Linkage to Care

Cost and Threshold Analysis of Positive Charge, a Multi-site Linkage to HIV Care Program in the United States (by Kim et al, 2015)

This costing study by Kim and colleagues, published in 2015, calculates cost-saving and cost-effective thresholds for Positive Charge, an HIV linkage-to-care initiative implemented in New York, Chicago, Louisiana, North Carolina, and San Francisco.

High-Yield HIV Testing, Facilitated Linkage to Care, and Prevention for Female Youth in Kenya (GIRLS Study): Implementation Science Protocol for a Priority Population (by Inwani et al, 2017)

Implementation science protocol using the sequential multiple assignment randomized trial [SMART] design to pilot adaptive linkage to HIV care interventions amongst girls and young women in Kenya. This study also will test two recruitment strategies and three test strategies.

Treatment Adherence & Care Retention

Stakeholder Perspectives on MAPS (by Sanchez et al, 2022)

An evidence-based intervention which increased HIV treatment adherence, managed problem solving (MAPS) has not been widely implemented in community clinic settings. This study conducts stakeholder interviews with Ryan White-funded clinics in Philadelphia, PA to understand perceived barriers and facilitators to using community health workers to deliver MAPS. The CFIR informs the interview guide development and the rapid qualitative analysis. Results are presented in alignment with the CFIR domains and constructs.

Understanding uptake of an intervention to accelerate antiretroviral therapy initiation in Uganda via qualitative inquiry (by Semitala et al, 2017)

This study uses qualitative methods to understand the uptake of the Streamlined Antiretroviral Therapy Initiation Strategy in health facilities in Uganda. START-ART is a multi-component intervention aimed at rapid ART initiation. The research team analyses in-depth interviews using the Theoretical Domains Framework to understand perceptions, attitudes, and the context of changes in ART initiation practices among providers.

Multilevel Determinants of Rapid Antiretroviral Treatment Implementation and Demand in Miami-Dade County (by Harkness et al, 2022)

This study aims to understand the determinants of rapid ART linkage and initiation. Implementation of rapid ART varies across clinics in the United States. The study team uses focus groups and in-depth interviews with clinic staff and patients in Miami-Dade County to identify factors impacting clinic implementation and patient demand for rapid ART. This study uses the CFIR to guide its qualitative analysis and presentation of results.

Using Implementation Science to Promote Integration and Sustainability of Community Health Workers in the HIV Workforce (by Rajabiun et al, 2022)

This study by Rajabiun et al identifies determinants for the integration of community health workers into HIV agencies in Shelby County, TN. This EBI aims to increase retention in care and improve viral suppression, particularly among rural populations. Key informant interviews are conducted with a variety of stakeholders and implementors. The research team uses both the EPIS and RE-AIM frameworks to guide their analysis.

Implementation Science using Proctor’s Framework and an adaptation of the Multiphase Optimization Strategy (MOST): Optimizing a Financial Incentive Intervention for HIV Treatment Adherence in Tanzania (by Packel et al, 2019)

This paper presents the process used in a hybrid implementation trial to optimize a cash transfer program aims at improving ART adherence and viral suppression among PLWHIV in Tanzania. The research utilizes both Proctor et al’s implementation outcomes framework and MOST. The study involved 3 trials: efficacy of cash/food assistance, dose-finding for cash/food assistance, RCT testing effectiveness of optimized intervention in multiple settings. This paper highlights the gains to be made by applying multiple implementation science frameworks in an optimization process, enabling the identification of an optimal implementation strategy.

Reengagement in HIV Care

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 (by Cox et al, 2020)

Lost & Found is an intervention aimed at re-engaging out-of-care patients living with HIV that is based on several EBI. This research protocol will adapt Lost & Found to the HIV clinic at McGill University Health Centre. The study aims to then assess both the implementation strategies used and the effectiveness of the intervention. The adaptation process is informed by Proctor et al’s implementation outcomes framework, among others.

Barriers, Facilitators, and Cost of Integrating HIV-Related Activities Into Sexually Transmitted Disease Partner Services in Jackson, Mississippi (by Digre et al, 2021)

The integration of HIV-related interventions into STD partner services programs is an implementation strategy used by many US health departments. In Mississippi, the DoH integrated HIV testing, relinkage to HIV care, and PrEP services into STD partner services. This study looked at the barriers, facilitators, and cost of integrating these activities. In addition to interviews and observations, this study also conducted time and motion studies to assess the cost of adding these HIV services into a standard partner service case.

