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Published in final edited form as: J Acquir Immune Defic Syndr. 2025 Apr 15;98(5 Suppl):e17–e27. doi: 10.1097/QAI.0000000000003628 Search in PMC Search in PubMed View in NLM Catalog Add to search Building the Road to End the HIV Epidemic through C oordinating and Capacity-building H ubs to E nhance the S cience of H IV I mplementation RE search (CHESHIRE): Reflections and Directions Debbie L Humphries Debbie L Humphries 1 Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT Find articles by Debbie L Humphries 1, *, ** , Carolyn M Audet Carolyn M Audet 2 Vanderbilt University Medical Center, Nashville, TN Find articles by Carolyn M Audet 2 , Bijal A Balasubramanian Bijal A Balasubramanian 3 Department of Epidemiology, The University of Texas Health Science Center at Houston School of Public Health; UTHealth Houston Institute for Implementation Science, Houston, TX Find articles by Bijal A Balasubramanian 3 , Nanette Benbow Nanette Benbow 4 Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL Find articles by Nanette Benbow 4 , Christopher G Kemp Christopher G Kemp 5 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Find articles by Christopher G Kemp 5 , Robin Gaines Lanzi Robin Gaines Lanzi 6 University of Alabama at Birmingham, Birmingham, AL Find articles by Robin Gaines Lanzi 6 , Sung-Jae Lee Sung-Jae Lee 7 Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, and Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA Find articles by Sung-Jae Lee 7 , Hannah Mestel Hannah Mestel 1 Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT Find articles by Hannah Mestel 1 , Alexandra B Morshed Alexandra B Morshed 9 Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA Find articles by Alexandra B Morshed 9 , Brian Mustanski Brian Mustanski 4 Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL Find articles by Brian Mustanski 4 , April Pettit April Pettit 11 Vanderbilt University Medical Center, Nashville, TN Find articles by April Pettit 11 , Borsika A Rabin Borsika A Rabin 12 Herbert Wertheim School of Public Health and Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA Find articles by Borsika A Rabin 12 , Olivia Sadler Olivia Sadler 13 Center for AIDS Research, Emory University, Atlanta, GA Find articles by Olivia Sadler 13 , Alison B Hamilton Alison B Hamilton 7 Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, and Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA Find articles by Alison B Hamilton 7 , Meryl E Millett Meryl E Millett 15 Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX; UTHealth Houston Institute for Implementation Science, Houston, TX Find articles by Meryl E Millett 15 , Sheree Schwartz Sheree Schwartz 16 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Find articles by Sheree Schwartz 16 , Kenneth Sherr Kenneth Sherr 17 Department of Global Health, University of Washington, Seattle, WA Find articles by Kenneth Sherr 17 , Nicole A Stadnick Nicole A Stadnick 18 Department of Psychiatry, Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, Child and Adolescent Services Research Center, La Jolla, CA Find articles by Nicole A Stadnick 18 , Dennis H Li Dennis H Li 4 Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL Find articles by Dennis H Li 4 Author information Copyright and License information 1 Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT 2 Vanderbilt University Medical Center, Nashville, TN 3 Department of Epidemiology, The University of Texas Health Science Center at Houston School of Public Health; UTHealth Houston Institute for Implementation Science, Houston, TX 4 Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL 5 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 6 University of Alabama at Birmingham, Birmingham, AL 7 Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, and Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 9 Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 11 Vanderbilt University Medical Center, Nashville, TN 12 Herbert Wertheim School of Public Health and Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA 13 Center for AIDS Research, Emory University, Atlanta, GA 15 Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX; UTHealth Houston Institute for Implementation Science, Houston, TX 16 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 17 Department of Global Health, University of Washington, Seattle, WA 18 Department of Psychiatry, Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, Child and Adolescent Services Research Center, La Jolla, CA ** Authors are in alphabetical order except for the first and last authors. * Address correspondence to Debbie Humphries at [email protected] . PMC Copyright notice PMCID: PMC12998397 NIHMSID: NIHMS2149796 PMID: 40163052 The publisher's version of this article is available at J Acquir Immune Defic Syndr This article has been corrected. See J Acquir Immune Defic Syndr. 2025 Apr 18 . Abstract Background: Because implementation remains the biggest challenge to Ending the HIV Epidemic (EHE) in the US, since 2019, the National Institutes of Health (NIH) has funded 248 supplements to identify best practices for delivering evidence-based HIV interventions. NIH also funded a coordination center (Implementation Science Coordination Initiative, “ISCI”) and nine IS consultation hubs (“Hubs”) to provide technical assistance and cross-project information sharing, measures harmonization, and data synthesis. This article describes this unique capacity-building model, lessons learned from the first 5 years, and opportunities created by this infrastructure. Methods: Beginning in FY20, Hubs were assigned 7–9 funded supplement projects each year in EHE priority jurisdictions. Primary Hub services included direct coaching, multi-project meetings, communities of practice, and technical webinars. ISCI and the Hubs met monthly to reflect on project support, discuss ways to enhance HIV IS broadly, and assess projects’ use of Hub services. Findings: Hub engagement strategies included grouping projects by HIV intervention type, setting data reporting expectations early, and tailoring engagement based on EHE team