, especially considering the extensive local knowledge and expertise related to the HIV/AIDS epidemic. Evidence Intervention Triangle (EIT) can be particularly useful in HIV/AIDS control and prevention as it combines three components of effective translation: 1) practical evidence-based interventions, 2) practical measures of progress, 3) participatory implementation process. Although still developing, the international field of Implementation Science can offer helpful perspectives for facilitating the more rapid integration of HIV/AIDS research, practice, and policy. |
Evidence Integration Triangle
PRECEDE-PROCEED Diffusion of Innovations RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) T1-T4 Model |
Not abstracted for this review | Other | Adoption
Cost Penetration Sustainability |
HIV/AIDS overview | Not described | Global | https://doi.org/10.1097/qai.0b013e3182920286 | |
| Implementation Science Research Examining the Integration of Evidence-Based Practices Into HIV Prevention and Clinical Care: Protocol for a Mixed-Methods Study Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Model | Carcone, et al. | 2019 | Convergent parallel mixed-methods study | This descriptive study aims to understand the barriers and facilitators associated with the preparation, implementation, and sustainment of four EBPs which aim to improve HIV-related self management among youth living with or at risk of contracting HIV.
Survey evaluating the role of the following in the implementation of EBPs: leadership, organizational support and climate, contextual fit. Part of the Scale It Up (SIU) program |
Exploration, Preparation, Implementation, Sustainment (EPIS) | Not abstracted for this review | Qualitative research
Organizational readiness/ assessment Adaptive designs/strategies Stakeholder & policy analysis |
Adoption
Feasibility Fidelity Sustainability |
Self-management across HIV prevention and treatment care cascades | Youth | USA | https://doi.org/10.2196/11202 | |
| Implementation Science Research Examining the Integration of Evidence-Based Practices Into HIV Prevention and Clinical Care: Protocol for a Mixed-Methods Study Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Model | Carcone, et al. | 2019 | Convergent parallel mixed methods | First IS study of the integration of evidence-based practices into adolescent HIV prevention and care settings; Goal is to understand barriers and facilitators of successful uptake and implementation of four EBPs and sustainment in clinical settings (13 ATN sites participating in the Scale It Up research project) as informed by EPIS model. | Adaptive designs/strategies
Exploration, Preparation, Implementation, Sustainment (EPIS) |
Not abstracted for this review | Organizational readiness/assessment
Qualitative research Stakeholder & policy analysis |
Acceptability
Adoption Appropriateness Feasibility Fidelity Penetration Sustainability |
HIV care cascade | Adolescents living with HIV | USA | https://doi.org/10.2196/11202 | |
| Implementation Science Using Proctor's Framework and an Adaptation of the Multiphase Optimization Strategy: Optimizing a Financial Incentive Intervention for HIV Treatment Adherence in Tanzania | Packel, et al. | 2019 | RCT
Trial 1: 3 arm RCT |
Utilization of multiple IS frameworks to demonstrate efficacy of an incentive-based approach to improve the HIV treatment cascade and the potential for scalability and sustainability of this implementation strategy. The article outlines evaluations which compare different incentive modalities and inform the iterative development of the incentive-based strategy.
This process led to a large-scale effectiveness study of a refined intervention optimized for multiple stakeholders that will soon be evaluated in multiple clinics in Tanzania. Given the wide range of strategies to implement motivational programs (ex. incentives, commitment devices) as a part of behavior change programs, implementation science approaches like the MOST framework are necessary to understand how to effectively draw from the toolbox of these interventions across HIV research. |
Multiphase optimization strategy (MOST)
Proctor's Implementation Outcomes Framework |
Not abstracted for this review | Adaptive design/strategies
Costing/economic evaluation Qualitative research |
Adoption
Acceptability Appropriateness Cost Feasible Fidelity Penetration Sustainability |
HIV treatment adherence
Viral suppression |
PLHIV | Tanzania | https://doi.org/10.1097/qai.0000000000002196 | |
| Implementation strategies for integrating pre-exposure prophylaxis for HIV prevention and family planning services for adolescent girls and young women in Kenya: a qualitative study | Roche, et al. | 2022 | Not described | A qualitative study of integrated PrEP-FP service implementation at two FP clinics in Kenya. Actions taken to implement PrEP were captured prospectively in 214 monitoring and evaluation documents and 15 interviews with PrEP implementers. Data were analysed using conventional and directed content analysis-informed by the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) compilation. Implementation strategies included train and educate stakeholders; developing stakeholder interrelationships ;provision of technical assistance; and change physical infrastructure and workflow. The strategies interacted with contextual factors relevant to inner setting, especially implementation climate and readiness for implementation. | Consolidated Framework for Implementation Research (CFIR)
Expert Recommendations for Implementing Change (ERIC) compilation |
Conduct ongoing training Provide local technical assistance Organize implementation teams and team meetings Audit and provide feedback Create a learning collaborative Assess and redesign workflow Change physical structure and equipment Involve executive boards Shadow other experts |
Qualitative research | None described | PrEP | Adolescent girls and young women | Kenya | https://doi.org/10.1186/s12913-022-07742-8 | |
| Implementing Implementation Science: An Approach for HIV Prevention, Care and Treatment Programs | Lambdin, et al. | 2015 | Not described | There remains a gap between what we know works and what we are actually achieving in HIV prevention, care and treatment programs.
This paper proposes an IS approach for HIV programs which consists of four components: 1) Identifying Bottlenecks and Gaps, 2) Developing and Implementing Strategies, 3) Measuring the Effectiveness and Efficiency of Strategies and 4) Utilizing Results. Engaging community stakeholders from the beginning can help facilitate this process. Within each of these components, the authors provide details, case studies, and identify relevant strategies and frameworks/theories which may be applied. Meaningful community and stakeholder engagement from the beginning and across the four components is key to successful implementation. A summary of potential study designs for implementation science is also presented. |
Consolidated Framework for Implementation Research (CFIR)
Diffusion of Innovations PRECEDE-PROCEDE |
Not abstracted for this review | Costing/economic evaluation
Qualitative research Quality improvement/process mapping |
Appropriateness
Cost Sustainability |
HIV care cascade | Not described | Global | https://doi.org/10.2174/1570162x1303150506185423 | |
| Incorporating operational research in programmes funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria in four sub-Saharan African countries | Camacho, et al. | 2020 | Force Field Analysis
Behavioral change assessment |
This article outlines approaches and opportunities to implement operational research components into Global Fund grants, first starting with the country needs assessment.