HIV Prevention (behavioral interventions, condoms, safe syringe programs, etc.)

Facilitators and barriers to effective scale-up of an evidence-based multilevel HIV prevention intervention (by Kegeles et al, 2015)

This article presents facilitators and barriers, categorized into three domains (HIV Prevention System Factors, community Factors, and Intervention Factors), to community-based organizations implementing a multilevel HIV prevention EBI for young gay and bisexual men. The implemented intervention was the Mpowerment Project. The study team analyzed interviews, and notes from TA providers to identify factors affecting effective implementation of the EBI.

Dissemination and uptake of HIV/STD preventive interventions in American Indian and Alaska Native communities: a case study (by Kaufman et al, 2018)

This work by Kaufman and colleagues attempts to fill a gap in the literature by examining factors the facilitate the uptake and successful implementation of HIV/STD EBIs in American Indian and Alaska Native (AIAN) communities. The study is guided by Roger’s theory of diffusion of innovation. Stakeholder interviews were analyses to identify perceived facilitators and barriers to implementation of a sexual risk reduction EBI (RESPECT) in AIAN communities. The article presents results for trialability, relative advantage, observability, complexity and compatibility and implications of these findings for future HIV/STD EBI implementation in AIAN communities.

Strengthening HIV Prevention Services Through an Implementation Science Approach: Perspectives From the HIV Testers in Philadelphia (by Wood et al, 2022)

Guided by the CFIR, this study looks at HIV testers’ implementing HIV prevention services in Philadelphia. The article reports perceived facilitators and barriers reported by individuals funded by the Philadelphia Department of Public Health to conduct HIV testing.

Understanding the impact of external context on community-based implementation of an evidence-based HIV risk reduction intervention (by Hamilton et al, 2018)

This work by Hamilton and colleagues focuses on the impact of external context on the implementation of an HIV prevention EBI. The article specifically looks at Eban II, an HIV prevention intervention implemented by community-based organizations. The study finds that despite high organizational readiness, external contextual barriers to implementation were substantial.

Costs and Cost‑Effectiveness of Biomedical, Non‑Surgical HIV Prevention Interventions: A Systematic Literature Review (by Bozzani et al, 2022)

This work by Bozzani and colleagues examines the cost and cost-effectiveness of PrEP, injectable long-acting PrEP, vaginal microbicides, HIV vaccines and other non-surgical HIV prevention interventions. The systematic review includes 87 costing studies.

Pre-Exposre Prophylaxis (PrEP)

Determinants of Implementation for HIV Pre-exposure Prophylaxis Based on an Updated Consolidated Framework for Implementation Research: A Systematic Review (by Li et al, 2022)

This paper uses the CFIR to systematically review the literature for studies about determinants of PrEP implementation. They identify both determinants of PrEP use by patients and determinants of PrEP delivery by providers. This study also produced a dashboard which users can use to explore these studies and the over 1900 determinants of PrEP implementation.

Examining the Factors Affecting PrEP Implementation Within Community-Based HIV Testing Sites in Florida: A Mixed Methods Study Applying the Consolidated Framework for Implementation Research (by Turner et al, 2021)

Turner and colleagues examine determinants of PrEP implementation at HIV testing sites. The study is informed by the CFIR; CFIR contracts are used to builed generalized linear mixed models to estimate PrEP implementation and to identify qualitative themes in interviews discussing PrEP implementation. The data were merged to finalized a list of CFIR constructs affecting PrEP implementation in community-based HIV testing sites

Barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework (by Kadiamada-Ibarra et al, 2021)

This study was a part of the ImPrEP demonstration project which distributed free PrEP to men who have sex with men (MSM) in Mexico. The article identifies barriers and facilitators of PrEP uptake among male sex workers in Mexico City. The findings are based on in-depth interviews and ImPrEP program data. The RE-AIM framework guides the analysis.

PrEP Implementation Behaviors of Community-Based HIV Testing Staff: A Mixed-Methods Approach Using Latent Class Analysis (by Turner et al, 2020)

This article presents a latent class analysis to estimate PrEP implementation as a function of staff groupings and staff characteristics. The study investigated subgroups of staff providing community-based HIV testing in Florida to explore the likelihood that the staff would discuss PrEP with their clients. Additionally, the study used the CFIR to analyze in-depth interviews to further explore constructs affecting PrEP implementation in this setting.

