INCREASING THE ACCESSIBILITY AND RELEVANCE OF IMPLEMENTATION SCIENCE FOR FRONT-LINE IMPLEMENTERS.

Abstract

Background: Implementation science has been heralded as a critical strategy for ending the HIV epidemic (EHE), and the United States (US) has made a tremendous financial investment in implementation research. However, several dynamics in its development and organization may alienate front-line implementers and recapitulate some of the same missteps that have stymied past translational work.

Setting: Increasing the accessibility and relevance of HIV implementation science for front-line implementers (e.g., health department and health systems directors, clinic administrators, program managers, clinicians, and other providers) is critical.

Methods: We review current challenges to the meaningful inclusion of front-line implementers in implementation science research, and consider specific changes to language, frameworks, and methods that would maximize the accessibility and relevance of the field.

Results: Our analysis suggests the need for greater attention to implementation strategies most relevant to front-line implementers, i.e., those focused on intervention recipients. We propose a novel, multi-layer framework for conceptualizing the strategies necessary to achieve HIV implementation outcomes by organizations, providers, and recipients. There is a compelling rationale to adopt incentive structures that prioritize research questions most important for practice.

Conclusions: Maximizing the impact of implementation science on EHE goals requires: (a) expanding the focus of implementation science to include more recipient-focused implementation strategies; (b) developing and applying frameworks that better reflect the experience and needs of front-line implementers; (c) using language most relevant and applicable to practice, and (d) prioritizing actionable research questions that directly address the needs and concerns of those doing implementation work.