The Structured Operational Research and Training Initiative (SORT IT) is a training program aimed at implementers with little or no prior research experience and may be a valuable tool to increase operational research capacity. Stakeholders reported an interest in integrating operational research activities into relevant health programs and the behavior change assessment indicated that all four countries had the necessary elements to initiate this integration into their health systems. However, specific action steps were not identified. Integration of operational research requires engagement of national and international stakeholders given that much of the health system funding comes from international donors. |
COM-B Model ( Capability, Opportunity, Motivation, Behaviour )
Fogg's behaviour models |
Not abstracted for this review | Qualitative research
Stakeholder & policy analysis |
Adoption | HIV/AIDS overview | Not described | Ghana
Sierra Leone Tanzania Zimbabwe |
https://doi.org/10.1186/s12992-020-00599-8 | |
| Insights for Implementation Science From 2 Multiphased Studies With End-Users of Potential Multipurpose Prevention Technology and HIV Prevention Products | Minnis, et al. | 2019 | Mixed methods: Cross over randomized clinical studies | Review of two studies from 2 multiphased studies (TRIO and Quatro) conducted with young women aged 18–30 years that included a crossover clinical study with placebo products, a discrete-choice experiment, and qualitative interviews with women, male partners, and health providers. TRIO evaluated 3 products (tablets, ring, and injections), and Quatro compared 4 vaginal products (ring, insert, film, and gel) for HIV prevention. Both were designed to assess product preferences, choice, and use. The use of multiple research methods allowed for evaluation of varied dimensions of acceptability, preference, and choice in the context of diverse biomedical HIV prevention delivery forms. Findings elucidated the value of product choice with differences in preference within and across settings. | Not described | Discreet choice experiments | Stakeholder & policy analysis | Acceptability | Multipurpose prevention technology and HIV prevention products | Young women | Kenya
South Africa Zimbabwe |
https://doi.org/10.1097/qai.0000000000002215 | |
| Integrating Adolescent Mental Health into HIV Prevention and Treatment Programs: Can Implementation Science Pave the Path Forward? | Boshe, et al. | 2022 | Not described | Adolescent mental health (AMH) is a critical driver of HIV outcomes but is often overlooked in HIV research and programming. The implementation science EPIS framework informed development of a questionnaire that was sent to a global alliance of adolescent HIV researchers, providers, and implementors working in sub-Saharan Africa with the aim to (1) describe current AMH outcomes incorporated into HIV research within the alliance; (2) identify determinants (barriers/gaps) of integrating AMH into HIV research and care; and (3) describe current AMH screening and referral systems in adolescent HIV programs in sub-Saharan Africa. Respondents reported on fourteen named studies that included AMH outcomes in HIV research. Barriers to AMH integration in HIV research and care programs were explored with suggested implementation science strategies to achieve the goal of integrated and sustained mental health services within adolescent HIV programs. | Exploration, Preparation, Implementation, Sustainment (EPIS)
Expert Recommendations for Implementing Change (ERIC) compilation |
Training paraprofessionals Assessing for readiness Digital technologies and mobile platform |
Intervention/implementation mapping | Not described | Mental health in HIV prevention and treatment | Adolescents | Sub-Saharan Africa | https://doi.org/10.1007/s10461-022-03876-2 | |
| Integrating Economic Evaluation and Implementation Science to Advance the Global HIV Response | Salomon | 2019 | Not described | Majority of cost effectiveness literature related to HIV/AIDS programming identifies strategies which are cost effective based on standard thresholds and therefore may fail to differentiate in a policy-relevant way between alternative options for resource allocation. Existing analyses may also be underspecified and disconnected from real-world programming. These challenges suggest that there may be systematic bias in cost-effectiveness analyses toward overly optimistic conclusions due to underestimation of costs or overestimation of potential impact, or both.
Suggest two priorities for advancing the field of economic evaluation in HIV/AIDS and global health (1) systematic reevaluation of the cost-effectiveness literature with reference to ex-post empirical evidence on costs and effects in real-world programs and (2) development and adoption of good practice guidelines for incorporating implementation and delivery aspects into economic evaluations. IS frameworks may help better understand implementation barriers/enablers, designing and choosing specific implementation and policy actions, and evaluating outcomes. Proposes typology for distinguishing between different objects of policy analysis and a framework outlining critical elements in strategy choice (drawn from IS literature) to inform comparative strategy evaluations. |
Behavior Change Wheel
Consolidated Framework for Implementation Research (CFIR) Ecological Framework Expert Recommendations for Implementing Change Greenhaugh et al. Conceptual Model Proctor's Implementation Outcomes Framework RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) |
Not abstracted for this review | Costing/economic evaluation
Stakeholder & policy analysis |
None described | HIV/AIDS overview | Not described | Global | https://doi.org/10.1097/qai.0000000000002219 | |
| INtegration of DEPression Treatment into HIV Care in Uganda (INDEPTH-Uganda): study protocol for a randomized controlled trial | Wagner, et al. | 2014 | Cluster RCT | This study will compare two task-shifting models of depression care (antidepressant treatment) integrated into HIV clinics. Additionally, the relationship between change in depression and key economic and public health outcomes (ex. HIV treatment adherence) will be evaluated.
Assessment of whether the two models of care delivery differ on implementation outcomes (proportion screened, diagnosed, treated, provider fidelity to model of care), provider adoption of treatment care knowledge and practices, and depression alleviation. |
RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) | Not abstracted for this review | Costing/economic evaluation | Adoption
Cost Fidelity |
HIV treatment & adherence | HIV clinics | Uganda | https://doi.org/10.1186/1745-6215-15-248 | |
| Integration of PrEP Services Into Routine Antenatal and Postnatal Care: Experiences From an Implementation Program in Western Kenya | Pintye, et al. | 2018 | Clinic flow mapping Time-and-motion study |
This paper captures the work flow patterns and additional staff time associated with integrating PrEP into ANC/PNC services to inform best practices for operationalizing PrEP delivery. The research team identified multiple approaches for integration of PrEP into ANC/PNC including co-delivery and sequential-delivery approaches. These delivery approaches were developed based on characteristics specific to each clinic (ex. clinic volume, staffing). Time spent on PrEP-specific activities somewhat higher for those clients who eventually initiated PrEP compared to those who eventually declined PrEP. The team observed a wide range of wait times to receive services.
Part of the PrEP Implementation for Young Women and Adolescents (PrIYA) program. |
Not described | Not abstracted for this review | Quality improvement
Process mapping |
Adoption | PMTCT | Adolescent girls and young women | Kenya | https://doi.org/10.1097/qai.0000000000001850 | |
| Jobs, food, taxis and journals: Complexities of implementing Stepping Stones and Creating Futures in urban informal settlements in South Africa | Gibbs, et al. | 2014 | Exploratory Qualitative methods | The aim of this study was to understand what factors shaped the implementation of the Stepping Stones and Creating Futures intervention and how these factors affected the emergence and sustaining of safe social spaces. This intervention seeks to reduce violence and HIV related risks among young people living in urban informal settlement and safe social spaces are a central to the theory of change for the intervention.
Focused on issues related to implementing behavioral and structural interventions (as opposed to technical interventions) and how these challenges may undermine the theoretical approach of these interventions. Identified challenges related to the perception that the intervention was a job (young people often seeking formal employment - impacted attitudes toward the intervention and attendance over time), upfront costs of minibus taxi to get to intervention site (even though they were reimbursed, not everyone was able to pay the upfront cost), disagreements about food provided during sessions, and concerns around safety of writing in journals. |
Freire: Pedagogy of the oppressed/ model of building safe social spaces | Not abstracted for this review | Qualitative research | Cost | HIV prevention | Young people | South Africa | https://doi.org/10.2989/16085906.2014.927777 | |
| Key population-led community-based same-day antiretroviral therapy (CB-SDART) initiation hub in Bangkok, Thailand: a protocol for a hybrid type 3 implementation trial | Lujintanon, et al. | 2022 | Hybrid type 3 implementation trial
Interrupted time series |
This is a study protocol that aims to document and inform implementation of same day ART in the community setting, and to assess the feasibility, fidelity, and sustainability of community based-SDART by describing and explaining the processes and factors influencing these implementation outcomes (IOs). Additionally, it will assess service and client outcomes, including timeliness, patient centeredness, function, and symptomatology of, and satisfaction with CB-SDART, as a secondary objective.The Proctor implementation outcome and CFIR frameworks will be used | Proctor's Implementation Outcomes Framework
Consolidated Framework for Implementation Research (CFIR) |
Developing stakeholder relationships Training and educating Adapting and tailoring intervention Using evaluative and iterative strategies to assess adherence |
Implementation/intervention mapping | Feasibility
Fidelity Sustainability |
Same day ART (HIV treatment) | Key populations | Thailand | https://doi.org/10.1186/s43058-022-00352-9 | |
| Landscape of HIV Implementation Research Funded by the National Institutes of Health: A Mapping Review of Project Abstracts | Smith, et al. | 2020 | Not described | 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 with a focus on the application of a guiding implementation model/theory/framework, measurement of implementation outcomes, and specific study aims (ex. examining barriers/facilitators, testing implementation strategies, comparing strategies, etc.).