IS expertise. Capacity-building and coordination provided by the Hubs and ISCI have developed generalizable IS knowledge from local knowledge (e.g., publications, tools). The network of ISCI, the Hubs, and EHE projects have also led to infrastructure for conducting multisite HIV implementation research. Implications for D&I Science: The Hub model is a novel, system-wide approach for rapidly improving IS capacity in a field. Implementation of this model will continue to be refined through an ongoing evaluation and as the funding transitions to regular, non-supplement NIH funding mechanisms. Keywords: capacity-building, implementation science, network, Ending the HIV Epidemic Introduction In 2019, agencies and offices in the US Department of Health and Human Services (HHS) aligned themselves under the Ending the HIV Epidemic in the US (EHE) initiative, a whole-of-government approach to scaling up and scaling out critical scientific advances and evidence-based innovations in HIV prevention, diagnosis, treatment, and outbreak response, such as pre-exposure prophylaxis, HIV self-testing, syringe services programs, models of effective care, and new epidemiological techniques. The EHE plan set ambitious goals to reduce new HIV infections by 75% by 2025, focusing on 57 priority geographic areas, and by at least 90% by 2030. As the nation’s medical research agency, the National Institutes of Health’s (NIH) role has been to shepherd research to study optimal implementation of these evidence-based HIV practices, informing other HHS partners on the best strategies for delivery. Implementation science (IS) is the scientific study of strategies to promote adoption and integration of evidence-based interventions (EBIs) into routine healthcare and public health settings. 1 IS offers theoretical frameworks and methods by which to identify and evaluate implementation strategies and is thus a critical component of EHE. At the start of the initiative, however, very little rigorous HIV implementation research had been conducted in the US. 2 IS expertise among domestic HIV researchers was limited. 3 In response, NIH infused the field with substantial resources for not only individual implementation research projects but also IS technical assistance and capacity-building Hubs. 4 , 5 Previous capacity-building efforts such as the Consultative Group on International Agricultural Research 6 – 8 and the NIH’s emerging Community Partnerships to Advance Science for Society (ComPASS) Initiative 9 (REF) have utilized hub-based models. Specific strategies recommended by these initiatives included identifying priority outcomes, increasing the quality of evaluation of capacity-building initiatives, 10 incorporating strong technical assistance and networking opportunities, 11 and planning for sustainability from the beginning of the initiative. 6 From 2019–2023, NIH rapidly funded 248 1–2-year supplements 12 through the networks of the National Institute for Allergy and Infectious Disease Centers for AIDS Research (CFARs) and the National Institute of Mental Health AIDS Research Centers (ARCs). Because implementation research cannot be conducted without the involvement of implementers, NIH required that these supplements engage community and health system partners in the research. Additionally, they funded the Implementation Science Coordination Initiative (ISCI) as a Coordination, Consultation, and Data Management Center (CCDMC) and subsequently nine Regional Consultation Hubs 13 to support rigorous IS among the 248 supplements. As ISCI and the Hubs collaboratively piloted and refined different ways to support projects, we coalesced into the C oordinating and Capacity-building H ubs to E nhance the S cience of H IV I mplementation RE search (CHESHIRE) network. With five years of EHE behind us and the midway point upon us, it is important to review our accomplishments and assess our trajectory toward helping to achieve the 2025 and 2030 EHE goals. The goals of this commentary were thus to describe the evolution of CHESHIRE into the current model; report on early outcome indicators of the network; reflect on lessons learned to inform future directions and/or replication in other health domains; and present ongoing plans for a more formal evaluation of network impacts on distal outcomes for researchers, the field of IS, and EHE jurisdictions. Methods Led by authors DLH and DHL, representatives from each Hub and ISCI (i.e., the co-authors) reflected asynchronously on how the structure and activities of the network have evolved over the initial five years of funding, partially in response to changes in the NIH’s requests for applications (RFAs) for IS Hubs and projects. We identified the theory of change for the network, implementation strategies underlying the approaches of the Hubs and the whole network, and evaluation efforts to date. We also identified lessons learned, key areas for continued research, and anticipated future challenges and opportunities. Evolution of CHESHIRE. Table 1 depicts the evolution of CHESHIRE, the formation of which has been described previously. 13 A precursor to the network, an Inter-CFAR IS Working Group formed in 2018 in response to growing interest in IS and hosted a workshop for HIV researchers. With the launch of EHE in 2019 and the funding of 65 one-year planning projects, ISCI was funded to support high-quality IS in these projects through technical assistance and to create opportunities for generalizable knowledge through data harmonization and synthesis. The IS Summit that brought all 65 projects and their community partners together was an expansion of the 2018 workshop and would eventually become the National EHE Meeting. The following year (2020), five IS Consultation Hubs were funded to provide more individualized mentoring and support to projects. To coordinate amongst the independently funded groups, ISCI and the Hubs established the Executive Committee. The subsequent four years saw the piloting of a multisite research study among ISCI and the Hubs and the funding of four additional Hubs and 248 total supplement projects. Most recently, NIH shifted away from the CFAR/ARC administrative supplement funding mechanism to traditional R mechanisms, including a coordinating center and hubs of the CHESHIRE network via an R24. 