Landscape of Nih Funding for Implementation Research in HIV: Establishing a Baseline and Informing New Opportunities

Introduction: There is a growing need for implementation research (IR) to ensure that evidence-based interventions for the prevention of HIV reach those at greatest risk and/or those people living with HIV to prevent new infections. The HIV continuum of care serves as a prominent example of the need for IR where, despite highly effective HIV interventions, only half of Americans living with HIV have been diagnosed, linked to care, and achieved viral suppression. This paper focuses on where efforts are currently underway to address the research to practice gap in HIV through the examination of recently-funded studies of HIV that are also implementation research (IR); that is, aiming to understand the implementation strategies to take evidence-based HIV interventions to scale.

Methods: From the 216 HIV-related implementation research (IR) studies identified through the scoping review process, we extracted and coded information on the characteristics of the HIV intervention(s), including study population; intervention type and delivery method; stage of the HIV care continuum; geographic location of study site; IR study design used; and examined relations with the stage of IR.

Results: Of the 596 studies meeting our definition of HIV-related, only 36% were identified as involving IR. Of these, 51% were in the US and 49% were international. A larger proportion of US studies focused on men who have sex with men (29%) and people who inject drugs (16%) than international studies (18% and 8% respectively) while international studies focused more on women (35% vs. 13%). Thirty-five percent of studies focused exclusively on HIV prevention, 71% of which conducted in the US. Twenty-three percent focused on one step of the HIV care continuum, and 42% focused on multiple steps. More than 50% of combination prevention and PrEP interventions involved exploratory analysis of implementation as compared to 60% of studies looking at HIV care retention involved comparative implementation.

Conclusions: This is one of the first studies to identify and characterize the degree and type of IR being conducted in the field of HIV. While this scoping review does not fully capture the full extent of IR in HIV due to the sole use of NIH RePORTER in the review process, it indicates the need for more emphasis in this area to ensure that interventions reach those people most affected by HIV at the right time and in the right dose to reach the National HIV/AIDS strategy goals.