Implementing PrEP Services in Diverse Health Care Settings (by Faro et al, 2022)

This study was done in partnership with a range of PrEP programs in New York. Stakeholder interviews were conducted and analyzed using the CFIR to explore PrEP implementation across different settings (primary care, emergency department, sexual health clinics, community-based settings, etc.). The study team used matrix analysis to identify contextual determinants of PrEP implementation strategies.

Determinants of Pre-exposure Prophylaxis (PrEP) Implementation in Transgender Populations: A Qualitative Scoping Review (by Zamantakis et al, 2022)

This scoping review by Zanabtajus and colleagues examines PrEP implementation in transgender populations. The review includes 33 studies. The authors based their analysis in the CFIR and identified barriers to implementing PrEP for transgender populations.

Prevention of Mother-to-Child Transmission

Systems analysis and improvement to optimize pMTCT (SAIA): a cluster randomized trial (by Sherr et al, 2014)

Study protocol for a two-arm, longitudinal cluster randomized trial design in Mozambique, Kenya and Côte d’Ivoire looking at SAIA effectiveness and implementation outcomes across the PMTCT service cascade. This study is guided by the CFIR.

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 (by Gimbel et al, 2016)

This article by Gimbel and colleagues presents a portion of the results from the Systems Analysis and Improvement Approach (SAIA) study which aimed to optimized PMTCT programs in Mozambique, Kenya and Côte d’Ivoire. The CFIR guided data collection and analysis of FGD and interviews across high and low performing clinics. The article presents constructs that explain the heterogeneity in SAIA’s success between facilities.

The Achilles’ heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability (by Rodriguez et al, 2017)

This article by Rodriguez and colleagues looks at challenges and solutions to the implementation, uptake, and sustainability of the PMTCT care cascade in South Africa. The study uses qualitative research methods and is guided by the CFIR. This article uniquely focuses on barriers to implementation of PMTCT programs in rural areas.

Long-acting injectables

A Layer Plus Approach to Implementation Research and Collaboration for Long-Acting Injectable Pre-Exposure Prophylaxis for HIV Prevention (by Pilgrim et al, 2022)

Long-acting injectable cabotegravir (CAB-LA) for HIV prevention has proven efficacious and statistically superior to oral PrEP in clinical trials. This article considers implementation science questions for getting CAB-LA to those who want to use it for HIV prevention. Pilgrim and colleagues describe a “Layer Plus Approach” for CAB-LA dissemination and implementation. This approach suggests layering CAB-LA into existing PrEP programs and the considerations for such an integration. The authors also suggest CAB-LA could be used to fill the gaps in PrEP reach.

The LAIs Are Coming! Implementation Science Considerations for Long-Acting Injectable Antiretroviral Therapy in the United States: A Scoping Review (by Kanazawa et al, 2021)

Long-acting injectable antiretroviral therapy (LAI-ART) is one of the newest advancements in HIV treatment. Identifying optimal strategies for its implementation will be key to make sure LAI-ART reaches the right populations and successfully overcomes barriers to adherence associated with oral ART. Kanazawa and colleagues conducted a scoping review of literature about LAI-ART implementation and LAI implementation more broadly. This article uses the PRISM model (Practical, Robust Implementation and Sustainability) to identify key questions for consideration in the development of an optimal implementation strategy for LAI-ART.

Adolescent HIV Care

Using the Exploration-Preparation-Implementation-Sustainment (EPIS) Framework to prepare for the implementation of evidence-based practices into adolescent HIV settings (by Carcone et al, 2022)

This article assesses the pre-implementation context to identify provider concerns about introducing four motivational interviewing (MI) interventions into youth-serving HIV prevention and treatment settings. The study uses the EPIS framework. Stakeholder interviews suggest several potential implementation strategies responsive to the context.

Implementation of Evidence-Based Practices to Reduce Youth HIV Transmission and Improve Self-Management: A Survey of Key Stakeholder Perspectives (by Butame, 2021)

This multi-center implementation study uses the EPIS framework to identify factors impacting the implementation of evidence-based interventions at 13 HIV prevention and care sites serving youth population. The study analyses survey responses from care providers to understand their perspectives on evidence-based interventions. The results highlight that provider attitudes, work climate, organizational support, and leadership impact the adoption and sustainment of evidence-based interventions.

