Implementation Science: A missing puzzle piece to ending the HIV epidemic?

With significant progress made in the fight against HIV, how do we make sure that clinically proven tools are implemented into real-world settings?

Smiley healthcare professional with stethoscope

After witnessing the dramatic, deadly rise of HIV in the 1980s, the idea of ending this epidemic may have seemed impossible to many. However, through incredible advancements made over the past 40 years, including biomedical breakthroughs in how we prevent and treat the virus, the goal of ending the epidemic is indeed possible. And yet, progress towards lowering HIV incidence is stalling, with around 1.7 million new individuals acquiring HIV in 2019.

Furthermore, of the 38 million people who are currently living with HIV worldwide, about 7.1 million are unaware of their status and over 15 million are not considered virally suppressed, creating the environment that allows this epidemic to continue to spread.1

We must now answer a difficult question. As asked by Dr. Anthony Fauci, Director of the National Institutes of Allergy and Infectious Diseases, “So why does this global pandemic continue to rage? It is not that we lack the medical advances and interventions to end the pandemic. It is that our proven tools have not been implemented adequately or uniformly.”

This is exactly the challenge that implementation science seeks to understand and address.

Getting under the skin of HIV implementation science

Implementation science focuses on improving the delivery of care in the often-complicated “real-world,” with the goal of identifying what works best, why it works, and how findings can be applied to improve lives.

Maggie Czarnogorksi, ViiV Healthcare’s Head of Implementation Science, explains the goals of implementation science

At the heart of implementation science is the recognition that there are fundamental differences between the way HIV care is delivered in a clinical trial or research setting compared to what happens in the real-world.

For example, a physician might be able to prescribe effective medicines available to treat HIV, but if a patient has difficulty getting transportation to and from a clinic or pharmacy, care and treatment become inaccessible. Unconventional working hours, child and family care demands, and the availability of services or resources can all act as barriers to the successful implementation of HIV treatment programmes.

By identifying and closing the gaps in actual, real-world practice that prevent the benefits of scientific innovation, we can make real progress in improving outcomes for people living with HIV. The reality is that customised approaches are needed. In moving from research settings to real-world environments, the delivery of healthcare is quickly met with the complexities of culture, economics, behavior, gender, social circumstances, and political environments that must be adequately considered.

An enduring commitment to implementation science

We believe implementation science is vital in addressing the challenges of delivering HIV care in real-world settings. As part of this commitment, Implementation Science studies led by ViiV Healthcare are ongoing globally to explore a variety of issues that include improving access to testing and clinical care, and also identifying ways to make it easier for people living with HIV to take their medicines regularly. We are collaborating with the broader HIV community to close the implementation gaps between evidence, policy and practice. We have also developed several initiatives, including Positive Pathways for HIV care, a programme intended to define best practices and interventions that can effectively close the gaps from HIV diagnosis to the successful treatment and management of HIV.

Man walking in the street

Notable examples of our pioneering Implementation Science programme, include, but are not limited to:

  • Improving access to care: A study partnership with the University of South Carolina to evaluate the benefits of ride-sharing services on improving access to care for people living with HIV. This study is a part of “Carolinas United to End HIV,” a cross-state collaboration between public health officials, clinical researchers, patients and patient advocacy groups in North Carolina and South Carolina to end the HIV epidemic.
  • Improving the delivery of HIV treatment: The first-ever implementation research studies in HIV treatments, CUSTOMIZE and CARISEL, explored how to integrate a long-acting treatment option into US and European healthcare practices.
  • Improving patient care: The PROgress study was designed to evaluate how the introduction of patient reported outcomes, or PROs, could improve communication between PLHIV and their healthcare providers using a short-pre-consultation tablet survey. Findings from the PROgress study showed that a short, pre-visit, electronic tablet survey improved healthcare provider awareness and ability to address hidden patient needs, behaviors and issues, including sensitive topics like mental health.

Through our support for implementation science, we are committed to solving real-world challenges to successful HIV prevention and treatment. Developing innovative healthcare solutions, smarter policies and practices will make an HIV-free future possible for the next generation.

Reference:

1. UNAIDS. Global HIV & AIDS statistics – 2020 fact sheet. Available at: https://www.unaids.org/en/resources/fact-sheet. Accessed January 2021.