14 Table 1. Timeline of CHESHIRE and NIH/EHE Milestones 2018 2019 2020 2021 2022 2023 2024 Milestones Formation of Inter-CFAR IS Working Group IS Coordination Initiative (ISCI) begins 1st year of HIV & IS Fellowship Formation of ISCI–Hub Executive Committee NOSI to fund R01s 1st ISCI–Hub multisite pilot NOSI to fund R21s, R34s, and R01s NOSI to fund R24 Events HIV IS Workshop: Catalyzing HIV IS through Methodological Innovation and Multi-Sector Partnerships IS Summit with EHE supplement projects and their community partners 1st National EHE Meeting 2nd National EHE Meeting 3rd National EHE Meeting Number of funded EHE projects N/A 65 34 36 66 47 To be determined Status of Hub funding N/A 1st year of funding for the IS Coordination Initiative (ISCI) 1st year funding for 5 IS Hubs 2nd year funding for ISCI 2nd year funding for 5 IS Hubs 3rd year funding for ISCI 1st year funding for 4 additional IS Hubs 3rd year funding for 5 IS Hubs 4th year funding for ISCI 2nd year funding for 4 IS Hubs 4th year funding for 4 IS Hubs 5th year funding for ISCI 3rd year funding for 4 IS Hubs 5th year funding for 4 IS Hubs 6th year funding for ISCI Process for grouping projects assigned to Hubs N/A N/A Hubs ranked preferences for individual projects and vice versa. Groupings made based on rankings. Projects grouped by similar strategies Most projects grouped by RFA-designated categories, the remainder by similar strategies Created formal communities of practice by topic/ population/ context To be determined Open in a new tab Changes in Funding Mechanism. The first RFA for IS Hubs identified seven key requirements for the Hubs ( Table 2a ). Those requirements remained the same until the funding opportunity was changed from a CFAR/ARC supplement to the R24 mechanism in 2024. 14 At that time, an emphasis on inclusion of leadership from implementing organizations and support for a wider variety of partners such as secondary and post-secondary students, local implementers, community leaders, policy makers, and people living with HIV was introduced. In addition, encouragement to include multidisciplinary teams, particularly including historically black colleges and universities, tribal colleges and universities, and other minority-serving institutions, was added. While the call for the Hubs remained unchanged from 2020–2023, the RFAs for supplement projects shifted both in focus and requirements ( Table 2b ). Initially, all grants were one year, and then a limited number of two-year opportunities were offered. In 2020, a specific requirement was made to include local community partners affected by HIV and to include partners in all phases of the project. In 2022, an addition was made to specifically define meaningful community engagement as “shared partnership as described in the community engagement continuum between communities and academic partners and should be mutually beneficial” (Sanders, et al., 2021). Focused topical proposals varied each year, such as: reaching cisgender heterosexual women with PrEP (2020); addressing social and structural determinants of HIV using an intersectional framework in partnership with community (2021); building strategic alliances across jurisdictions (2022); and leveraging pharmacies to advance HIV testing, prevention, and care (2023). Table 2a. Comparable and Unique Components of IS Hub Request for Applications, 2019–2024 Hub RFA Requirements Focus Area 2019 - 2023 2024 Technical Assistance on Implementation Science (IS) Provide technical assistance to EHE projects on IS designs, frameworks, strategies, measures, and outcomes and on partnership formation. Develop webinars, workshops, and other resources Generalizable Knowledge Translate local knowledge within EHE projects into generalizable knowledge. Develop generalizable knowledge and disseminate best practices. Training and Coaching Services Provide coaching/training sessions to project teams seeking IS consultations and technical assistance. Provide coaching and technical assistance services available to EHE research teams, including planning for dissemination. Include leadership from implementing organizations from the beginning of the research process. Consultation Agreements Develop consultation agreements with EHE project teams that includes a communication and data collection plan. (no comparable requirement) Coordination with CCDMC Facilitate coordination with the CCDMC. Collaborate with the CCDMC, including conducting systematic reviews of promising strategies identified in the first phase of EHE and other cross-network activities such as meeting planning, data harmonization and coordination activities, and planning and evaluation of dissemination approaches. Data Collection on Measures and Outcomes Collect data on measures and outcomes from EHE projects receiving consultation and technical assistance from the RCH. Collect data on characteristics, measures and outcomes from awarded projects based on established criteria from the CCDMC from all EHE projects receiving consultation and technical assistance from the RCH. Data Reporting to CCDMC Provide data to CCDMC as requested by NIH for the EHE projects and send an RCH representative(s) to the Executive Committee. Collect data on characteristics, measures and outcomes from awarded projects based on established criteria from the CCDMC from all EHE projects receiving consultation and technical assistance from the RCH. Support for Early-Stage Investigators and Stakeholders (no comparable requirement) Support Early-Stage Investigators, secondary and post-secondary students, local implementers, community leaders, people living with HIV, and policymakers, as appropriate. Multidisciplinary Research Teams (no comparable requirement) Multidisciplinary research teams are preferred, including collaborations with Historically Black Colleges and Universities (HBCUs), Hispanic-serving Institutions (HSIs), Tribally Controlled Colleges and Universities (TCCUs), Alaska Native and Native Hawaiian Serving Institutions, and Asian American Native American Pacific