Abstract
To improve health outcomes in people living with HIV, adoption of evidence-based interventions (EBIs) using effective and transferable implementation strategies to optimise the delivery of healthcare is needed. ViiV Healthcare’s Positive Pathways initiative was established to support the UNAIDS 90-90-90 goals. A compendium of EBIs was developed to address gaps within the HIV care continuum, yet it was unknown whether efforts existed to adapt and implement these EBIs across diverse clinical contexts. Therefore, this review sought to report on the use of implementation science in adapting HIV continuum of care EBIs. A systematic literature review was undertaken to summarise the evaluation of implementation and effectiveness outcomes, and report on the use of implementation science in HIV care. Ten databases were reviewed to identify studies (time-period: 2013–2018; geographic scope: United States, United Kingdom, France, Germany, Italy, Spain, Canada, Australia and Europe; English only publications). Studies were included if they reported on people living with HIV or those at risk of acquiring HIV and used interventions consistent with the EBIs. A broad range of study designs and methods were searched, including hybrid designs. Overall, 118 publications covering 225 interventions consistent with the EBIs were identified. These interventions were evaluated on implementation (N = 183), effectiveness (N = 81), or both outcomes (N = 39). High variability in the methodological approaches was observed. Implementation outcomes were frequently evaluated but use of theoretical frameworks was limited (N = 13). Evaluations undertaken to assess effectiveness were inconsistent, resulting in a range of measures. This review revealed extensive reporting on implementation science as defined using evaluation outcomes. However, high variability was observed in how implementation outcomes and effectiveness were defined, quantified, and reported. A more specific and consistent approach to conducting and reporting on implementation science in HIV could facilitate achievement of UNAIDS 90-90-90 targets.
Highlights
To accelerate progress toward ending acquired immunodeficiency syndrome (AIDS) as a public health threat by 2030, the Joint United Nations Program on HIV/AIDS (UNAIDS) established the 90-90-90 targets [1]. These ambitious targets aim to diagnose 90% of all people living with HIV (PLHIV), provide antiretroviral therapy (ART) for 90% of those diagnosed and achieve virological suppression in 90% of those treated with ART by 2020
Given the number of theoretical frameworks available to evaluate the implementation of evidence-based interventions (EBIs), we considered it most appropriate to focus on the taxonomy of implementation outcomes as defined by Proctor et al [23]
Regardless, the lack of consistency in labelling a study as implementation research and adhering to proper methodology and reporting in HIV studies in this review remains a large problem. This issue highlights the need for more capacity building in implementation science within HIV research. This systematic literature review provides an empirical review of implementation science approaches used to evaluate 12 EBIs in support of the HIV continuum
Summary
To accelerate progress toward ending acquired immunodeficiency syndrome (AIDS) as a public health threat by 2030, the Joint United Nations Program on HIV/AIDS (UNAIDS) established the 90-90-90 targets [1]. These ambitious targets aim to diagnose 90% of all people living with HIV (PLHIV), provide antiretroviral therapy (ART) for 90% of those diagnosed and achieve virological suppression in 90% of those treated with ART by 2020. PLHIV need to know their HIV-infection status, be linked and engaged in care, and receive and adhere to the prescribed ART regimen. As of 2017 only 47% of all PLHIV achieved virological suppression, which is far lower than the target of 73%, suggesting many regions are not on track to meet the 2020 target [1]
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