"Your Package Could Not Be Delivered": The State of Digital HIV Intervention Implementation in the US

Abstract

Purpose of review: Despite continuous innovations and federal investment to create digital interventions addressing the HIV prevention and care continua, these interventions have not reached people in the U.S. at scale. This article reviews what is known about U.S. implementation of digital HIV interventions and presents a strategy to cross the research-to-practice chasm for these types of interventions.

Recent findings: We conducted a narrative review of U.S.-based original research on implementation of digital HIV interventions and identified few studies reporting on implementation determinants, strategies, processes, or outcomes, particularly outside the context of effectiveness trials. To supplement the literature, in 2023, we surveyed 47 investigators representing 64 unique interventions about their experiences with implementation after their research trials. Respondents placed high importance on intervention implementation, but major barriers included lack of funding and clear implementation models, technology costs, and difficulty identifying partners equipped to deliver digital interventions. They felt that responsibility for implementation should be shared between intervention developers, deliverers (e.g., clinics), and a government entity. If an implementation center were to exist, most respondents wanted to be available for guidance or technical assistance but largely wanted less involvement. Numerous evidence-based, effective digital interventions exist to address HIV prevention and care. However, they remain "on the shelf" absent a concrete and sustainable model for real-world dissemination and implementation. Based on our findings, we call for the creation of national implementation centers, analogous to those in other health systems, to facilitate digital HIV intervention delivery and accelerate progress toward ending the U.S. epidemic.

Keywords: Digital intervention; Dissemination; HIV care; HIV prevention; Implementation; Intervention technology; eHealth; mHealth.

Figure 1.. Current and potential future states of digital HIV intervention implementation in the US.

In the current state (A), preparing evidence-based digital HIV interventions for implementation is a long and arduous path for research teams (trucks) that is fraught with challenges (explosions). Even overcoming those, researchers have no way to get the interventions to deliverers (workers) and recipients (people) because of insurmountable barriers related to lack of funding, infrastructure, and implementation support (water). In a proposed future state (B), a national infrastructure comprising technological infrastructure and coordination, implementation funding, and deliverer-centered implementation strategies (bridge) supports both researchers and deliverers in implementation. Implementation science also helps shorten the route from intervention science to implementation.