Dorlim A Moiana Uetela, Orvalho Augusto, James P Hughes, Onei A Uetela, Eduardo Samo Gudo, Sérgio A Chicumbe, Aleny M Couto, Irénio A Gaspar, Diogo L Chavana, Sandra E Gaveta, Marita R Zimmermann, Sarah Gimbel & Kenneth Sherr
University of Washington affiliated authors are displayed in bold.
Published: October 2023
Tessa Concepcion, Peter Mogere, Kenneth Ngure, Njoroge Mwathi, Roy Njiru, Boaz Kipkorir, Catherine Kiptinness, Gakuo Maina, Emmah Owidi, Tamara Owens, Pamela Kohler, Bradley H. Wagenaar, Shannon Dorsey, Pamela Y. Collins, and Jennifer Velloza
University of Washington affiliated authors are displayed in bold.
Published: September 2023
Kenyan adolescent girls and young women (AGYW) experience a dual burden of HIV and common mental disorders (CMD). HIV clinics are a key entry point for AGYW in need of integrated CMD and HIV care; however, rates of screening and referral for CMDs are low. Our objective was to test an evidence-based provider training strategy, simulated patient encounters (SPEs), on CMD service delivery for AGYW in a Kenyan HIV clinic.
This pilot study was conducted in a public HIV clinic in Thika, Kenya from January to November 2021. The simulated patient encounter (SPE) implementation strategy included case script development from prior qualitative work, patient actor training, and a three-day SPE training including four standardized mock clinical encounters followed by quantitative surveys assessing provider competencies for each encounter. We abstracted medical record data related to HIV and CMDs such as HIV status, reason for visit, CMD screening test performed, and counselling or referral information. We conducted an interrupted time series analysis using abstracted HIV and CMD screening rates from AGYW ages 16–25 years visiting the clinic 7 months before and 3 months after SPE training. We used generalized linear models to assess changes in CMD screening rates after training.
A total of 10 providers participated in the training. Competency ratings improved across four mock encounters (mean score from 8.1 to 13.7) between first and fourth encounters. We abstracted all medical records (n = 1,154) including from 888 (76%) AGYW seeking HIV treatment, 243 (21%) seeking prevention services, and 34 (3%) seeking other services. CMD screening rates increased immediately following training from 8 to 21% [relative risk (RR) = 2.57, 95% confidence interval (CI) = 1.34–4.90, p < 0.01]. The 3 months following the SPE training resulted in an 11% relative increase in CMD screening proportion compared to the 7 months pre-SPE (RR: 1.11, 95% CI: 1.04–1.17, p < 0.01). Finally, 1% of all pre-SPE screens resulted in referral versus 5% of post-SPE screens (p = 0.07).
The SPE model is a promising implementation strategy for improving HIV provider competencies and CMD service delivery for adolescents in HIV clinics. Future research is needed to explore effects on adolescent clinical outcomes in larger trials.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Arianna Rubin Means, Anjuli D. Wagner, Eli Kern, Laura P. Newman, and Bryan J. Weiner
University of Washington affiliated authors are displayed in bold.
Published: September 2020
The COVID-19 pandemic continues to expand globally, requiring massive public health responses from national and local governments. These bodies have taken heterogeneous approaches to their responses, including when and how to introduce and enforce evidence-based interventions—such as social distancing, hand-washing, personal protective equipment (PPE), and testing. In this commentary, we reflect on opportunities for implementation science to contribute meaningfully to the COVID-19 pandemic response. We reflect backwards on missed opportunities in emergency preparedness planning, using the example of PPE stockpiling and supply management; this planning could have been strengthened through process mapping with consensus-building, microplanning with simulation, and stakeholder engagement.
We propose current opportunities for action, focusing on enhancing the adoption, fidelity, and sustainment of hand washing and social distancing; we can combine qualitative data, policy analysis, and dissemination science to inform agile and rapid adjustment to social marketing strategies to enhance their penetration. We look to future opportunities to enhance the integration of new evidence in decision-making, focusing on serologic and virologic testing systems; we can leverage simulation and other systems engineering modeling to identify ideal system structures. Finally, we discuss the ways in which the COVID-19 pandemic challenges implementation science to become more rapid, rigorous, and nimble in its approach, and integrate with public health practice. In summary, we articulate the ways in which implementation science can inform, and be informed by, the COVID-19 pandemic, looking backwards, proposing actions for the moment, and approaches for the future.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Anne F. Rositch, Karla Unger‐Saldaña, Rebecca J. DeBoer, Anne Ng’ang’a, & Bryan J. Weiner
University of Washington affiliated authors are displayed in bold.
Published: April 2020
Global disparities in breast cancer outcomes are attributable to a sizable gap between evidence and practice in breast cancer control and management. Dissemination and implementation science (D&IS) seeks to understand how to promote the systematic uptake of evidence‐based interventions and/or practices into real‐world contexts. D&IS methods are useful for selecting strategies to implement evidence‐based interventions, adapting their implementation to new settings, and evaluating the implementation process as well as its outcomes to determine success and failure, and adjust accordingly.
Process models, explanatory theories, and evaluation frameworks are used in D&IS to develop implementation strategies, identify implementation outcomes, and design studies to evaluate these outcomes. In breast cancer control and management, research has been translated into evidence‐based, resource‐stratified guidelines by the Breast Health Global Initiative and others. D&IS should be leveraged to optimize the implementation of these guidelines, and other evidence‐based interventions, into practice across the breast cancer care continuum, from optimizing public education to promoting early detection, increasing guideline‐concordant clinical practice among providers, and analyzing and addressing barriers and facilitators in health care systems. Stakeholder engagement through processes such as co‐creation is critical.
In this article, the authors have provided a primer on the contribution of D&IS to phased implementation of global breast cancer control programs, provided 2 case examples of ongoing D&IS research projects in Tanzania, and concluded with recommendations for best practices for researchers undertaking this work.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Arianna R. Means, David E. Phillips, Grégoire Lurton, Anne Njoroge, Sabine M. Furere, Rong Liu, Wisal M. Hassan, Xiaochen Dai, Orvalho Augusto, Peter Cherutich, Gloria Ikilezi, Caroline Soi, Dong (Roman) Xu & Christopher G. Kemp
University of Washington affiliated authors are displayed in bold.
Published: November 2016
Bridging the ‘know-do gap’ is an enormous challenge for global health practitioners. They must be able to understand local health dynamics within the operational and social contexts that engender them, test and adjust approaches to implementation in collaboration with communities and stakeholders, interpret data to inform policy decisions, and design adaptive and resilient health systems at scale. These skills and methods have been formalized within the nascent field of Implementation Science (IS). As graduates of the world's first PhD program dedicated explicitly to IS, we have a unique perspective on the value of IS and the training, knowledge, and skills essential to bridging the ‘know-do gap’. In this article, we describe the philosophy and curricula at the core of our program, outline the methods vital to IS in a global health context, and detail the role that we believe IS will increasingly play in global health practice. At this junction of enormous challenges and opportunities, we believe that IS offers the necessary tools for global health professionals to address complex problems in context and raises the bar of success for the global health programs of the future.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**