Adolescent transition to adult care for HIV-infected adolescents in Kenya (ATTACH): study protocol for a hybrid effectiveness-implementation cluster randomised trial (by Njuguna et al, 2020)

This study protocol describes a hybrid trial in Kenya looking at transitioning adolescents to adult HIV care. A hybrid type 1 effectiveness-implementation cluster randomized controlled trial, this study will examine the effectiveness of an adolescent transition package in addition to assessing implementation outcomes and program costs.

Implementation determinants and mechanisms for the prevention and treatment of adolescent HIV in sub-Saharan Africa: concept mapping of the NIH Fogarty International Center Adolescent HIV Implementation Science Alliance (AHISA) initiative (by Aarons et al, 2021)

This paper presents results from a concept mapping exercise conducted with the Adolescent HIV Prevention and Treatment Implementation Science Alliance to identify implementation determinants of HIV prevention and care programs for adolescents in sub-Saharan Africa.

eHealth & HIV

Explorations of the Role of Digital Technology in HIV-Related Implementation Research: Case Comparisons of Five Ending the HIV Epidemic Supplement Awards (by Jones et al, 2022)

Jones and colleagues present a review of five EHE supplement projects that utilized technology either as an intervention component or an implementation strategy. This article aims to identify and describe challenges specific to technology-based implementation research. The EPIS framework is used to classify each of the five studies.

An Implementation Strategy to Expand Mobile Health Use in HIV Care Settings: Rapid Evaluation Study Using the Consolidated Framework for Implementation Research (by Cohn et al, 2021)

This study analyzes the facilitators and barriers to implementing a clinic-deployed mobile health app aimed at improving care for people living with HIV. Interviews were conducted at Ryan White clinics and the CFIR was used to analyze the data collected. Results from this study informed an optimization process of the implementation strategy used.

Economic evaluation of mobile phone text message interventions to improve adherence to HIV therapy in Kenya (by Patel et al, 2017)

This cost-effectiveness study looks at the added value of SMS-based ART adherence interventions. The authors compare the cost-effectiveness of weekly SMS adherence interventions and standard of care among PLWHIV in Kenya. Quality adjusted life years and lifetime HIV-related costs from a healthcare perspective are calculated using modeling methods.

Implementation of eHealth Interventions Across the HIV Care Cascade: a Review of Recent Research (by Kemp & Velloza, 2018)

This paper is a review of implementation science literature published between 2015 and 2018 that focuses on eHealth interventions. All 17 articles included in the review look at implementation outcomes of eHealth interventions along the HIV care cascade. This article also identifies gaps in the literature and proposes directions for future eHealth implementation science research.

Development and Implementation of a Mobile Phone-Based Prevention of Mother-To-Child Transmission of HIV Cascade Analysis Tool: Usability and Feasibility Testing in Kenya and Mozambique (by Kawakyu et al, 2019)

This paper by Kawakyu and colleagues studies the usability of a mobile phone-based PMTCT care cascade analysis tool used by health facility staff in clinics in Kenya and Mozambique. This application supports health workers in tracking mother-infant pairs through the PMTCT care cascade. The study is guided by the Nielsen Usability Framework and aims to assess health workers’ experience with the tool. Results from the first round of usability testing informed an adaptation of the application, after which a second round of usability testing was conducted to assess acceptability, use, and recommendations for adaptations of the tool.

HIV Stigma & Discrimination

Implementation science and stigma reduction interventions in low- and middle-income countries: a systematic review (by Kemp et al, 2019)

This systematic review looks at studies on stigma reduction interventions (across a range of conditions including HIV) in LMIC that report on implementation outcomes. The articles were assessed using the 12-item Template for Intervention Description and Replication. 20 of the 35 eligible studies included in this review focus on stigma related to HIV/AIDS.

HIV and Intersectional Stigma Reduction Among Organizations Providing HIV Services in New York City: A Mixed-Methods Implementation Science Project (by Rodriguez-Hart et al, 2022)

This study by Rodriguez-Hart and colleagues interviewed and surveyed over 25 HIV services organizations in New York City. The team carried out a mixed-methods mapping exercise to identify HIV-related stigma-reduction activities being implemented by these organizations. The team also assessed the evidence base of these interventions and characterized facilitators and barriers associated with their implementation.

