Human immunodeficiency virus (HIV) targets the immune system and can lead to acquired immunodeficiency syndrome (AIDS) if left untreated. In the U.S., approximately 1.2 million people live with HIV and about 13% of those who are HIV-infected do not know their status. Although decades of research have made HIV infection both preventable and treatable, HIV continues to disproportionately affect populations that often face challenges to prevention, testing, treatment, and care.
Today, people at risk of HIV acquisition can use daily or long-acting medicines to help prevent infection. For people living with HIV, both daily and long-acting treatment options can help them live long, healthy lives, and can reduce the levels of virus in the body to undetectable levels, which eliminates the risk of sexual transmission of the virus (Undetectable = Untransmittable (U=U)) to their sexual partners.
The Need for HIV Implementation Research
Despite critical advances in HIV testing, prevention, treatment, and care, the existing tools are not reaching all communities equally, particularly the populations that need them the most. Persistent challenges such as limited access, stigma, discrimination, cost, fragmented care, and gaps in awareness and health care delivery continue to drive preventable HIV infections as well as HIV coinfections and comorbidities.
NIAID is continuing to prioritize HIV implementation science to identify the most effective ways to reduce these challenges and improve access to evidence-based HIV testing, prevention, treatment, and care strategies. Moving forward, NIAID is focusing on three core priorities through strategic implementation research investments:
Strengthen the HIV implementation science field by providing researchers with improved resources, support, training, and collaboration opportunities.
NIAID programs accelerate HIV implementation science by expanding workforce capacity and fostering scientific collaborations. The Centers for AIDS Research (CFARs) provide shared expertise, resources, and services to affiliated investigators across multidisciplinary research areas, including implementation science. The CFARs were integral in launching the Department of Health and Human Services Ending the HIV Epidemic (EHE) initiative.
NIAID also supports training and career development awards to promote the professional development of early-career HIV researchers and has co-sponsored the highlighted topic for Training and Career Development in Dissemination and Implementation Science to encourage applications in this field.
Further, NIAID also established innovative capacity-building infrastructure through the Coordinating Hub to Enhance the Science of HIV Implementation Research (CHESHIRE) network. This network includes a national coordinating center and regional implementation science hubs that provide consultation, training, methodological expertise, and cross-project learning opportunities, with the goal of rapidly accelerating implementation knowledge to end the HIV epidemic in the U.S. These resources are available to all extramural researchers working on domestic-focused HIV implementation research projects.
Engage with communities to study and improve HIV programs so that they have lasting, positive impacts on public health.
NIAID has made sustained investments in community-partnered HIV research, building crucial collaborations with community organizations, health departments, healthcare systems, and people living with or at risk for HIV. These partnerships are essential for translating scientific advances into real-world impact. Since 2019, these efforts have been bolstered through the EHE initiative. You can read more about the impact of NIH-supported EHE projects at NIAID News.
NIAID also supports several large cohort studies that partner with communities in the U.S. and globally to collect observational data representing people living with and at-risk for HIV. Investigators leverage these data to address a broad range of research questions, including those associated with implementation science. These include:
Leverage NIAID’s existing HIV research and clinical trials networks to help HIV advances move more quickly from research into public use.
The NIAID HIV/AIDS Clinical Trials Networks (CTNs) provide research and infrastructure resources to support coordinated, multidisciplinary efforts to advance HIV research. These networks provide a platform for integrating implementation research objectives into clinical trials for emerging interventions. The CTNs conduct large-scale implementation science studies, such as the HIV Prevention Treatment Network (HPTN) study entitled, “Getting to Zero Among Highest HIV Incidence (HHI) Men Who Have Sex with Men (MSM) in the American South: Testing an Integrated Strategy”. NIAID is planning to move forward with the CTNs in future fiscal years, which will include an increased focus on implementation research.
Resources – Research focused on implementation science helps scientists and public health partners improve delivery of effective HIV prevention, treatment, and care tools. Current efforts expand implementation science resources, strengthen coordination and sharing of findings, and support training for the next generation of researchers.
Community Engagement – Research focused on community-partnered implementation helps scientists and public health partners better understand how to strengthen HIV programs in real-world settings. Current efforts build on the Ending the HIV Epidemic initiative and related programs to support lasting improvements to public health.
Existing Programs – NIAID is using existing HIV programs, networks, and infrastructure to launch and scale up implementation science studies. These efforts help accelerate the adoption of emerging innovations such as novel prevention and treatment approaches, vaccine and immune-based strategies, and HIV cure science, into real-world use.
Implementation Research in Action
Implementation science asks how effective health tools can reach more people in everyday settings. In a recent NIAID-supported study, researchers tested a community-based HIV strategy in rural Kenya and Uganda that brought testing, prevention, and treatment services to the people who need them.
The Challenge: Highly effective HIV prevention and treatment tools exist, but healthcare providers often struggle to reach, engage, and retain people who most need HIV prevention and care.
The Approach: NIH-supported research tested a community-based strategy in rural Kenya and Uganda that paired home HIV testing, tailored prevention and care, and digital tools connecting community health workers with clinicians and health centers.
The Impact: The intervention reduced new HIV cases by 70% and increased use of HIV prevention tools four-fold, showing how implementation research can help existing tools reach more people and inform strategies to reduce HIV in other settings, including the United States.
Read more about the study through NIH News Releases.
Funding Opportunities
Researchers are welcome to submit unsolicited investigator-initiated grant applications on topics relevant to implementation science that are within the NIAID mission. Additionally, researchers can respond to specific Notices of Funding Opportunities and Highlighted Topics issued or supported by NIAID, such as:
- Implementation Science to End the HIV Epidemic (Forecast)
- Dissemination and Implementation Research in Health (R01 Clinical Trial Optional)
- Dissemination and Implementation Research in Health (R21 Clinical Trial Optional)
- Implementation Science to Optimize HIV Prevention and Treatment (Highlighted topic)