Better Service by Doing Less: Introducing De-implementation Research in HIV
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IMPLEMENTATION SCIENCE (E GENG, SECTION EDITOR)
Better Service by Doing Less: Introducing De-implementation Research in HIV Virginia R. McKay 1 & Emmanuel K. Tetteh 1 & Miranda J. Reid 1 & Lucy M. Ingaiza 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The course of HIV research has led to a multitude of interventions to prevent and treat HIV. With the arrival of more effective interventions comes the need to end, or de-implement, less effective interventions. Purpose of Review To describe the state of de-implementation research in HIV and provide a rationale for expanded research in this area. Recent Findings Existing studies have identified a set of HIV-specific interventions appropriate for de-implementing and described the persistence of interventions that should be ended. However, to our knowledge, strategies to successfully promote appropriate de-implementation of HIV-specific interventions have not been examined. Summary De-implementing interventions that are no longer needed is an opportunity to improve the quality and effectiveness of HIV services. Opportunities to expand this field of research abound. Keywords HIV . De-implementation . De-adoption . Medical overuse . Public health
Introduction We are now embarking on our fifth decade of HIV research in the USA [1]. Long-term investment in science to prevent and treat HIV has led to the development of numerous interventions and services. The implementation of these services has subsequently led to reduced HIV incidence and improved quality of life for people living with HIV and AIDS. For instance, antiretroviral therapies (ARTs) to treat HIV have changed remarkably since approximately 1990, when ARTs were first introduced. People living with HIV were required to take a handful of drugs according to a complicated regimen with numerous, harmful side effects, leading to missed doses and poor adherence [2]. With the introduction of single-pill regimens with minimal side effects roughly a decade later, people began to take just one pill a day, improving adherence This article is part of the Topical Collection on Implementation Science * Virginia R. McKay [email protected] 1
The Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
and health outcomes [3]. Because improved treatment, the life expectancy for someone living with HIV has increased drastically from a few years to decades. Currently, an individual living with HIV, who is able to maintain adequate treatment, is more likely to die from a disease not related to their HIV [3]. ARTs are just one type of intervention in a multitude of interventions at the disposal of practitioners to prevent HIV, treat HIV and co-occurring conditions, and address factors that drive the HIV epidemic [4, 5•]. With continued improvement in intervention and scientific investigation comes a need to either end current interventions or treatment guidelines. De-implementation research is an emerging line of research within the field of dissemination and implementati
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