Working to enhance HIV care: integrating implementation science and improvement science for effective quality...

Healthcare systems struggle to balance the need for frontline problem-solving with the requirement for theory-driven strategies that ensure sustainable system-wide improvement. Implementation science, improvement science and quality improvement have emerged as complementary approaches to bridge gaps between evidence and practice, yet their integration remains limited. This scoping review examines how these disciplines intersect and can be applied to enhance HIV care delivery.

We conducted a scoping review of peer-reviewed articles published between 2016 and 2025. From an initial identification of 244 articles, 18 core studies were selected for snowball sampling, resulting in a pool of 113. After screening for accessibility and relevance, 30 studies were included in the final review that explicitly addressed overlaps between implementation science, improvement science and quality improvement. Data were charted on study objectives, methodologies, frameworks and relevance to healthcare improvement, and synthesised to identify common themes, models and barriers to integration.

The integration of these three disciplines creates a robust framework for health system change: implementation science emphasises fidelity and evidence-based uptake, improvement science prioritises generalisable knowledge and quality improvement enables rapid, local problem-solving. Their combined application can enhance the scalability, sustainability and efficiency of interventions. Models such as the HIV/AIDS Bureau Implementation Science Model, Reach-Effectiveness-Adoption-Implementation-Maintenance and the Learning Evaluation framework illustrate practical integration, showing how iterative quality improvement efforts can inform broader implementation strategies. Barriers include siloed approaches, variable terminology and limited organisational capacity, highlighting the need for cross-disciplinary collaboration, training and infrastructure support.

Integrating implementation science, improvement science and quality improvement provides a pathway to accelerate evidence translation, strengthen system-wide healthcare quality and improve patient-centred outcomes in HIV care. Synthesising shared principles and alignment opportunities offers actionable guidance for healthcare systems seeking to leverage the strengths of each discipline for more effective, scalable and sustainable care delivery.