Acceptability and feasibility were the most commonly reported implementation outcomes and the majority of studies were developmental/formative/field/observational designs, followed by randomized trials. The most commonly used models/theories/frameworks included ADAPT-ITT, CFIR, RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance), and PRECEDE/PROCEED. NIH-funded HIV IR abstracts inconsistently used IR terminology and applied mixed methodology. The authors present recommendations to strengthen and expand the portfolio of IR projects: 1) integration of best-practice IR methods into current studies, and 2) align study designs with IR-related questions and aims rather than those aligned with clinical trials (hybrid trials provide a strong opportunity). Additional challenges which need to be address include: 1) lack of clarity around implementation strategies applied across projects and the distinction between strategies and interventions, and 2) decreasing number of NIH defined IR studies in IR despite ongoing pandemic. |
ADAPT-ITT
Consolidated Framework for Implementation Research (CFIR) PRECEDE-PROCEED RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) |
Not abstracted for this review | Mathematical modeling | Acceptability
Adoption Appropriateness Cost Feasibility Fidelity Penetration |
HIV/AIDS overview | Not described | Global | https://doi.org/10.1007/s10461-019-02764-6 | |
| Lessons Learned From Early Implementation of Option B plus : The Elizabeth Glaser Pediatric AIDS Foundation Experience in 11 African Countries | Kieffer, et al. | 2014 | Not described | Overview of implementation strategies for Option B+ roll-out across 11 countries. Facility readiness assessments prior to roll-out were common features across all countries (tool is linked in the article). QI efforts in Uganda led to increased retention in care. Delays in the finalization of registers and data systems tools in combination with increased data demands resulted in data quality issues at the start of implementation. Strategies to improve low retention in ART care during pregnancy include specific counseling, male partner engagement, community support, and improved tracking systems. | Not described | Not abstracted for this review | Organizational readiness/assessment
Quality improvement Process mapping Surveillance and data systems |
Acceptability | PMTCT (option B+) | Pregnant women living with HIV | Cameroon
DRC Kenya Lesotho Malawi Mozambique Swaziland Tanzania Uganda Zambia Zimbabwe |
https://doi.org/10.1097/qai.0000000000000372 | |
| Making Smarter Decisions Faster: Systems Engineering to Improve the Global Public Health Response to HIV | Wagner, et al. | 2019 | Not described | Operational definition of systems engineering for global health: an approach that uses data to improve decision making within a given global health system by (1) diagnosing problems and identifying needs, (2) evaluating decision options to address a selected problem or need through modeling or optimization, and (3) translating optimized decision options into practical recommendations or actions
SE is a flexible approach for making smarter decisions faster, and has an important role for delivering HIV services in LMICs. As HIV funding is plateauing, SE can help ensure program decisions are guided by efficiency, improved program coverage, and equity |
Not described | Not abstracted for this review | Mathematical modeling
Costing/economic evaluation |
Adoption
Cost |
HIV/AIDS overview | Not described | LMICs | https://doi.org/10.1007/s11904-019-00449-2 | |
| Operationalizing mHealth to improve patient care: a qualitative implementation science evaluation of the WelTel texting intervention in Canada and Kenya | Bardosh, et al. | 2017 | Comparative quality case study | This paper reports the results of a qualitative study assessing the perceptions, diffusion, adoption, and implementation of a two-way SMS intervention (WelTel). Results are categorized under five sections: how the WelTel intervention influenced the provider-patient relationship, interactions between the intervention and service provision and organization at the clinic level, the socio-technical dimensions of the intervention, the role of evidence and data in generating support from stakeholders, and scale-up.
Effective implementation and scale-up of mHealth interventions is dependent on the technical, social, and political dynamics in that setting/organization. |
Consolidated Framework for Implementation Research (CFIR) | Not abstracted for this review | Dissemination research
Qualitative research Surveillance & data systems |
Adoption
Cost Sustainability |
HIV treatment & adherence | Not described | Canada
Kenya |
https://doi.org/10.1186/s12992-017-0311-z | |
| Optimizing access to PrEP based on MSM preferences: results of a discrete choice experiment | Dubov, et al. | 2019 | Choice-based conjoint survey | The objective of this study was to elicit MSM stakeholder preferences in order to inform program development aimed at improving uptake of PrEP. The research team evaluated preferences across five attributes: dosing frequency, dispensing venue, prescription practices, adherence support, and cost. Cost, specifically out of pocket costs, was the most important attribute across all groups. Program delivery type also impacted likelihood of intended uptake of PrEP. | Not described | Not abstracted for this review | Discrete choice experiment
Stakeholder & policy analysis |
None described | PrEP | MSM | USA | https://doi.org/10.1080/09540121.2018.1557590 | |
| Optimizing Antiretroviral Therapy (ART) for Maternal and Child Health (MCH): Rationale and Design of the MCH-ART Study | Myer, et al. | 2016 | 3 phases: Cross Sectional Evaluation, Observational cohort, RCT |
*Study overview (ongoing at the time of publication)
Evaluation of strategies for delivering HIV care and treatment services during the postpartum period to women living with HIV who initiate ART during pregnancy and their HIV-exposed infants. Combining observational and experimental components, the MCH-ART study presents one approach to understand the optimization of ART delivery for MCH. |
Social Action Theory | Not abstracted for this review | Costing/economic evaluation
Qualitative research |
Acceptability
Feasibility |
PMTCT | Women living with HIV
HIV-exposed infants |
South Africa | https://doi.org/10.1097/qai.0000000000001056
Results from RCT: Costing data: ART delivery evaluations: Additional results: |
|
| Option B plus in Mozambique: Formative Research Findings for the Design of a Facility-Level Clustered Randomized Controlled Trial to Improve ART Retention in Antenatal Care | Napua, et al. | 2016 | Stepped-wedged cRCT
Mixed methods |
Identification of inefficiencies and bottlenecks in the current Option B+ care cascade to prioritize workflow modifications and develop an enhanced adherence and retention package.
