NIH Investment in HIV and Implementation Science

Research supported by the National Institutes of Health (NIH) has revolutionized HIV prevention and treatment, but not all people have benefited from these advancements. Implementation science seeks to bridge the gap between a discovery and when it is applied in the real world, by elucidating the methods that promote the adoption, uptake and integration of evidence-based strategies into routine care. Disparities in who benefits from the advancements have prompted calls to accelerate HIV implementation science. This paper provides a snapshot of research funded by the NIH at the intersection of HIV and implementation science.

The NIH Office of AIDS Research conducted portfolio analyses using the Information for Management Planning Analysis and Coordination (IMPAC II) database; the Research, Condition, and Disease Categorization (RCDC) system; and manual coding to describe select award characteristics. We examined awards coded as both RCDC categories HIV and Dissemination and Implementation Research (D&IR) from fiscal years (FY) 2021-2024, followed by more detailed analyses of awards made in FY2024.

NIH invested USD 697 million in 1569 awards at the intersection of HIV and D&IR from FY2021-2024. During this period, funding for D&IR and HIV increased by 65%. In FY24 alone, 407 awards were made in D&IR and HIV, representing 7% of the total NIH HIV budget appropriated by Congress. Led by the National Institute of Mental Health, support for D&IR in HIV was represented by 15 NIH institutes, centres and offices. Among a subset of 226 FY24 awards consisting of R-mechanisms, studies spanned the HIV prevention and treatment cascade and focused on multiple age groups. Forty-one percent of the awards included hybrid effectiveness-implementation designs, and the Consolidated Framework for Implementation Research (CFIR) was the most frequently cited framework (n = 82; 37%). Over 93% of awards employed both quantitative and qualitative methods.

The NIH investment in HIV-related implementation science is growing, but it made up a small portion (7%) of the total HIV budget in FY24. Challenges characterizing awards on key implementation science factors underscore opportunities to strengthen the science. These data support NIH's commitment to accelerate implementation research to end HIV and ensure its full public health benefit.