There is a substantial gap between innovative approaches in HIV prevention and treatment and their delivery to communities most affected with HIV.[i] [ii] As defined by the Annual NIH Conference on Implementation and Dissemination, implementation is the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings.[iii] Implementation science addresses the level to which health interventions can fit within real-world public health and clinical service systems. Other aims of the implementation science are to investigate and address major bottlenecks (e.g. social, behavioral, economic, management) that impede effective implementation, test new approaches to improve health programming, as well as determine a causal relationship between the intervention and its impact.[iv] [v] Implementation science and effective implementation require interdisciplinary and multidisciplinary collaboration between researchers, implementers, policymakers, civil society, and others.
Implementation science has similarities with monitoring and evaluation programmes as both seek to understand what is working well and what is not working well. However, implementation science seeks to understand the etiology of gaps between expected results and observed outcomes.[vi] For example, although PMTCT interventions like prophylactic antiretroviral therapy and replacement feeding have worked well in clinical settings, increasing coverage in rural areas (where women have limited access to clean water and formal health care) may require testing of novel approaches. Unlike operations research, which may identify and address barriers related to performance of specific projects, implementation science creates generalizable knowledge that can be applied across settings and contexts.[vii]
The aim of this course is to provide participants with practical guidance on how to apply an implementation science framework to improve delivery and effectiveness of HIV prevention and treatment in their countries.
The first part of the course is focused on issues such as setting prevention priorities according to (changing) epidemic characteristics and differences in community contexts, selection of the right strategies to engage key stakeholders, selection of intervention mix
and methods used in implementation science such as “gold standard” randomization approaches and quasi-experimental designs. The second part gives examples of implementation and evaluation of specific HIV programmes such as PMTCT, prevention in IDUs and new programme initiatives such as HIV treatment as prevention.[viii] [ix]
The course consists of lectures, presentation of case studies, exercises and group work. A key part of the course is a group work which consists of participants’ work on proposals for implementation research in their countries.
Some examples of the research questions for proposals are:
- What are the most effective ways to optimize ART delivery for IDUs and what types of tailoring might be required?
- What is the feasibility of intensified HIV testing approaches and immediate ART for prevention in MSM?
- How to encourage routine testing behaviours among FSW with negative test results?
- How to improve retention and adherence to ART among IDUs?
- How can PrEP be scaled up to be an effective public health programme, and what kinds of design strategies can be harnessed for quality evaluations?
- What are barriers to mother-to-child transmission prevention interventions and how can coverage of such prevention interventions be improved?
- Can routine HIV care be shifted from physicians to nurses?
Epidemiologists, public health professionals, social scientists
- Professor George W. Rutherford, MD, Global Health Sciences, University of California, San Francisco, USA
- Associate Professor Ivana Bozicevic, MD, DrPH, WHO Collaborating Centre for HIV Surveillance, School of Medicine, University of Zagreb, Croatia
- Associate Professor Margaret Handley, PhD, MPH, Department of Epidemiology and Biostatistics and Department of Medicine, University of California, San Francisco, USA
- Professor Aleksandar Stulhofer, PhD, WHO Collaborating Centre for HIV Surveillance, School of Medicine, University of Zagreb, Croatia
- Abu S. Abdul-Quader, PhD, Global AIDS Program, US Centers for Disease Control and Prevention
Duration and site:
The course takes place in five days.