Application of an implementation science approach within formative work allows for the identification of points in the workflow and patient flow that could be targeted to improve key outcomes related to retention in care and of existing resources which could be effectively deployed to improve implementation. This formative work was used to design an intervention to optimize patient retention (evaluated elsewhere). Given the often changing dynamics and context in which implementation research is often conducted in health systems settings, formative research is an essential component of implementation science efforts to strengthen health systems. |
Not described | Not abstracted for this review | Quality improvement
Process mapping Qualitative research |
Feasibility | PMTCT | Pregnant women with HIV starting ART in ANC visit | Mozambique | https://doi.org/10.1097/qai.0000000000001061 | |
| Perspectives on preparing for long-acting injectable treatment for HIV among consumer, clinical and nonclinical stakeholders: A qualitative study exploring the anticipated challenges and opportunities for implementation in Los Angeles County | Jolayemi, et al. | 2022 | Not described | The study entailed pre-implementation assessment of potential barriers and facilitators to use of long acting injectable ARVs for HIV treatment in the US following regulatory approvals in 2021. Qualitative data from consumers ,clinical and non-clinical stakeholders to determine anticipated individual-consumer, healthcare system, and structural levels barriers and facilitators to Long-Acting Injectable ART implementation in Los Angeles County, California was collected. Thematic analysis was guided by the CFIR implementation science model. Under intervention characteristics, anticipated facilitators included the relative advantage of LAI ART over pills for adherence and reduced treatment management burden and related anxiety; barriers included non-adherence to injection appointments, concerns of developing HIV resistance, discomfort with injection and cost. Anticipated facilitators based on individual characteristics included overall acceptability based on knowledge and positive beliefs about LAI ART. Participant noted several characteristics of the outer setting that could negatively impact implementation. Results from this pre-implementation study may inform rollout and scale-up of LAI ART in Los Angeles County. | Consolidated Framework for Implementation Research (CFIR) | Not described | Qualitative research | Not described | Long acting injectables (LAI) for HIV treatment | Adults | USA (Los Angeles) | https://doi.org/10.1371/journal.pone.0262926 | |
| Postnatal clubs for integrated postnatal care in Johannesburg, South Africa: a qualitative assessment of implementation | Makina-Zimalirana, et al. | 2022 | Not described | South Africa has reported challenges in retaining women in Prevention of Mother to Child Transmission of HIV (PMTCT) programs postnatally. Due to the success of PMTCT in the antenatal period, proportionally more infant transmissions now occur after delivery. The MSF Postnatal Club (PNC) model allows for integrated postnatal care and support. The study assessed implementation outcomes of PNCs implemented outside MSF clinics. RE AIM was used to explore success and factors influencing implementation. PNC providers reported reduced waiting times, reduced number of clinic visits .However, lacking resources (e.g., space, medical equipment, staff ) negatively impacted reach, implementation and sustainability. | RE-AIM (Reach, Adoption, Implementation, Maintenance) framework | Not described | Impact evaluation
Qualitative research |
IS outcomes Reach Implementation Sustainability Adoption Maintenance Service outcomes Reduced waiting times Reduced number of clinic visits |
PMTCT | Postnatal clients | South Africa | https://doi.org/10.1186/s12913-022-08684-x | |
| PrEP implementation: moving from trials to policy and practice | Caceres, et al. | 2015 | Not described | Overview of research and policy related to PrEP implementation which make up a special issues of JIAS (10 articles).
Slow uptake and optimization of PrEP delivery has lead to concerns related to ensuring adherence, magnitude of the potential benefit, drug resistance. |
Not described | Not abstracted for this review | Costing/economic evaluation
Mathematical modeling Social marketing |
Feasibility | PrEP | Not described | Global | https://doi.org/10.7448/ias.18.4.20222 | |
| Prioritizing the PMTCT Implementation Research Agenda in 3 African Countries: INtegrating and Scaling up PMTCT Through Implementation REsearch (INSPIRE) | Rollins, et al. | 2014 | Not described | Overview of priority implementation research questions related to PMTCT identified through stakeholder workshops in Malawi, Nigeria, and Zimbabwe.
Applied the participatory process developed by the Child Health Nutrition Research Initiative to identify priorities for research. Across countries and stakeholder groups, health systems approaches for integrating and decentalizing services or increasing access and uptake to interventions were consistently prioritized. This process helps to promote country ownership and direct the strategic allocation of research resources. |
Not described | Not abstracted for this review | Stakeholder & policy analysis | None described | PMTCT | Not described | Malawi
Nigeria Zimbabwe |
https://doi.org/10.1097/qai.0000000000000358 | |
| Project Khanya: a randomized, hybrid effectiveness-implementation trial of a peer-delivered behavioral intervention for ART adherence and substance use in Cape Town, South Africa | Magidson, et al. | 2020 | Hybrid: Type I Effectiveness-Implementation Trial
RCT |
Evaluation of a task-sharing intervention to integrate evidence-based substance use behavioral intervention components into HIV care. Implementation strategies included peer delivery of the intervention and the use of a flipchart to promote fidelity. | Proctor's Implementation Outcomes Framework
RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) |
Not abstracted for this review | Qualitative research | Acceptability
Feasibility Fidelity |
HIV treatment adherence
VLS |
PLHIV with moderate substance use | South Africa | https://doi.org/10.1186/s43058-020-00004-w | |
| Provider Perspectives on Evidence-Based HIV Prevention Interventions: Barriers and Facilitators to Implementation | Owczarzak and Dickson-Gomez | 2011 | Exploratory | Interviews with HIV prevention services providers involved in the implementation of EBIs included in the CDC Diffusion of Effective Behavioral Interventions program highlight the tension between the need to implement interventions with fidelity and the lack of guidance on how to adapt the interventions for their constituencies and organizational contexts. Institutional, intervention, and programmatic factors impact the diffusion process and the design of many EBIs do not consider actual capabilities and needs of implementing organizations. Additionally, interventions included in the DEBI program did not often reflect providers' particular client base. EBIs need to be accompanied with clearer guidelines as to core and adaptable elements of an intervention and resources for adaptation.
There is a need for further research on how aspects of organizational capacity, systems of support and technical assistance, and elements particular to one intervention interact and affect implementation of a single EBI. |
Not described | Not abstracted for this review | Qualitative research | Acceptability
Adoption Cost Feasibility Fidelity |
HIV prevention | Community-based HIV service providers | USA | https://doi.org/10.1089%2Fapc.2010.0322 | |
| Providing "a beam of light to see the gaps": determinants of implementation of the Systems Analysis and Improvement Approach applied to the pediatric and adolescent HIV cascade in Kenya | Beima-Sofie, et al. | 2022 | Not described | The Systems Analysis and Improvement Approach (SAIA) was adapted and piloted for the pediatric and adolescent HIV care and treatment cascade (SAIA PEDS) at 6 facilities in Kenya. SAIA PEDS includes three tools: continuous quality improvement (CQI), flow mapping, and pediatric cascade analysis (PedCAT). Qualitative evaluation was conducted to determine determinants of implementation. Data collection and analysis were grounded in CFIR. SAIA PEDS strategy was acceptable, and the three tools complemented one another and provided a relative advantage over existing processes. The flow mapping and CQI tools were compatible with existing workflows and resonated with team priorities and goals while providing a structure for group problem solving that transcended a single department’s focus. The PedCAT was overly complex, making it difficult to use. Leadership and hierarchy were complex determinants. | Consolidated Framework for Implementation Research (CFIR) | Not described | Systems Analysis and Improvement Approach (SAIA) | Not described | HIV care cascade (paediatric and adolescent) | Children and adolescents living with HIV | Kenya | https://doi.org/10.1186/s43058-022-00304-3 | |
| Proyecto Compadre: Using Implementation Science to Tailor Peer Navigation for Latino Men in the US–Mexico Border Region | Tsuyuki, et al. | 2022 | Mixed methods | Mixed-methods implementation science study measurement, and analysis of barriers and facilitators to accessing and providing HIV testing and care to develop a peer navigation implementation strategy among Latino men. | Exploration, Preparation, Implementation, Sustainment Framework (EPIS) | Peer navigation | Implementation/intervention mapping | None described | HIV testing
Linkage to care |
MSM | USA | http://dx.doi.org/10.1097/QAI.0000000000002985 | |
| Qualitative evaluation of the Systems Analysis and Improvement Approach as a strategy to increase HIV testing in family planning clinics using the Consolidated Framework for Implementation Research and the Implementation Outcomes Framework | Eastment, et al. | 2022 | Nested within a cluster-randomized trial | Significant gaps remain in HIV testing and counselling (HTC) in family planning (FP) clinics. To address these gaps, Systems Analysis, and Improvement Approach(SAIA), was used and evaluate implementation using the Consolidated Framework for Implementation Research (CFIR) and assess the Implementation Outcomes Framework outcomes of acceptability, appropriateness, and feasibility. Assessment was done qualitatively nested within the cluster-randomized trial. Most clinics had a positive implementation climate, engaged leadership, and access to resources and information. Most reported a strong culture of embracing change and recognition of the importance of HIV testing within FP clinics. Interviews highlighted very high acceptability, appropriateness, and feasibility of SAIA. The implementation strategy was not complicated and fit well into existing clinic processes. | Consolidated Framework for Implementation Research (CFIR)
Implementation Outcomes Framework (OIF) |
Systems Analysis and Improvement Approach (SAIA) | System engineering | Feasibility
Appropriateness Acceptability |
HIV testing | Family planning clients | Kenya | https://doi.org/10.1186/s43058-022-00342-x | |
| Repositioning Implementation Science in the HIV Response: Looking Ahead From AIDS 2018 | Hargreaves, et al. | 2019 | Not described | Review of abstracts from the 2018 International AIDS Conference which included a range of implementation strategies to delivery HIV testing, prevention, and treatment services. Suggest four areas in need for more research: delivery of primary prevention programs, strengthened/more frequent economics and financing studies, routine data systems, innovative methodologies for evaluations.
