Global HIV Implementation Science Training Program

This fall marks the launch of a new training program that will immerse scholars in HIV implementation science, a growing field that focuses on how to best translate research findings into effective healthcare policy and practice.

The Global HIV Implementation Science Research Training Fellowship will have spots for three predoctoral and two postdoctoral trainees, several of who will come from the Department of Epidemiology. The first-of-its-kind program is funded by the NIH’s National Institute of Allergy and Infectious Diseases and is run by faculty in ICAP and Epidemiology.

The program incorporates implementation science, which draws on research findings and evidence-based interventions to improve the quality and effectiveness of health services. It combines a broad range of disciplines, including epidemiology, biostatistics, health economics, decision science, and sociology.

Implementation science offers a unique opportunity for universities. "Academic institutions have an opportunity to embrace societal challenges more fully by placing value not only on discovering the ‘what’ but also on elucidating the ‘how’ and bringing to action discoveries with broad benefits," according to a perspective piece about implementation science that was published in March in the New England Journal of Medicine, written by Wafaa El-Sadr, MD, MPH, university professor of medicine and epidemiology at the Mailman School of Public Health and director of ICAP, Jessica Justman, MD, associate professor of Medicine and Epidemiology at Columbia and senior technical director of ICAP, and Neena M. Philip, a program coordinator at ICAP.

Cancer researchers have drawn on the principles of implementation science for a while, but it is relatively new to scientists in the field of HIV/AIDS, who in earlier years were focused on finding treatments and means of preventing viral infection. While there is still no AIDS vaccine, scientists have developed antiretroviral treatments that keep the disease from worsening and reduce the risk of transmitting the virus. However, because resource-limited areas have been some of the hardest hit by HIV/AIDS, one of the greatest challenges has been getting this treatment to those who are infected. Challenges include getting people to get tested for HIV, linking those who test positive to care, and ensuring that people who are infected are regularly taking antiretroviral medicines.

"We know what needs to be done, but it’s how to deliver the services and thinking at the provider, patient, and programmatic level about what needs to be in place. It’s about, how do you take scientific findings and bring them to a programmatic setting?" says Andrea Howard, MD, associate professor of Epidemiology and clinical and training unit director of ICAP, who is the principal investigator and director of the training program. This is often described as the "know-do gap," according to Howard.

Each trainee in the program will be placed in the field with a faculty mentor. Possible projects include several sponsored by ICAP: a trial in Swaziland looking at a strategy for preventing transmission of HIV from mothers to children, a study of combination care for patients who are infected with both tuberculosis and HIV in Lesotho, and an evaluation in Harlem of the use of pre-exposure prophylaxis or PreP to prevent HIV from spreading between black men who have sex with men.

Trainees will also meet in a weekly faculty-fellow seminar, a popular feature of several other Epidemiology-affiliated training programs, train in manuscript and grant preparation, and get instruction on how to conduct responsible research. Predoctoral fellows will complete coursework in epidemiology, and postdoctoral fellows will take select courses based on their individual training needs.

In addition to ICAP and Epidemiology, faculty will come from the departments of Sociomedical Sciences, Health Policy and Management, and Population and Family Health; the College of Physicians and Surgeons, the Psychiatric Institute, and the School of Social Work. "It really builds upon the medical center’s experience and expertise in this area," says Howard. "We’ve assembled a large number of research mentors who are known not only for their excellent science but also for their track record as excellent mentors."

Says Howard: "We’re really thrilled to implement this program. We’re very excited. I think there’s a rich training environment here at Mailman, with a wide range of opportunities for field placements both here in the U.S. as well as abroad."