Expanding Collaborative Implementation Science for the End the Epidemic National Plan
Suzanne Pollard, Ph.D.
Division of AIDS Research
This concept aims to encourage implementation science research to strengthen the evidence for effective interventions and implementation strategies that address social and structural determinants of health (SSDoH), reduce inequities, and ultimately improve HIV outcomes. Research studies under this initiative may include hybrid implementation-effectiveness studies that simultaneously test the effectiveness of interventions addressing SSDoH and implementation strategies to facilitate their uptake or adaptation. This concept is closely aligned with the goals of the Ending the HIV Epidemic in the United States initiative, coordinated by the Health and Human Services Office of the Assistant Secretary of Health.
Despite the existence of highly effective prevention strategies and treatments for HIV, disparities in HIV outcomes and inequitable access to these life-saving measures remain persistent and pervasive. It is increasingly recognized that Social and Structural Determinants of Health (SSDoH), or the “conditions in the environments where people are born, live, and learn, work, play, worship, and age,” are important contributors to HIV inequities. These determinants are embedded in societal structure and can be reinforced by the same institutions and organizations intended to positively influence health outcomes and wellbeing. Examples of SSDoH include structural racism, poverty, stigma and discrimination, unstable housing, transportation challenges, food insecurity, medical mistrust, and inadequate access to health services.
There are several evidence-based structural HIV interventions designed to address SSDoH. However, these interventions have yet to be adapted to new contexts and brought to scale. At the same time, there is an urgent need to develop novel and effective HIV interventions that aim to address SSDoH and to better understand the factors that facilitate or hinder implementation of these interventions. Thus, implementation science approaches are urgently needed to simultaneously strengthen the evidence for multi-level HIV interventions that explicitly address SSDoH, while deploying implementation strategies to facilitate their uptake and adaptation in real-world contexts. Research examining implementation strategies across diverse real-world settings may help develop a generalizable knowledge base that can inform implementation across additional settings.
This concept aims to encourage research focused on increasing uptake or persistence of HIV Pre-Exposure Prophylaxis, improving HIV viral suppression, or both. A focus on a common set of HIV outcomes would enable and enhance cross-site comparisons of diverse SSDoH-encompassing interventions and strategies. A data coordination and consultative hub could enable funded teams to harmonize data collection plans and identify opportunities for cross-site learning. Finally, meaningful partnerships with communities and relevant local organizations or agencies are important for fostering research that is locally driven and carried out with an equity lens.