Islander Serving Institutions (AANAPISIs). Engagement with HHS and NIH (no comparable requirement) Engage with HHS implementing agencies, and regularly communicate research progress, challenges, outcomes, findings, and best practices to NIH officials and HHS implementing agencies. Annual EHE Meeting Participation (no comparable requirement) Participate in an annual EHE meeting. Open in a new tab Note. Underlined text represents noteworthy additions to the RFAs, discussed further in the text. Table 2b. CFAR/ARC Supplement Request for Applications, 2019–2023 Supplement RFA Requirements Requirements 2019 2020 2021 2022 2023 Geography All projects should focus on the 50 jurisdictions as well as the rural areas of the 7 states with a heavy HIV burden . CFARs and ARCs may work with jurisdictions outside of their institution’s location, particularly if relationships have already been established. Guiding Principles The CFAR and ARC principle of local control must be emphasized in the collaborations with entities funded by the CDC, HRSA, and other implementing agencies, and/or local and state health departments. There must be value added for all members of the partnership. In all proposed collaborations and projects, teams should examine any local policies that have created unintended structural barriers to HIV treatment and prevention and seek ways to transform these processes. It is encouraged that these planning projects include consideration of creative, locally-defined concepts. These concepts should differ substantially from conventional means of service delivery, especially conventional approaches that are not effectively addressing the diversity of needs in the highest burden communities. Proposals should consider innovative ways to enhance engagement efforts, and community-based and outreach approaches that remove barriers to conventional prevention and treatment access. Added in 2020: There must be value added for all members of the partnership, including representation of local community partners affected by HIV. This includes communication and collaboration with all partners in all phases of the project including planning/development, initiation, execution, and dissemination . Added in 2022: Meaningful community engagement is defined as shared partnership as described in the community engagement continuum between communities and academic partners and should be mutually beneficial (Sanders, et al., 2021). Research priorities EHE Team-initiated Implementation Research Reaching Cisgender Heterosexual Women with PrEP Evaluating and Developing Data-Driven Messages and Communication Strategies for EHE EHE Team-initiated Implementation Research Planning projects to address social and structural determinants of HIV using an intersectional framework in partnership with community to enhance efforts toward Ending the HIV Epidemic in the United States Equity-focused approaches to reduce HIV-related health disparities Planning projects to support participatory data science research efforts toward Ending the HIV Epidemic in the United States Strategic alliances across jurisdictions to reach EHE goals through implementation research Applying behavioral economic approaches to design implementation strategies for HIV testing, prevention, and care Implementation Strategies to Facilitating a Status Neutral Approach to HIV Prevention and Treatment Syndemic approaches to HIV Prevention, Treatment and Care Leveraging Pharmacies to Advance HIV Testing, Prevention, and Care Strategies to Improve Linkage to HIV Care and Services Post-Incarceration Cluster Detection and Response Strategies Open in a new tab Note. Underlined text represents noteworthy additions to the RFAs, discussed further in the text. CHESHIRE Theory of Change. Across the timeline, adaptations and development of the network were made to strengthen its ability to achieve the EHE goals of decreasing incidence of HIV by 2025 and 2030. Developed as part of a collaborative evaluation of the CHESHIRE network, Figure 1 depicts the theory of change linking IS capacity-building for researchers and practitioners to those goals. Our capacity-building efforts aim to rapidly strengthen the quality of IS evidence generated around EBI implementation while also supporting increased dissemination of said evidence, leading to widespread uptake of EBIs that effectively reduce and prevent new infections. Figure 1. Open in a new tab CHESHIRE Theory of Change EBIs: evidence-based interventions; EHE: Ending the HIV Epidemic Evaluation of CHESHIRE. Multiple Hubs planned rigorous internal collection of evaluation data such as regular assessments and feedback from assignment projects in their original proposals. However, the Hubs rapidly discovered that such assessments and input were not feasible due to the burdens on EHE supplement leads, and the planned assessments needed to be modified. Hubs shared their individual experiences at Executive Committee meetings, which led to the establishment of an evaluation working group. From 2021–2023, the evaluation working group met regularly to develop a data collection tool that ISCI now uses to collect common metrics on Hub activities, particularly around the creation of technical support resources, technical support provided to projects, and feedback from projects on technical support. The evaluation working group identified the challenge of collecting data on technical support quality without overburdening the supplement teams, many of whom already felt burdened by the data reporting requirements of the EHE supplement mechanism. Figure 2 presents the CHESHIRE program evaluation logic model describing ISCI, Hub, and collaborative activities, all of which contribute to short-, medium-, and long-term outcomes related to more rigorous implementation research and more use of findings by practitioners. Figure 2. Open in a new tab CHESHIRE Logic Model EHE: Ending the HIV Epidemic; ISCI: HIV Implementation Science Coordination Initiative; IR: implementation research; IS: implementation science; ART: anti-retroviral therapy; TA: technical assistance Activities in the model correspond to dissemination, capacity-building, and scale-up strategies