Suggest that hybrid designs offer one potential method to obtain high quality data at a lower cost and that pursuing evaluations powered on implementation, process, and short term mediating outcomes may be helpful. |
Not described | Not abstracted for this review | Costing/ economic evaluation
Mathematical modeling Qualitative research Surveillance & data systems |
Acceptability
Cost Feasibility |
HIV care cascade | Not described | Global | https://doi.org/10.1097/qai.0000000000002209 | |
| Research for change: Using implementation research to strengthen HIV care and treatment scale-up in resource-limited settings | Hirschhorn, et al. | 2007 | Not described | This article reviews the current understanding of the field of implementation research and discusses its association with other areas of health services research, clinical research, and quality management work with specific examples from the field of HIV/AIDS. Opportunities for conducting implementation research are proposed, and future steps to develop the field are outlined in relation to HIV/AIDS programming. | Not described | Not abstracted for this review | Costing/ economic evaluation
Mathematical modeling Quality improvement Process mapping |
None described | HIV/AIDS overview | Not described | LMICs | https://doi.org/10.1086/521120 | |
| Research translation to inform national health policies: learning from multiple perspectives in Uganda | Ssengooba, et al. | 2011 | Case studies: cohort and RCT | Engagement of stakeholders from local research institutions and agencies is important in health policy development, implementation, and dissemination of evidence/research findings.
Factors facilitating PMTCT policy uptake and continued implementation include: shared platforms for learning and decision making among stakeholders, implementation pilots to assess feasibility of intervention, the emerging of agencies to undertake operations research and the high visibility of policy benefits to child survival. Safe Male Circumcision was stalled following dissemination of study findings: policy makers demanded additional research to assess implementation feasibility within ordinary health systems and high level leaders publicly contested SMC evidence. Policy makers concerned about local relevance and "indigenization" of research evidence. Implementation research plays a key role in guiding the policy process, specifically regarding feasibility of implementing new and effective interventions at a large scale following research studies. This is facilitated through the use of a shared platform for learning and decision making across various stakeholders. This article also provides details on strategies to address policy maker's priorities, questions, concerns. |
Not described | Not abstracted for this review | Dissemination research
Qualitative research Stakeholder & policy analysis |
None described | PMTCT
HIV prevention |
Stakeholders: researchers, policy makers, media practitioners | Uganda | https://doi.org/10.1186/1472-698x-11-s1-s13 | |
| SBIRT Implementation for Adolescents in Urban Federally Qualified Health Centers | Mitchell, et al. | 2016 | Cluster RCT | *Focused primarily on substance use but detailed integration of implementation outcomes and descriptions of implementation strategies.
This study aims to inform expansion of the SBIRT (Screening, Brief Intervention and Referral to Treatment) model to address HIV risk behaviors among adolescents. This model has generally been used for substance use interventions. This protocol outlines the on-going study comparing the implementation of a generalist versus specialist brief intervention model for adolescents receiving primary care. |
Proctor's Implementation Outcomes Framework | Not abstracted for this review | Costing/economic evaluation
Mathematical modeling Qualitative research |
Acceptability
Adoption Appropriateness Cost Feasibility Fidelity Penetration Sustainability |
HIV and drug use | Adolescents | USA | https://doi.org/10.1016/j.jsat.2015.06.011 | |
| Scale up of PrEP integrated in public health HIV care clinics: a protocol for a stepped-wedge cluster-randomized rollout in Kenya | Mugwanya, et al. | 2018 | Stepped-wedge cRCT | Partners Scale Up Project aims to study the process of integrating PrEP services for HIV serodiscordant couples in HIV clinics. The work combines nationally sponsored PrEP delivery with technical support and implementation science from academic partners, defining a new but sustainable paradigm for public health collaboration.
Example of how implementation science can guide optimization and contextualization of an intervention when moving from clinical trial evidence to programmatic delivery. |
RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance)
Consolidated Framework for Implementation Research (CFIR) |
Not abstracted for this review | Qualitative research
Costing/economic evaluation Quality improvement Process mapping |
Acceptability
Adoption Cost Fidelity |
PrEP | HIV serodiscordant couples | Kenya | https://doi.org/10.1186/s13012-018-0809-7 | |
| Social marketing interventions to increase HIV/STI testing uptake among men who have sex with men and male-to-female transgender women | Wei, et al. | 2011 | Not described | Review of three studies, two of which were serial cross-sectional pretest-posttest designs without a control and the third had a control group.
