BACKGROUND: Treatment of HIV represents a global challenge but also an opportunity to explore how innovations in an emerging Digital and Trustworthy Evidence Ecosystem could make a difference in Africa and other Low and Middle Income Country (LMIC) settings.

OBJECTIVES: We aim to respond to new evidence for treatment of HIV with the rapid creation, dissemination and implementation of trustworthy recommendations at the point of care in Africa.

METHODS: Figure 1 visualizes the Digital and Trustworthy Evidence Ecosystem for this case study. Here, evidence producers have published a trial on pregnant women with HIV. This potentially practice-changing the new evidence was presented to a collaborative network of clinicians, patients, researchers and experts in systematic review and guideline development (Rapid Recommendations panel). The panel created and published trustworthy recommendations, evidence summaries and decision aids within 90 days, following well defined methods and processes (BMJ Rapid Recommendations). Dissemination was performed through the BMJ in novel publication formats and through www.magicapp.org in digitally structured multi-layered presentation formats available "online and offline anywhere, anytime on all devices". Selected practices in Africa then worked to actively implement the trustworthy recommendations, followed by evaluation and improvement of care, also to study barriers and facilitators of the evidence ecosystem in an LMIC setting.

RESULTS: We will present the BMJ Rapid Recommendations for HIV within the Evidence Ecosystem, including barriers and facilitators for active implementation and evaluation of delivered care in Africa.

CONCLUSIONS: The Evidence Ecosystem for HIV exemplifies opportunities for closing the loop between new evidence and improved care but also remaining challenges, some likely to be particular for LMIC settings.