from the interactive system framework, 15 as the CHESHIRE network acts on the support and the synthesis and translation systems rather than the delivery system that is integrating and implementing IS (i.e., EHE projects and implementation partners). Specific activities are described in CHESHIRE Activities . Outputs are measured quantitatively by each Hub and reported to ISCI for compilation using the tool developed by the evaluation working group. Outcomes, which are at the EHE project and practitioner levels, are assessed through pre–post surveys of projects, disseminated by ISCI, that assess IS knowledge, satisfaction with Hubs, and the specific HIV implementation research questions addressed by each project. Because data from the pre–post surveys on changes in IS capacity of EHE supplement teams are not yet available, and a full evaluation is outside the scope of this commentary, we present analyses of available data to characterize the spread of CHESHIRE activities thus far, as a precursor for the short-term uptake/use outcomes. CHESHIRE Activities Individual Hub Activities While all Hubs proposed activities to address the RFA requirements, after the first year, most Hubs also developed some unique components that created an array of resources and experiences across CHESHIRE ( Table 3 ). Common capacity-building strategies included providing technical assistance on IS to a group of supplement teams, providing coaching and training opportunities, supporting projects in reporting on IS outcomes using a shared outcomes crosswalk, and regularly reporting to ISCI on Hub activities. Unique activities included hands-on analysis and drafting of manuscripts, conducting a study of community-engaged research activities of EHE supplement awardees, hosting an annual fellowship program for mentored training in IS, and providing training in IS for EHE jurisdiction health departments (in partnership with the National Alliance of State and Territorial AIDS Directors [NASTAD]). Hub activities were complemented by ISCI’s strategies to disseminate and scale-up IS, such as conducting and reporting on systematic reviews of HIV implementation studies and developing interactive research tools, respectively. Table 3. Dissemination, Capacity-building, and Scale-up Strategies of ISCI and IS Hubs Who Provided Description of Activities All Hubs Technical assistance and coaching on IS designs, frameworks, strategies, measures, and outcomes crosswalk. Provide coaching/training sessions to project teams seeking IS consultations and technical assistance. Support reporting of data on measures and outcomes from EHE projects receiving consultation and technical assistance. Implementation Science Coordination Initiative (ISCI) Conducting systematic reviews of implementation determinants and strategies for common HIV interventions; establishing criteria for evaluating best-practice implementation strategies; coordinating, collecting, and disseminating EHE project data; developing technical support tools (e.g., interactive implementation research logic model, implementation outcomes crosswalk); consolidating and disseminating HIV IS news and resources; conducting IS training for practitioners; editing journal special issues on HIV IS; coordinating Executive Committee, multisite research, and cross-regional mentorship Emory IS Hub Learning collaborative and community of practice (facilitated sessions and peer support); customized consultations and technical support; seminar and workshop series; grant and manuscript development services; Hub newsletter; priority focus on dissemination. Johns Hopkins Mid-Atlantic CFAR Consortium (MACC+) Hub Systematic reviews of implementation outcomes and measures; community-engaged research study of EHE awardees; annual implementation science fellowship providing mentored training in HIV & IS for early-stage investigators; development of a dashboard to highlight published EHE studies. Tennessee IS Hub Weekly IS seminar series plus several intensive training sessions in qualitative IS research, Hybrid study designs, and equity-focused IS measures. Sponsored the incentives for community-engaged research study of the EHE awardees, sponsored Visiting Scholar, conducted cross-hub activities with Texas (Community of Practice) and Emory (Seminars). Publish a quarterly hub newsletter highlighting mentee successes and created website with links to all lectures/seminars. Support for networking across EHE supplement teams. Texas IS Hub to End HIV Fall seminar series and workshop on IS, webinar and workshop on IS for practitioners University of Alabama Birmingham CFAR IS Hub Project-specific consultative teams that include 3 subject matter experts (HIV clinical care, community engagement and IS) in addition to topical experts; individualized project development plans; monthly seminars ( https://www.youtube.com/channel/UCo7TIYVEXlY2VuBvfS476hQ ); Hub-Wide Workshop on IS Cross-Walk; cross-project Latinx Working Group; multi-project Academic-Public Health Partnerships Working Group with projects and NIH; Cross-Hub Seminars (Community Engaged Research with Community Experts [Yale Hub] and on Rapid Qualitative Methods [UCSF/UCSD Hubs]); Supported and hosted 2nd Annual National EHE IS conference in Birmingham, AL University of California Los Angeles Rapid, Relevant, Rigorous (3R) IS Hub IS Beachside Chats; Cross-awardee collaborative papers (community-partnered social media campaign manuscript); IS topic webinars and methods workshops (some in collaboration with other Hubs) ( https://www.youtube.com/playlist?list=PLIeXfMZXqWd5YHUfQhmlSwfKjgwcbIAj7 ) Communities of Practice (e.g., with Emory Hub, CoP with projects focused on HIV and the criminal justice system) University of California San Diego IS Hub Bimonthly advanced IS topic workshops; interactive website forum ( https://sdcfarimplementationhub.org/events ); dissemination awards for EHE projects; systematic review of IS theories, models, and frameworks applied in HIV research and guidance to be incorporated into the widely used D&I Models in Health interactive webtool ( http://www.dissemination-implementation.org ). Strategies: centralized technical assistance, offered