Limited evidence suggests that multi-media social marketing campaigns can significantly increase HIV testing uptake among men who have sex with men. Future research should employ more rigorous designs in evaluating social marketing interventions, measure their long term impact, identify intervention components that are most effective in reaching the target population and changing behaviours, and include studies in LMICs. Much of the prior literature on social marketing and HIV/STI testing not specific to MSM and transgender women. |
Not described | Not abstracted for this review | Social marketing | None described | HIV testing & diagnostics | MSM
Transgender women |
HICs | https://doi.org/10.1002/14651858.cd009337 | |
| Systems Analysis and Improvement Approach to optimize the pediatric and adolescent HIV Cascade (SAIA-PEDS): a pilot study | Wagner, et al. | 2022 | Pre and post pilot study | The Systems Analysis and Improvement Approach (SAIA) is a multi‑component implementation strategy previously shown to improve the HIV care cascade for pregnant women and infants. The study adapted the SAIA strategy components to be applicable to the pediatric and adolescent HIV care cascade (SAIA‑PEDS) in Kenya and tested SAIA‑PEDS strategy improved HIV testing, linkage to care, antiretroviral treatment (ART), viral load (VL) testing, and viral load suppression for children and adolescents ages 0–24 years at 5 facilities. A pre‑post analysis with 6 months pre‑ and 6 months post‑implementation strategy (coupled with an interrupted time series sensitivity analysis) using abstracted routine program data to determine changes attributable to SAIA‑PEDS was conducted. There was no substantial or significant change in the ratio of HIV testing and linkage to care. ART initiation increased substantially .There were significant and substantial improvements in the ratio of VL tests ordered but no substantial or significant change in the ratio of VL results suppressed. | Systems Analysis and Improvement Approach (SAIA) | Continous quality improvement Pediatric/adolescent cascade analysis tool (PedCAT) Flow mapping |
Systems engineering | None described | HIV care cascade | Children living with HIV | Kenya | https://doi.org/10.1186/s43058-022-00272-8 | |
| Systems analysis and improvement to optimize pMTCT (SAIA): a cluster randomized trial | Sherr, et al. | 2014 | Longitudinal cRCT | Goal is to improve maternal and infant outcomes by reducing drop-offs along the pMTCT cascade. The SAIA intervention provides tools to guide decision making for pMTCT program staff at the facility level, and to identify low cost, contextually appropriate pMTCT improvement strategies | Consolidated Framework for Implementation Research (CFIR) | Not abstracted for this review | Systems Analysis and Improvement Approach (SAIA)
Process mapping Qualitative research |
Acceptability
Adoption Feasibility Penetration Sustainability |
PMTCT | Women living with HIV | Côte d'Ivoire
Kenya Mozambique |
https://doi.org/10.1186/1748-5908-9-55 | |
| Task shifting and integration of HIV care into primary care in South Africa: The development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention | Uebel, et al. | 2011 | RCT | This article describes the development and content of an intervention involving two strategies (shifting ART prescription from doctors to ART nurses and shifting routine HIV care for patients not yet eligible for ART from ART nurses to primary care nurses at ART assessment sites), as part of the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) pragmatic randomized controlled trial. Intervention components and detailed information regarding different sets of trainings are included.
Clinic staff and all levels of management were heavily involved in intervention development and implementation. This article provides an example of how features of participatory action research can be integrated into trial intervention design and implementation. |
Not described | Not abstracted for this review | Stakeholder & policy analysis | None described | HIV treatment & adherence | PLHIV | South Africa | https://doi.org/10.1186/1748-5908-6-86 | |
| The Achilles' heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability | Rodriguez, et al. | 2017 | Exploratory Qualitative | Utilizing the five CFIR domains and constructs, the influence of healthcare system-, clinic staff-, and patient-level challenges and solutions were examined at each healthcare system level on implementation and effectiveness of the PMTCT protocol.
Several strategies to improve PMTCT were suggested with male partner involvement and increased clinic staffing as two main categories. |
Consolidated Framework for Implementation Research (CFIR) | Not abstracted for this review | Qualitative research
Stakeholder & policy analysis |
Acceptability
Adoption Fidelity Sustainability |
PMTCT | Not described | South Africa | https://doi.org/10.1080/17290376.2017.1375425 | |
| The effect of a local change team intervention on staff attitudes towards HIV service delivery in correctional settings: a randomized trial | Visher, et al. | 2014 | Cluster RCT | This study aimed to determine whether a change team approach to implementing improved HIV services increased the perceived value of HIV services among staff of correctional and community HIV organizations. Staff in the facilities that implemented a modified-NIATx change team approach for improving the delivery of the HIV service continuum increased their perceptions of the value of HIV services as compared to staff in the control facilities. Additionally, medical staff at facilities that applied the change team approach reported higher acceptability and feasibility of implementing HIV services in their facility. However, perceived feasibility declined among correctional staff at facilities with a change team, potentially due to increased workload. The impact of this organizational intervention varied across different types of staff. | HIV-STIC conceptual model | Not abstracted for this review | Organizational readiness/ assessment
Quality improvement Process mapping |
Acceptability
Feasibility |
HIV care cascade | Staff of correctional and community HIV organizations | USA | https://doi.org/10.1521/aeap.2014.26.5.411 | |
| The Healthy Native Youth Implementation Toolbox: Using Implementation Mapping to adapt an online decision support system to promote culturally-relevant sexual health education for American Indian and Alaska Native youth | Markham, et al. | 2022 | Not described | In this project, researchers applied Implementation Mapping (IM) to adapt iCHAMPSS (CHoosing And Maintaining Effective Programs for Sex Education in Schools) to facilitate the adoption and implementation of culturally-relevant sexual health EBPs in American Indian and Alaska Native communities. Implementation Mapping provided a systematic approach to guide the adaptation process and integrate community voice with the ultimate goal of enhancing sexual health equity among AI/AN youth. | Implementation Mapping | Elaboration Persuasive communication Modelling Shifting perspective Goal-setting Technical assistance |
Intervetion/implementation mapping | Adoption
Implementation Maintenance |
HIV prevention (sex education) | Youth | USA | https://doi.org/10.3389/fpubh.2022.889924 | |
| The immediate effect of the Same-Sex Marriage Prohibition Act on stigma, discrimination, and engagement on HIV prevention and treatment services in men who have sex with men in Nigeria: analysis of prospective data from the TRUST cohort | Schwartz, et al. | 2015 | Prospective cohort study | Comparison of HIV clinical outcomes and stigma among the MSM community following the implementation of the Same Sex Marriage Prohibition Act in 2014. Cohort was part of the TRUST study which aims to assess the feasibility and effectiveness of engagement of MSM from Abuja into HIV prevention and treatment services at sites located within a CBO trusted by the MSM community.
This legislation can have a negative public health effect via restrictions on uptake of HIV prevention, treatment, and care services in those most at risk for HIV transmission. Observed significantly higher proportions of MSM reporting fear of seeking health care and avoidance of health care following the implementation of the law. Essential to identify strategies to reach MSM who are less likely to engage in HIV testing and care in highly stigmatized environments to reduce the time between HIV diagnosis and treatment. |
Not described | Not abstracted for this review | Stakeholder & policy analysis | None described | HIV care cascade | MSM | Nigeria | https://doi.org/10.1016/s2352-3018(15)00078-8 | |
| The Importance of Context in Implementation Research | Edwards and Barker | 2014 | Not described | A key feature of implementation science is understanding the interactions between interventions and context through an adaptation lens, and the transposition of findings to other contexts and systems. This perspective is important in HIV/AIDS programming to ensure scalability of effective/efficacious interventions.
Reviewed articles describing study protocols related to HIV/AIDS to assess how context was included as a factor in the evaluation of HIV implementation studies in complex environments. Provides suggestions for characterizing context when reporting HIV/AIDS interventions and emphasizes the need for a framework for understanding and describing context, as well as an adaptive approach for implementing and scaling up interventions in a context-sensitive way. Frameworks such as the WHO health systems framework and Greenhalgh framework for organizational change can be a good starting point for describing context. |
Not described | Not abstracted for this review | Adaptive designs/strategies
Quality improvement Process mapping |
Feasibility | HIV/AIDS overview
PMTCT |
Not described | LMICs
South Africa |
https://doi.org/10.1097/qai.0000000000000322 | |
| The LAIs Are Coming! Implementation Science Considerations for Long-Acting Injectable Antiretroviral Therapy in the United States: A Scoping Review | Kanazawa, et al. | 2021 | Scoping Review | Review of the literature using components of the PRISM model to anticipate and examine implementation considerations for LAI-ART.
