Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
Curr HIV/AIDS Rep. 2024 Jun;21(3):152-167. doi: 10.1007/s11904-024-00693-1. Epub 2024 Mar 19.
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.
目的综述:尽管不断创新和联邦投资创造了针对 HIV 预防和护理连续体的数字干预措施,但这些干预措施并未在全美范围内大规模推广到目标人群。本文回顾了美国在实施数字 HIV 干预措施方面的情况,并提出了一种策略,以跨越这类干预措施的研究到实践的鸿沟。
最新发现:我们对美国开展的关于数字 HIV 干预措施实施情况的原始研究进行了叙述性综述,仅发现少数研究报告了实施的决定因素、策略、过程或结果,尤其是在有效性试验之外。为了补充文献,我们在 2023 年对 47 位代表 64 个独特干预措施的研究人员进行了调查,了解他们在研究试验后的实施经验。受访者高度重视干预措施的实施,但主要障碍包括缺乏资金和明确的实施模式、技术成本以及难以确定有能力提供数字干预措施的合作伙伴。他们认为实施的责任应由干预措施开发者、提供者(如诊所)和政府实体共同承担。如果存在实施中心,大多数受访者希望提供指导或技术援助,但主要希望减少参与度。有许多基于证据的有效数字干预措施可以用于 HIV 预防和护理。然而,在没有现实世界传播和实施的具体和可持续模式的情况下,它们仍然“束之高阁”。基于我们的发现,我们呼吁建立类似于其他卫生系统中的国家实施中心,以促进数字 HIV 干预措施的提供,并加速实现美国终结艾滋病流行的目标。
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