training and co-design opportunities with EHE researchers and their implementation partners on IS methods selection and evaluation, facilitated access to new funding to advance EHE research and practice. University of Washington Research Alliance in Implementation Science to End HIV (RAISE) In partnership with NASTAD, provide targeted technical assistance for EHE jurisdictions; hold monthly webinar series tailored to health departments; IS needs assessment of EHE health departments; Evaluating EHE Implementation workshop. Yale Rigorous, Rapid and Relevant Evidence aDaptation and Implementation to Ending the HIV Epidemic (R3EDI) IS Hub Team accompaniment by joining regular team meetings; Hands on analysis and manuscript preparation as needed; regular methods-focused webinars focused on researchers. Strategies: Interactive assistance, adapting and tailoring capacity building activities Open in a new tab The CHESHIRE Executive Committee has met monthly throughout the five years, with one or two representatives from each Hub attending. Initial meetings discussed collaborative decision-making processes, and members agreed upon a consensus model, with votes taken when consensus cannot be reached. Typical agendas for the meetings cover issues such as project assignments, measurement tools, reporting requirements, dissemination planning, challenges faced by Hubs, cross-cutting themes and lessons learned, the EHE meeting, and feedback from NIH program officers; more complex activities, such as the multisite study, warranted the creation of separate cross-Hub working groups. Over the years, we assigned projects to Hubs in various ways, initially based on methodological similarities or use of similar implementation strategies and later based on interventions, populations, and/or contexts. We found the latter to be more fruitful in terms of facilitating shared learning and collaboration among projects. We formalized this grouping process into communities of practice in 2024, of which some groups have already produced shared products, including articles in this supplemental issue (e.g., Ogunbajo et al., this issue ). 16 Innovative Collaborative Activities. In addition to common Hub activities and unique Hub contributions, through the CHESHIRE Executive Committee, the network collaboratively developed further activities to collectively strengthen the quality of science and address the need for generalizable knowledge highlighted in the Hub RFAs. For example, each Hub agreed to include in their 2021 renewal application a specific aim for conducting a cross-Hub multisite pilot, a point person for the Johns Hopkins University fellowship program, shared text related to working with ISCI and other Hubs on direct consultation with supplement projects and to additionally support the IS needs of federal partners and EHE R01s as needed. Multisite Pilot Implementation Research Studies. One of the key innovations in 2021 was a multisite pilot implementation research study proposed by ISCI and the five original Hubs. In response to the RFA, the previous year, ISCI convened a planning meeting to arrive at consensus on shared activities to be proposed in the renewals. Given the EHE goal of leveraging IS, CHESHIRE members identified the development of a platform for multisite IS as an essential foundation for generalizable knowledge. 17 Shared text was developed that each of the five Hubs and ISCI included in their renewal applications, committing a portion of their budgets to developing the platform and conducting the study in six EHE priority jurisdictions. Program officers were consulted to confirm the proposal would be entertained. The following year, CHESHIRE facilitated the submission of two pairs of supplement proposals (four proposals in all) to fund additional multisite studies. Priority topics were identified in consultation with community partners from each Hub, and then prioritized by the ISCI Community Implementation Partners Committee. The final priority topics were identified based on capacity and expertise of hub teams. Two of the studies (Project RISE; PI Brewer & PI Humphries) focused on identification and prioritization of implementation strategies for status neutral community health workers in five EHE jurisdictions and were conducted together with joint research team meetings and cross-site data analysis. The other two studies (PIs Kemp/Schwartz & PI Elopre) directly compared implementation strategies to expand availability of rapid PrEP in different settings. In the absence of a more formal platform (e.g., HIV Prevention Trials Network) to coordinate multisite implementation research, these approaches demonstrate how CHESHIRE has innovated to advance HIV IS within existing parameters. IS Fellowships for ESI. Contemporaneous to the development of CHESHIRE, in 2019, the MACC+ Hub established a fellowship program for mentored training in IS for early-stage HIV investigators. 5 The fellowship had 12 mentors in its inaugural year but has grown to include 17 mentors and 8 associated faculty, including the additions of mentors from all IS Hubs. To date, 128 early-stage investigator fellows have been trained, 28 of whom have been awarded EHE supplements. Furthermore, in 2024, a Visiting Scholars Program was launched by the CHESHIRE network, focused on forming and strengthening academic-community partnerships to conduct collaborative HIV IS relevant to EHE. Eight academic-community pairs were selected and assigned to hubs for mentorship. CHESHIRE chose to have an annual theme to increase opportunities for cross-project learning in the Visiting Scholars Program, and the 2024 theme is organizations focused on services in the LGBTQ+ community, culminating in attendance at the National LGBTQ Health Conference. Spread of CHESHIRE Activities Although a more formal evaluation of the network is underway (see Future Challenges and Opportunities ), here we describe some preliminary evidence of diffusion for the technical support activities of IS Hubs. Figures 3a and 3b describe the 248 funded supplement projects from RFAs released FY19–FY23. 