Surveying the Literature on Implementation Determinants and Strategies for HIV Structural Interventions: A Systematic Review Protocol.

BACKGROUND

Despite improvements in HIV prevention, treatment, and surveillance, vast disparities remain in access, uptake, and adherence of evidence-based interventions. These disparities are most pronounced among racially, sexually, and gender minoritized populations, as well as among those living in poverty and/or who use injectable drugs. Structural interventions, or interventions that target social and structural determinants of health like housing, transportation, or income, are needed to increase access to, use of, and adherence to HIV EBIs to advance the aims of the national Ending the HIV Epidemic initiative. However, it is unclear to what extent barriers and facilitators of structural interventions have been identified in the U.S. and what implementation strategies and adjunctive interventions have been developed to enhance their delivery.

METHODS

To identify what implementation determinants, implementation strategies, and adjunctive interventions have been identified for HIV structural interventions, we carried out a broad database search between May and July 2024, identifying a total of 8,098 articles. We will use a multi-step process to identify articles to include in the systematic review. We will use natural language processing to identify articles for exclusion, followed by manual text review and extraction using COVIDENCE software. Literature on determinants will be coded according to the Consolidated Framework for Implementation Research. Implementation strategies and adjunctive interventions will be coded according to the Expert Recommendations for Implementing Change, the Theoretical Domains Framework, and COM-B. We will descriptively analyze determinants, implementation strategies, and adjunctive interventions, use natural language processing for thematic analysis of determinants, implementation strategies, and adjunctive interventions, and provide narrative description of implementation strategies and adjunctive interventions.

DISCUSSION

This systematic review will identify key barriers and facilitators for HIV structural intervention implementation strategies, including multi-level approaches to address disparities among marginalized populations. Findings will provide insights for advancing equitable, scalable interventions to support the goals of the Ending the HIV Epidemic initiative.

SYSTEMATIC REVIEW REGISTRATION

CRD42024554315.