Implementation Science

Too often, there are gaps between research and practice -- research is conducted in controlled settings without engaging with dynamics of real-world implementation, and practitioners lack access to research tools and findings that are useful in their work. At HART, our projects try to bridge these gaps, conducting research within community settings, designing evaluations that operationalize intervention components, and developing frameworks for using research findings in day-to-day practice. Our implementation science projects are conducted in collaboration with community partners at every step of the research process -- from conceptualization of research questions to development of measures and data collection protocols to analysis and dissemination.

Funded Research Projects

Partnership to increase Access, Client-Centered Care, and Equity in HIV Services (Project PACE)
Funded by the Centers for Disease Control & Prevention (CDC) | U01PS005239 (Sarit Golub, PI)
September 2022- August 2027

Project PACE is a collaboration with the New York City Health Department (NYC HD) to understand and evaluate a new approach to funding and evaluating their HIV prevention contracts — Quality-Based Financing (QBF). Under the NYC QBF model, quality is defined and operationalized in terms of availability, accessibility and equity, and funded agencies are evaluated (and paid) based on their ability to meet specific process, experience, and outcomes indicators. As a complement to our analysis of the GOALS Approach as a agency-level implementation strategy (see project description under the Gender & Sexuality tab), this component of Project PACE uses an interrupted time series (ITS) analysis to evaluate the impact of implementing the QBF model on implementation outcomes, service outcomes, and patient outcomes across NYC. In addition, we will conducting Rapid Assessment Procedure-Informed Clinical Ethnography Method (RAPICE) site visits to qualitatively explore factors that potentially explain differences in successful implementation of QBF across funded agencies. Secondary analyses will measure model fidelity and monitor QBF implementation at the agency- and health department-levels, and will identify factors significantly associated with differential effectiveness of the QBF model.

Building, Learning, and Understanding Prevention Interventions for HIV (BLUPrInt)
Funded by the National Institutes of Health (NIMH) | R01MH123262 (Sarit Golub & Kathrine Meyers, MPI)
April 2020 - February 2025

BLUPrInt is an NIMH-funded implementation science project designed to synthesize lessons from HIV prevention programs and models, and develop data-driven tools and resources that can accelerate equitable diffusion of proven prevention strategies. BLUPrInt is based on the scientific premise that systems-level behavior determines successful implementation of innovation, and that clinical settings and jurisdictions need implementation tools to support the introduction of new interventions. Our goal is to support the development of a “biobehavioral infrastructure” –knowledge, guidelines, tools, and collaborative practice – that will ensure that emerging HIV prevention options and modalities expand HIV prevention coverage and increase health equity.

Fast Track: Improving Prevention Systems to Reduce Disparities for High Priority Populations
Funded by the National Institutes of Health (NIMH) | R01MH115835 (Sarit Golub, PI)
May 2018 - January 2023

Fast Track is a collaboration with the New York City Health Department ACE (HIV partner services) Team to develop new strategies for reaching individuals who have been exposed to HIV and are in need of testing and care. We have developed and piloted two strategies for expanding partner services to include more comprehensive sexual health care: a field-based model that includes self-testing for STIs and a video tele-health visit and a phone-based model that includes expedited assessment, referral, and PrEP benefits navigation. Fast Track is also developing novel strategies for engaging partner services clients and increasing their motivation and self-efficacy in the context of sexual health care.

READY: Preparing for Implementation of Sustained Release Antivirals for HIV Prevention (COMPLETED)
Funded by the National Institutes of Health (NIMH) | R01MH105268 (Sarit Golub, PI)
January 2015 - November 2019