18 Each of these projects engaged with ISCI and/or a Hub as a requirement of their awards. Of the 57 counties and rural states prioritized by EHE, the projects covered 43 jurisdictions in FY19, 24 in FY20, 28 in FY21, 41 in FY22, and 19 in FY23. Only 7 of the 57 EHE jurisdictions have not yet had funded projects (Maricopa, AZ; Palm Beach, FL; Marion, IN; Wayne, MI; Hudson, NJ; Franklin, OH; Hamilton, OH); excluding those, the median number of projects per jurisdiction was 7. Figure 3. Open in a new tab a: One-Year Projects and Two-Years Projects b: Percent Supplements addressing EHE Pillars by Year Lessons Learned While IS-focused capacity-building initiatives have grown over the last twenty years, with a broad range of objectives and approaches, 11 , 19 – 21 the CHESHIRE network differs from others as it provides technical support for teams who have already received funding for IS planning and research projects, and project teams are generally seeking technical support for problem-solving and troubleshooting project progress. Utilizing the CFAR/ARC supplement mechanism allowed NIH to rapidly review and fund projects over a 4–5-month period. The mechanism also allowed NIH to make rapid changes in the supplement calls to reflect lessons learned from prior funding cycles. The CHESHIRE model emphasizes the applied practice side of capacity-building, and the 1–2-year timelines sometimes were a challenge to more proactive longer-term capacity-building focused on the funded project. Hubs addressed this challenge by encouraging projects to seek input as they developed manuscripts and grant proposals for future projects so that Hub support could strengthen IS methods in those proposals. Early evaluation data indicated use of consultation serves increased the likelihood of future funding. 13 Hubs worked to maintain a balance between immediate response and developing skills for future work, with activities such as offering webinars to strengthen IS knowledge in general in addition to the tailored support and creating an IS fellowship program for young investigators. Utilization of the administrative supplement mechanism created a flexible system that could vary supplement calls rapidly in response to emerging needs and priorities. However, the limited grant period for the supplement projects also created challenges, as teams struggled to complete administrative tasks and research within a constrained timeframe. Assignment of a go-to technical support Hub for each funded project assured all project teams of the availability of expert assistance when questions arose. Depending on the in-house IS expertise of the research teams, there has been variation in how much IS support projects need and are interested in receiving. In some cases, Hubs found creative ways to support projects with advanced IS knowledge, such as identifying skills beyond IS they needed for success (e.g., need to assess engagement and/or identify strategies for health equity, develop rapid qualitative methods), offering support for establishing data safety and monitoring boards, and discussing the needs of community partners to receive non-academic IS training. Supporting rigorous community engagement and partnership building has been essential. Given the NIH requirement in the supplement RFAs for research teams to include implementing partners, many teams created new partnerships and struggled with partnership growing pains. Hubs responded with individual coaching, webinars, collaborative reflections on challenges and opportunities (Beres et al., this issue ) and a research study to identify best practices in community engagement among EHE supplements (Datar et al., this issue ). What we have stopped doing The initial RFA for the Hubs included development of a consultation agreement between hubs and their assigned projects, and the CHESHIRE network developed a template for such an agreement. Hubs reached out to assigned projects to complete the agreements with varying success, as project teams struggled with the request and the creation of a formal relationship with their assigned Hub. Some EHE supplement teams understood them as legally binding documents and did not want to go through the institutional process for completion, and other supplement teams saw them as an informal document and were fine signing them without institutional review. Given the heterogeneity in interpretation and use, the agreements were found to complicate the hub/project relationship and were discontinued. The requirement for the agreements was removed from the 2024 R24 RFA. 14 Potential areas for future adaptation Uniform assignment of projects to Hubs based on methods or strategies or approaches, without regard to the networks projects were already embedded in through their CFARs/ARCs, sometimes led to projects having multiple CFARs/ARCs reaching out to provide technical assistance on IS. Of the different assignment approaches tried, the community of practice (CoP) has been the most successful in terms of engagement and generation of generalizable knowledge. Multiple CoPs also engaged implementation partners; for example, the SD CFAR IS Hub CoP focusing on syndemics submitted a manuscript describing unique challenges of implementers led by implementation partners with support from academic partners. Like most capacity-building initiatives, as the CHESHIRE network has been focused primarily on individual- and research-team-level support, future attention to capacity-building needs of relevant downstream delivery systems, such as academic infrastructure, implementing organizational systems, and clinics, is a priority. One Hub, UW RAISE, is working closely with health departments to begin to address some of this need. Future Challenges and Opportunities As the CHESHIRE network enters the next five years of the EHE initiative, it faces both opportunities and challenges in demonstrating its impact and adapting to structural shifts in funding mechanisms. These changes—such as the transition from supplements to the R24 funding structure—offer the potential for long-term sustainability but also introduce complexities, including increased competition for resources and evolving evaluation criteria that may shape the types of activities proposed