Golub Sarit A, Wolfer Carly, Chastain Cody A
Department of Psychology, Hunter College of the City University of New York, New York, NY.
Department of Psychology, Basic and Applied Social Psychology PhD Program, Graduate Center of the City University of New York, New York, NY.
J Acquir Immune Defic Syndr. 2025 Apr 1;98(4):372-376. doi: 10.1097/QAI.0000000000003580. Epub 2025 Feb 19.
Implementation science has been heralded as a critical strategy for ending the HIV epidemic, and the United States 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.
Increasing the accessibility and relevance of HIV implementation science for front-line implementers (eg, health department and health systems directors, clinic administrators, program managers, clinicians, and other providers) is critical.
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.
Our analysis suggests the need for greater attention to implementation strategies most relevant to front-line implementers, that is, those focused on intervention recipients. We propose a novel, multilayer 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.
Maximizing the impact of implementation science on ending the HIV epidemic goals requires (1) expanding the focus of implementation science to include more recipient-focused implementation strategies, (2) developing and applying frameworks that better reflect the experience and needs of front-line implementers, (3) using language most relevant and applicable to practice, and (4) prioritizing actionable research questions that directly address the needs and concerns of those doing implementation work.
实施科学被誉为终结艾滋病流行的关键策略，美国已在实施研究方面投入了巨额资金。然而，其发展和组织过程中的一些动态因素可能会使一线实施者疏离，并重现一些阻碍以往转化工作的失误。
提高艾滋病实施科学对一线实施者（如卫生部门和卫生系统负责人、诊所管理人员、项目经理、临床医生及其他提供者）的可及性和相关性至关重要。
我们审视了一线实施者有意义地纳入实施科学研究当前面临的挑战，并考虑对语言、框架和方法进行具体变革，以最大限度地提高该领域的可及性和相关性。
我们的分析表明，需要更加关注与一线实施者最相关的实施策略，即那些关注干预接受者的策略。我们提出了一个新颖的多层次框架，用于概念化组织、提供者和接受者实现艾滋病实施成果所需的策略。采用优先考虑对实践最重要的研究问题的激励结构有令人信服的理由。
要使实施科学对终结艾滋病流行目标产生最大影响，需要（1）扩大实施科学的重点，纳入更多以接受者为重点的实施策略；（2）开发并应用能更好反映一线实施者经验和需求的框架；（3）使用与实践最相关和适用的语言；（4）优先考虑直接解决实施工作者需求和关切的可操作研究问题。