Limited existing research on patient acceptance of LAI-ART but initial research suggests PLWH have a general positive view of LAI-ART. Providers recognize the benefits of LAI-ART but note that the use of LAI-ART should be decided on a case by case basis. This paper outlines barriers and facilitators from both perspectives. Assessment of the characteristics of the patients and organizations/providers at which and by whom the intervention is to be administered, as well as the external factors that must be considered when designing an optimal implementation strategy for LAI-ART (ex. drug costs, distribution, insurance coverage, stigma) and the infrastructural design. As LAI-ART is implemented in the real-world, it will be important to study how the external environment and organizational characteristics influence implementation, as well as how potential facilitators may be used to maximize its acceptability and uptake. |
Practical, Robust Implementation and Sustainability Model (PRISM)
PRISMA Extension for |
Not abstracted for this review | Qualitative research | Acceptability
Cost Sustainability |
HIV treatment & adherence | PLHIV | USA | https://doi.org/10.1089/aid.2020.0126 | |
| The PrEP Laboratory Service Gap: Applying Implementation Science Strategies to Bring PrEP Coverage to Scale in the United States |
Siegler, et al. | 2022 | Not described | This article details how, by using ERIC's strategies compilation, a national system for covering both standard and telemedicine laboratory testing would support a national PrEP program in the USA. Implementation strategies are identified that could facilitate success and lead to cost-effective provision of PrEP services. | Expert Recommenda- tions for Implementing Change (ERIC) strategies |
Alter patients’ fees Make billing easier Quality monitoring Audit and feedback Educational Outreach Change services sites Centralize technology assistance Facilitate data access |
Implementation mapping | None described | PrEP | Not described | USA | https://doi.org/10.1017%2Fjme.2022.34 | |
| The role of healthcare providers in the roll out of preexposure prophylaxis | Krakower and Mayer | 2016 | Not described | Overview of recent studies which assess the preparedness of healthcare practitioners to provide PrEP, specifically related to awareness of PrEP prescribing guidelines, provider concerns related to PrEP, who is the main prescriber of PrEP, guidelines/provider perspectives outside of US settings, and identification of those who would benefit from PrEP.
Diffusion of Innovation theory provides a helpful framework for understanding the trajectory of PrEP uptake in care settings. |
Diffusion of Innovation | Not abstracted for this review | Dissemination research
Qualitative research Stakeholder & policy analysis |
Adoption
Feasibility |
PrEP | Not described | Global | https://doi.org/10.1097%2FCOH.0000000000000206 | |
| The Roles of Expert Mothers Engaged in Prevention of Mother-to-Child Transmission (PMTCT) Programs: A Commentary on the INSPIRE Studies in Malawi, Nigeria, and Zimbabwe | Cataldo, et al. | 2017 | Comparative Synthesis Study | This paper compares the role of expert mothers in supporting PMTCT clients in 3 implementation research studies (part of the INSPIRE initiative) to then inform guidance for developing standardized models for expert mother engagement in PMTCT programs.
Overall high acceptability of expert mother services among patients and community members and this was facilitated by strong relationships and confidence in confidentiality and privacy. However, there was mixed acceptability of expert mother services from the HCW perspective in Nigeria and Malawi. The authors identify four key factors to consider for scalability and sustainability of these interventions: 1) acceptability of the role of expert mothers and potential stigma, 2) need for adequate training, supervision, and remuneration in EM programs, 3) importance of defining expert mother roles in relation to HCWs and the formal health system, with a more well defined role leading to higher acceptance, 4) this model is applicable in both urban and rural settings. |
Not described | Not abstracted for this review | Qualitative research | Acceptability
Sustainability |
PMTCT | Mothers living with HIV | Malawi
Nigeria Zimbabwe |
https://doi.org/10.1097/qai.0000000000001375 | |
| Understanding the impact of external context on community-based implementation of an evidence-based HIV risk reduction intervention | Hamilton, et al. | 2018 | Hybrid Type II (parent study) | This paper presents key features of external context and their impact on implementation of Eban II, an evidence-based HIV/AIDS prevention intervention currently being tested in community-based organizations (CBOs) across Northern and Southern California. Despite high internal organizational readiness for implementation, key contextual barriers impacted implementation processes.
External contextual barriers to implementation of Eban II fall into three categories: community agency resources, patient needs as a manifestation of social determinants of poverty, and local and national policy changes, all of which map onto CFIR constructs. Authors argue that there is a need to further develop the understanding and measurement of the ways in which external context can affect implementation. |
Consolidated Framework for Implementation Research (CFIR) | Not abstracted for this review | Organizational readiness/ assessment
Qualitative research Stakeholder & policy analysis |
Sustainability | HIV care cascade | African American HIV-serodiscordant heterosexual couples | USA | https://doi.org/10.1186/s12913-017-2791-1 | |
| Understanding uptake of an intervention to accelerate antiretroviral therapy initiation in Uganda via qualitative inquiry | Semitala | 2017 | Stepped-wedge cRCT | Qualitative component of a larger cRCT (START-ART); Engaged health care providers at intervention sites to understand how new practices at facilities were rapidly disseminated through a network beginning from the Uganda HIV programme, to facility health workers, and into peer counselors. Uptake of the intervention to accelerate ART initiation affected by the institutional context (specifically strong existing relationships at the institutional and interpersonal levels), strong history of partnership between MJAP and facilities, and strong intrinsic motivation among providers. Peer counselors, although not directly targeted during the knowledge transfer phase, played a key role as enablers of rapid ART initiation.
Fostering stable institutional relationships between institutional actors (non-governmental organization (NGOs) and ministry-operated facilities) as well as between facilities and the community (through peer health workers) can enhance uptake of innovations targeting the HIV cascade in similar clinical settings. For researchers seeking to understand implementation processes, qualitative methods are essential for understanding unknown unknowns, which are expected in implementation research. Second, for implementers involved in the global response to HIV, we suggest that effective health systems innovations to optimize health outcomes often occur at the intersection of health systems and communities. The incorporation of people living with HIV as peer counsellors in the health care workforce represents a generalizable strategy to naturally bridge and connects systems and communities. |
Theoretical Domains Framework(TDF)
PRECEDE - PROCEDE |
Not abstracted for this review | Dissemination research
Qualitative research |
Adoption
Cost |
HIV treatment & adherence | PLHIV | Uganda | https://doi.org/10.1002/jia2.25033 | |
| Uptake and Acceptability of Oral HIV Self-Testing among Community Pharmacy Clients in Kenya: A Feasibility Study | Mugo, et al. | 2017 | Feasibility study | Assessment of the feasibility of pharmacy-based HST.