and implemented. Assessment of the impact of CHESHIRE is a key priority and has become the focus of a cross-Hub study. The previous evaluation working group focused on self-report and pre–post data collection, with a vision of being able to invite qualitative stories of change, although the self-reported data collection was all that was feasible given the resources and capacity available at the time. After developing a Hub reporting tool, which is still in use, the working group disbanded to address other CHESHIRE priorities such as training early-stage researchers and developing communities of practice among projects. We learned that we could not do a high-quality evaluation on capacity-building/volunteer time. We also learned that some originally planned evaluation activities were not feasible because research teams have limited time to spend on administrative activities and EHE projects had limited capacity to respond to requests for evaluation data. The decision by CHESHIRE to commit current multisite funding to the assessment of impact highlights an awareness of the need to devote more and designated resources to identifying rigorous, multilevel, mixed-methods evaluation approaches that are acceptable, appropriate, and feasible for all partners involved and can reflect the multitude of impacts of CHESHIRE. The evaluation of CHESHIRE will also focus on the network’s ability to translate capacity-building efforts into measurable outcomes, such as improved HIV intervention uptake sustained partnerships, and the dissemination of generalizable IS knowledge. In 2024, NIH shifted how it would continue to support IS coordination and capacity-building moving into the next five years of EHE. They released an RFA for an R24 Resource-Related Research Project that will provide five years of funding for a coordinating center and IS Hubs. 14 Although this opportunity creates a more sustainable funding structure for each institution, this shift also brings the challenges of maintaining cohesion and a sense of unity across the network. The supplement mechanism fostered collaboration by funding Hubs in cohorts, which created a collective identity and encouraged shared learning. The rolling nature of R24 applications may dilute this unity, but it also offers an opportunity for CHESHIRE to innovate. The network must prioritize strategies for integrating new Hubs into its structure, preserving institutional knowledge, and fostering collaboration even amidst increased competition. CHESHIRE can achieve this by formalizing onboarding processes, developing mentorship models for new Hubs, and leveraging cross-Hub working groups to sustain collective learning. One of CHESHIRE’s key strengths is its ability to respond to diverse and evolving needs of the EHE projects. By providing tailored technical assistance, supporting multisite collaborations, and offering coaching and training for early-stage investigators, the network has successfully addressed both the immediate project needs and longer-term capacity building. However, as the field of HIV implementation science evolves, CHESHIRE must now expand its focus beyond individual- and team-level capacity-building to include more systems-level strategies. This could involve strengthening academic infrastructure, enhancing the capacity of implementing organizations, and fostering health systems that are resilient and adaptive to emerging challenges. The next phase of CHESHIRE’s work also presents an opportunity to broaden its impact beyond HIV. The model of coordinated Hubs and a central Coordinating Center can be adapted to other public health priorities, such as addressing health disparities in mental health, substance use, chronic disease management, and other syndemic stressors contributing to the HIV burden. By aligning its efforts with broader health equity goals, 22 CHESHIRE can demonstrate the scalability and transferability of its approach. In conclusion, the CHESHIRE network stands out in the field of IS capacity-building by offering targeted technical support for funded project teams. Its innovative model has not only facilitated problem-solving for funded projects but also advanced the field of IS by creating generalizable knowledge and fostering collaborative partnerships. As CHESHIRE evolves, its commitment to rigorous evaluation, systemic capacity-building, and alignment with health equity priorities will ensure that it continues to be a driving force in achieving the ambitious goal of the EHE initiative while providing a blueprint for other critical public health challenges. Acknowledgements: The CHESHIRE coordinating center and Hubs have been funded through supplements to the following NIH-funded Centers for AIDS Research and NIMH-funded AIDS Research Centers: Implementation Science Coordination Initiative (MPIs: Mustanski & Benbow): Third Coast Center for AIDS Research (P30AI117943) Yale Rigorous, Rapid and Relevant Evidence aDaptation and Implementation to Ending the HIV Epidemic Hub (PI: Spiegelman): Center for Interdisciplinary Research on AIDS (P30MH062294) University of California, Los Angeles Rapid, Relevant, Rigorous Implementation Science Hub (PI: Hamilton): Center for HIV Identification, Prevention and Treatment Services (P30MH058107) Mid-Atlantic CFAR Consortium Plus (MPIs: Baral & Schwartz): Johns Hopkins University Center for AIDS Research (P30AI094189) Research Alliance in Implementation Science to End HIV (PI: Sherr): University of Washington/Fred Hutch Center for AIDS Research (P30AI027757) UAB CFAR Implementation Science Consultation Hub (MPIs: Lanzi, Mugavero, Hearld): University of Alabama at Birmingham Center for AIDS Research (P30AI027767) SD CFAR Implementation Science Hub (MPIs: Rabin & Stadnick): San Diego Center for AIDS Research (P30AI036214) Tennessee CFAR Implementation Science Hub (MPIs: Pettit & Audet): Tennessee Center for AIDS Research (P30AI110527) Texas Implementation Science Hub to End HIV (PI: Markham): Texas Developmental Center for AIDS Research (P30AI161943) Emory CFAR Implementation Science Hub (PI: Sales): Emory Center for AIDS Research (P30AI050409) References 1. 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