In this career development proposal, I aim to use implementation science strategies for evaluation of the integrated care continuum within a Getting to Zero (GTZ) Framework. GTZ frameworks propose expansion and scale-up of effective HIV treatment and prevention interventions such as pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP), with the goal of eliminating new HIV transmission events. GTZ initiatives are most commonly operationalized through integrated care continuums. The integrated care continuum describes HIV care and prevention steps for HIV positive and HIV negative, but susceptible, persons: both critical to ending HIV transmission. Many jurisdictions have undertaken systematic efforts to end HIV transmission through Getting to Zero initiatives. Challenges in implementation have occurred, with a primary one being monitoring, evaluating, and providing timely feedback for iterative improvements in the implementation strategy. In order to be efficient within constrained resources, GTZ efforts need to be systematically and routinely assessed to provide feedback for successful implementation ? a data-driven cornerstone of implementation science. Developing and organizing monitoring and evaluation systems has been recognized as a discrete implementation strategy. There is a clear need to develop rigorous methods of evaluation within an implementation science framework that can provide public health implementers of GTZ plans clear and contemporary feedback, and serve as a tool driving cyclical improvements in integrated care continuum outcomes. For this career development proposal, I will use the Exploration, Preparation, Implementation, and Sustainment (EPIS) model to explore adoption of a GTZ evaluation tool in Illinois in collaboration with public health partners. Therefore, this proposal will 1) use an implementation framework to examine capacity, readiness and feasibility of key stakeholders to adopt diverse data sources to evaluate GTZ HIV elimination efforts, 2) demonstrate the appropriateness and feasibility of candidate data sources in evaluating the integrated care continuum through a case example, and 3) develop tools for evaluation of the integrated care continuum through data monitoring and feedback. The knowledge from this proposal will fill important gaps in how to provide context-specific implementation support in the form of monitoring, feedback, and evaluation within multi-pronged jurisdictional programs for HIV elimination. The resulting knowledge has the potential to drive service improvements for elimination efforts both in Illinois and other jurisdictions. This K award will provide advanced training in implementation research, health services, and mixed methods that will build on my background in epidemiology and HIV prevention. I will bring my research experience together with that of my strong mentorship team to develop the skills necessary to become an independent investigator. These experiences will position me to become a leader in the field of HIV prevention and implementation.
This study has the potential to impact public health by improving the implementation and scale-up of effective HIV prevention and treatment interventions used in Getting to Zero initiatives for HIV elimination. It will do so through development of a monitoring, feedback, and evaluation tool, an implementation intervention to improve scale up and sustainability of Getting to Zero initiatives. This research addresses the priorities of the NIMH Division of AIDS Research to support implementation science research to enhance public health impact of effective interventions.