Pharmacy service providers and research assistant were engaged in discussions related to quantitative results, experiences during the survey, and things to consider during scale-up. Uptake of HIVST was highest among clients seeking HIV testing compared to clients seeking other services, suggesting a client-initiated approach may be more feasible than a pharmacy-initiated testing; Cost does not appear to be a barrier to uptake ($1 USD); Majority of participants reported high acceptability of HIVST and that pharmacies are the best place to access HIVST. |
Not described | Not abstracted for this review | Qualitative research
Stakeholder & policy analysis |
Acceptability
Cost Feasibility |
HIV testing & diagnostics | General population | Kenya | https://doi.org/10.1371/journal.pone.0170868 | |
| Use of the Consolidated Framework for Implementation Research (CFIR) to Characterize Health Care Workers’ Perspectives on Financial Incentives to Increase Pediatric HIV Testing | Atkins, et al. | 2020 | Not described | A qualitative study evaluating health care providers' perceptions of barriers and facilitators of a previously completed financial incentives intervention for pediatric HIV testing was conducted at in Kenya. Explored determinants of acceptability, feasibility, and sustainability of a financial incentive scale-up for pediatric HIV testing using the Consolidated Framework for Implementation Research to inform question guides and thematic analysis. Providers found the use of financial incentive interventions for pediatric HIV testing to be highly acceptable. Concerns about how financial incentives would be implemented influenced perceptions of feasibility and sustainability including already overburdened staff and high costs of financial incentive programs and possible negative effects due to expectations of repeated financial support and program manipulation. | Consolidated Framework for Implementation Research (CFIR) | Alter incentive/allowance structures (Financial incetives) |
Qualitative Research | Acceptability
Feasibility Sustainability |
HIV testing | Children | Kenya | http://dx.doi.org/10.1097/QAI.0000000000002323 | |
| Using the Exploration-Preparation-Implementation-Sustainment (EPIS) Framework to prepare for the implementation of evidence- based practices into adolescent HIV settings | Carcone, et al. | 2022 | Mixed methods longitudinal design | Study used the EPIS framework to guide the implementation of four Motivational Interviewing (MI) and MI-framed interventions into youth-serving HIV prevention and treatment settings. Stakeholders identified two critical factors for effective implementation: fit with the patient population and provider receptivity, including concerns about scope of practice, buy-in, and time. Stakeholders recommended strategies for structuring training, fidelity monitoring, and facilitating implementation including engaging informal leaders, collaboratively developing the implementation strategy, and site-wide implementation. Results highlight the importance of pre-implementation contextual assessment and strategic planning for identifying provider concerns and developing responsive implementation strategies. | Exploration, Preparation, Implementation, Sustainment (EPIS) | Not described | Implementation/intervention mapping | Not described | HIV prevention
HIV treatment |
Adolescents | USA | https://doi.org/10.1007/s10461-022-03735-0 | |
| Using the Implementation Research Logic Model as a Lens to View Experiences of Implementing HIV Prevention and Care Interventions with Adolescent Sexual Minority Men—A Global Perspective |
Nelson, et al. | 2022 | Multiple case study design | Interventions aimed at optimizing HIV prevention, testing and viral load suppression for adolescents must also attend to the intersectional realities influencing key sub-populations of sexual minority males (SMM). There is no robust evidence-base to guide researchers and program partners on optimal approaches to implementing interventions with adolescent SMM. Using a multiple case study design, the study integrated Implementation Research Logic Model with components of the CFIR , both applied to a comparative description of ten HIV related interventions implemented across five countries (Ghana, Kenya, Nigeria, Tanzania, and United States) , and used to conduct qualitative surveys . 17 of the most influential implementation determinants as well as a range of 17 strategies were identified. Publications summarizes lessons learned in the process and provide recommendations for researchers considering future HIV implementation science studies with adolescent SMM. | Implementation Research Logic Model
Consolidated Framework for Implementation Research (CFIR) Expert Recommenda- |
Use advisory boards Promote adaptability Audit and feedback Prepare patients to be active participants Assess for readiness Build a coalition Provide technical assistance Tailor strategies Conduct ongoing training Provide ongoing consultation Promote network weaving Using mass media Involving patients and consumers Developing educational materials Conduct local consensus discussions |
Qualitative research | Feasibility
Acceptability Appropriateness Fidelity |
HIV prevention
HIV treatment |
Adolescent sexual minority men | Global | https://doi.org/10.1007/s10461-022-03776-5 | |
| What do the implementation outcome variables tell us about the scaling-up of the antiretroviral treatment adherence clubs in South Africa? A document review | Mukumbang, et al. | 2019 | Qualitative document review analysis | Although there is evidence demonstrating that adherence club models can be more effective than standard clinic-based ART services in terms of retention in care and improving adherence to medication, rollout in South Africa has been limited. Therefore, this paper conducted a document review to understand the scale-up of adherence clubs using implementation outcome variables. The authors provide some policy recommendations to improve rollout of adherence clubs.
Overall, adherence clubs have been demonstrated to be cost effective in South Africa and the wide adoption within the Western Cape suggests further scale-up is feasible while noting that certain challenges will need to be addressed to maintain efficacy and sustainability. |
Peters et al. implementation outcomes | Not abstracted for this review | Qualitative research | Acceptability
Adoption Appropriateness Cost Feasibility Fidelity Penetration Sustainability |
HIV treatment & adherence | PLHIV | South Africa | https://doi.org/10.1186/s12961-019-0428-z | |
| Will an Unsupervised Self-Testing Strategy for HIV Work in Health Care Workers of South Africa? A Cross Sectional Pilot Feasibility Study | Pai, et al. | 2013 | Cross Sectional Pilot feasibility study | This pilot evaluated the feasibility and accuracy of an unsupervised self-testing strategy among HCWs, as well as HCWs' preferences, concerns, and experiences with the self testing strategy and HIV sero-positivity. The self testing strategy includes the integration of internet services, public health counsellors, and mobile phones to facilitate testing, interpretation of results, and linkages.
The majority of participants reported positive self-testing experiences, due to confidentiality and anonymity. Larger real life implementation research studies and controlled trials on self-testing are urgently needed to generate stronger evidence for scale up, including those which assess this strategy among different populations at increased risk for HIV. |
Not described | Not abstracted for this review | Impact evaluation | Feasibility | HIV testing & diagnostics | Health care workers | South Africa | https://doi.org/10.1371/journal.pone.0079772 | |
| Working with HIV clinics to adopt addiction treatment using implementation facilitation (WHAT-IF?): Rationale and design for a hybrid type 3 effectiveness-implementation study | Edelman, et al. | 2020 | Hybrid: Type III effectiveness-implementation stepped-wedge design | Rationale for a formative evaluation of barriers and facilitators of implementing addiction treatment for people living with HIV followed by an evaluation of the impact of implementation facilitation (IF) on promoting the adoption of evidence-based addiction treatments and clinical outcomes.
Assessed the following implementation outcomes: provision of addiction treatment, organizational and clinician and staff readiness to adopt addiction treatment, changes in organizational models of care used to deliver addiction treatment. A hybrid type 3 effectiveness-implementation approach was appropriate given the existing evidence and clinical guidance supporting the use of addiction treatment among PWH and our interest in primarily evaluating the impact of the implementation strategy on practice change. PARiHS framework guided the quantitative and qualitative assessments. *results pending - will provide information related to whether IF is a reproducible strategy to promote addiction treatment in HIV clinics. |
Promoting Action on Research Implementation in Health Services (PARIHS) framework | Not abstracted for this review | Organizational readiness/ assessment
Qualitative research Stakeholder & policy analysis |
Adoption | Addiction treatment among PLHIV | PLHIV | USA | https://doi.org/10.1016/j.cct.2020.106156 | |
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*Please note, this database includes only an exemplary subset of the existing literature. For more complete databases, you can visit the HIV Implementation Literature Review Dashboard from Northwestern University’s HIV Implementation Science Coordination Initiative (ISCI) and the Living Analysis of HIV Implementation Science in Low-to-Middle Income Countries (LIVE) Dashboard from a team of researchers at Washington University in St. Louis, Johns Hopkins University, New York University and the World Health Organization.