Use of implementation theories, models, and frameworks in PrEP implementation research from 2022-2025: innovation and...

Use of implementation theories, models, and frameworks (TMFs) in HIV research is growing substantially, yet their impact may be limited by superficial application and poor alignment with community needs. This review highlights recent examples of TMF use in pre-exposure prophylaxis (PrEP) implementation studies and discusses how to increase their accessibility and utility for more equitable implementation.

Studies from 2022-2025 ( n  = 26) demonstrate more sophisticated TMF use, often layering frameworks and integrating participatory approaches and co-creation. Key themes include treating TMFs as boundary objects to facilitate partner dialogue, grounding theory in lived experience, and developing specific program theories.

TMFs can support equitable PrEP implementation when applied flexibly and in partnership with communities. Researchers and practitioners can use TMFs as adaptable tools for dialogue and as the basis for further co-creation. Structured, participatory methods that help co-adapt frameworks and develop context-specific theories of change are crucial for translating assessment into effective, actionable strategies and improving HIV prevention outcomes.