This project was designed to identify relevant healthcare system delivery factors, provider dynamics, and patient preferences that might inform optimal delivery of long-acting ARV formulations for HIV prevention (LAI PrEP), and develop specific recommendations for provider education, clinical guidance, and strategies for optimizing delivery of LAI PrEP to highest priority populations. Over the course of the project, we collected data on over 700 participants, including LAI clinical trial participants (n = 30), PrEP demonstration project participants (n = 156), LGBTQIA+ youth (n =356), oral PrEP users (n = 147) and providers serving adults and adolescents in need of HIV prevention services (n = 46). We published twelve papers focusing on different categories of recommendations, including: clinic-level strategies for mitigating structural stigma in PrEP implementation (Price et al., 2022); predictors of patient preferences for long-acting (Meyers et al., 2018) and event driven modalities (Carneiro et al., 2021); recommendations from LGBTQIA+ youth regarding engagement in biomedical HIV prevention (Golub et al., 2020), and analyses of PrEP retention (Golub & Enemchukwu, 2018) and discontinuation (Unger et al., 2022).

Impact Spotlights — how our research is making a difference

translating research into practice

As part of our BLUPrInt project (see summary above), we have created a website designed to synthesize and disseminate existing research knowledge about PrEP implementation for application in practice settings. Our PrEP Program builder includes guideline, checklists, standard operating procedures (SOPs), training manuals and educational materials that clinical settings can download and tailor to their specific setting and needs.

Three of our most popular resources (pictured at the left) are the Planning Roadmap, which provides clinics with a checklist of recommended activities to introduce or enhance PrEP delivery, Visit Flow and Staffing Models, which provide samples that clinics can adapt to determine the division of labor in their PrEP program, and the PrEP Patient Tracker and Manual, which is an excel data entry form and database that provides clinics with a free and adaptable tool to support PrEP navigators.

In addition to dissemination of the data that informed the development of these tools within the scientific community, our research team is committed to community-focused dissemination. We led a workshop for service providers, clinic administrators, and local health departments at the 2022 Biomedical HIV Prevention Summit, and we conducted a four-session workshop series for community-health centers in May 2022, in collaboration with the National Association of Community Health Centers.

Selected Publications in implementation Science

Golub, S.A. & Fikslin, R.A. (2022). Recognizing and disrupting stigma in implementation of HIV prevention and care: a call to research and action. Journal of the International AIDS Society 25(S1), 119-126.

Price, D. M., Unger, Z., Wu, Y., Meyers, K., & Golub, S. A. (2022). Clinic-Level Strategies for Mitigating Structural and Interpersonal HIV Pre-Exposure Prophylaxis Stigma. AIDS Patient Care and STDs, 36(3), 115-122.

Unger, Z. D., Golub, S. A., Borges, C., Edelstein, Z. R., Hedberg, T., & Myers, J. (2022). Reasons for PrEP Discontinuation Following Navigation at Sexual Health Clinics: Interactions among Systemic Barriers, Behavioral Relevance, and Medication Concerns. Journal of Acquired Immune Deficiency Syndromes, 90(3):316-324

Carneiro, P. B., Rincon, C., & Golub, S. (2021). Predictors of Event-Driven Regimen Choice in Current PrEP Users and Sexual Behavior Characteristics of MSM Receiving Sexual Health Services in New York City. AIDS and Behavior, 25(8):2410-2418.

Meyers, K., Price, D., & Golub, S.A. (2020). Behavioral and social science research to support accelerated and equitable implementation of long-acting preexposure prophylaxis. Current Opinion in HIV and AIDS 15(1): 66-72.

Golub, S. A., Meyers, K., & Enemchukwu, C. (2020). Perspectives and Recommendations From Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning Youth of Color Regarding Engagement in Biomedical HIV Prevention. Journal of Adolescent Health, 66(3), 281-287.

Golub, S.A. & Myers, J.E. (2019). Next wave HIV pre-exposure prophylaxis (PrEP) implementation for gay and bisexual men. AIDS Patient Care and STDs, 33(6), 253-261.

Golub, S. A., & Enemchukwu, C. U. (2018). The critical importance of retention in HIV prevention. The Lancet HIV. https://doi.org/10.1016/S2352-3018(18)30130-9

Meyers, K., Wu, Y., Brill, A., Sandfort, T., & Golub, S. A. (2018). To switch or not to switch: Intentions to switch to injectable PrEP among gay and bisexual men with at least twelve months oral PrEP experience. PloS one, 13(7), e0200296.