Abstract
BACKGROUND: Implementation science has been heralded as a critical strategy for ending the HIV epidemic, and the United States has made a tremendous financial investment in implementation research. However, several dynamics in its development and organization may alienate front-line implementers and recapitulate some of the same missteps that have stymied past translational work. SETTING: Increasing the accessibility and relevance of HIV implementation science for front-line implementers (eg, health department and health systems directors, clinic administrators, program managers, clinicians, and other providers) is critical. METHODS: We review current challenges to the meaningful inclusion of front-line implementers in implementation science research, and consider specific changes to language, frameworks, and methods that would maximize the accessibility and relevance of the field. RESULTS: Our analysis suggests the need for greater attention to implementation strategies most relevant to front-line implementers, that is, those focused on intervention recipients. We propose a novel, multilayer framework for conceptualizing the strategies necessary to achieve HIV implementation outcomes by organizations, providers, and recipients. There is a compelling rationale to adopt incentive structures that prioritize research questions most important for practice. CONCLUSIONS: Maximizing the impact of implementation science on ending the HIV epidemic goals requires (1) expanding the focus of implementation science to include more recipient-focused implementation strategies, (2) developing and applying frameworks that better reflect the experience and needs of front-line implementers, (3) using language most relevant and applicable to practice, and (4) prioritizing actionable research questions that directly address the needs and concerns of those doing implementation work.