Reducing Intersecting Stigmas in HIV Service Organizations: An Implementation Science Model (by Rodriguez-Hart et al, 2022)

In this article, Rodriguez-Hart and colleagues build off the results from the Stigma Reduction and Resilience (STAR) implementation science (IS) Mapping Project in New York City (above). That study highlighted the need for an IS framework to help HIV organizations use implementation science methodologies to improve implementation of stigma reduction interventions. The results of an interagency team exercise are presented in this article as the Stigma Reduction Logic Model.

Equity in HIV Services

A Computational Future for Preventing HIV in Minority Communities: How Advanced Technology Can Improve Implementation of Effective Programs (by Hendricks et al, 2013)

This article presents a variety of approaches for using computational systems to improve HIV prevention in minority populations, specifically Black and Latinx populations. The authors focus on how integrating technology into behavioral interventions can increase the scale, fidelity, efficacy, and appropriateness of these interventions. The article includes a ecological model of implementation for an EBI and highlights focal points where computational approaches can be used to improve implementation.

Webinar: Pre-Implementation Activities to Ensure Equity on the HIV Care Continuum (by Woodward and Momplaisir)

Harnessing “Scale-Up and Spread” to Support Community Uptake of the HoMBReS por un Cambio Intervention for Spanish-Speaking Men: Implementation Science Lessons Learned by a CBPR Partnership (by Rhodes et al, 2020)

HoMBReS por un Cambio is an HIV prevention intervention that decreases sexual risk among Spanish-speaking, predominately heterosexual Latinx men. This intervention was developed through community-based participatory research and has proven efficacious. The article presents results from using the Scale-Up and Spread implementation science framework to study implementation of HoMBReS por un Cambio in three different settings (an AIDS service organization, a Latinx-serving organization, and a county public health department). Qualitative research methods are used to identify constructs affecting implementation across the sites.

HIV-Related Implementation Research for Key Populations: Designing for Individuals, Evaluating Across Populations, and Integrating Context (by Schwartz et al, 2019)

This study presents an applied CFIR model specific to key populations. The article highlights key considerations and unique challenges for implementation science research with key populations. The authors focus namely on men who have sex with men, transgender people, sex workers, people who inject drugs, and incarcerated populations, which generally experience higher burdens of HIV but are not always reached by effective and appropriate interventions. A series of recommendations for future IS work with key populations is included.

Integration of Services in HIV Care Settings

Implementation science for integration of HIV and non-communicable disease services in sub-Saharan Africa: a systematic review (by Kemp et al, 2018)

This systematic review by Kemp and colleagues evaluates the existing literature using implementation science methods to study integrated HIV/NCD programs in sub-Saharan Africa. 31 studies are included in this review. The authors conclude that “implementation science has a promising role in supporting HIV/NCD integration, although its impact will be limited unless theoretical frameworks, rigorous study designs, and reliable measures are employed.”

Application of the Consolidated Framework for Implementation Research to Facilitate Delivery of Trauma-Informed HIV Care (by Piper et al, 2021)

In hopes of addressing the high prevalence of trauma among PLWHIV, researchers and practitioners have suggested integrating trauma-informed care (TIC), an evidence-based approach to address trauma and its physical and mental sequelae, into HIV clinics. This study by Piper and colleagues presents a pre-implementation assessment using qualitative methods and informed by the CFIR to identify factors related to TIC adoption in HIV clinics.

Exploring the heterogeneity of factors that may influence implementation of PrEP in family planning clinics: a latent profile analysis (by Piper et al, 2021)

This study aims to understand the heterogeneity of PrEP implementation at Title X-funded family planning clinics in the southern US. Piper and colleagues use the CFIR to design a survey aimed at assessing integration of PrEP services at family planning clinics. The research team also conducts a latent profile analysis using nine CFIR constructs to group clinics into distinct sub-groups of PrEP implementation success. A multi-level analysis is done to look at the relationship between group membership and readiness for implementation of PrEP.

Systems analysis and improvement approach to optimize the hypertension diagnosis and care cascade for PLHIV individuals (SAIA-HTN): a hybrid type III cluster randomized trial (by Gimbel et al, 2020)

This study protocol outlines a hybrid type II cluster randomized trial looking at the impact of SAIA-HTN on hypertension management and HIV clinical outcomes in health facilities in Mozambique. This study will look at implementation fidelity, determinants of implementation success, and core v. adaptable components of the intervention. The study team will also measure organizational readiness for change.