Young women in Ghana learn how to protect themselves from HIV through evidence-based prevention methods.

Photo credit: Yakuba Yusuf/ProjectHope

Iman Barré
HIV Implementation Science Intern

Iman Barré is a recent master of science in public health graduate committed to social justice and bridging the gap between health research and advocacy for access to quality care and treatment.

I’ve gotten used to my friends and family reacting with a slight tilt of the head, furrowed brow and curious look as I try to explain the definition of Implementation Science. Before beginning an internship with the Implementation Science Branch of the U.S. Agency for International Development’s (USAID’s) Office of HIV/AIDS (OHA) Research Division, my explanation of Implementation Science tended to vary quite a bit. Upon starting with the Agency this past February, I quickly realized that variations are common because Implementation Science is a diverse field and so, too, are the words used to describe it.

What Is Implementation Science?

Textbook definitions of Implementation Science often include overlapping and related terms such as “implementation research” or “operations research.” To a layperson, this doesn’t mean much. Additionally, the same term can have a different meaning depending on which organization you ask or even which department you ask within a given organization. These concepts differ in the type of research questions they address, in how they are organized and in how they interface with the health system. Despite the many definitions that exist, Implementation Science boils down to this: Implementation Science bridges the gap between evidence and the use of data in decision-making and program planning. At its crux, it applies research to the real world and has an impact on the lives of people around the world!

Implementation Science aims to translate evidence-based interventions into policy and practice. In other words, even if a practice has been demonstrated to be effective through research, maintaining these programs in the real world, beyond a clinical trial environment, will prove difficult without the contextual understanding that Implementation Science demands. Contextual understanding encourages the consideration of the real-life social, political and technical environments that may influence how well an intervention or policy performs. For example, HIV and AIDS key populations, such as men who have sex with men (MSM), are often stigmatized and historically have been denied access to quality health services. Therefore, if an HIV and AIDS intervention hopes to increase MSM participation, it would likely need to move beyond the traditional clinical setting in favor of a more innovative community-centered approach.  

What Role Does the Office of HIV/AIDS Play in Implementation Science?

The U.S. President’s Emergency Plan for AIDS Relief’s (PEPFAR’s) definition of Implementation Science shapes and informs much of OHA’s strategy. PEPFAR embraces what is called an “Implementation Science Framework.” In HIV and AIDS, Implementation Science is used to identify, develop and measure the impact of innovative strategies to improve HIV service delivery, to inform policies and programs, and ultimately, to strengthen the global response.

The Research Division’s Implementation Science Branch provides research leadership to assess and improve HIV and AIDS service delivery, interventions, products and technologies in real world settings and collaborates with a variety of stakeholders. Implementation Science plays a key role across the many programs in OHA, working to translate important research findings to improve HIV and AIDS services for those people around the world who need them most. OHA supports a number of research partners to carry out Operations Research and Implementation Science, focusing on a range of HIV prevention, care and treatment priority areas.

Our current Implementation Science portfolio, made up of three funding mechanisms, works toward reaching the Joint United Nations Programme on HIV/AIDS’ (UNAIDS’) ambitious “90-90-90” global goals: 90 percent of people with HIV diagnosed; 90 percent of those diagnosed on antiretroviral therapy (ART); and 90 percent of those on ART virally suppressed by 2020. Through these three mechanisms ─ Supporting Operational AIDS Research (Project SOAR), HIVCore Project and Implementation Science Annual Program Statement (APS ) ─ the IS Branch recently supported a study in Tanzania expanding coverage of HIV testing and ART for infants of HIV-positive mothers. We also supported an evaluation of an intervention that used a mix of strategies to help link and retain people in care in Mozambique, as well as an evaluation on interventions that focus on decreasing stigma to improve the effectiveness of existing HIV prevention, treatment and care services for key populations in Senegal.

Why Does Implementation Science Matter?

Overall, Implementation Science is about applying research and scientific evidence to real world settings. Without considering context and how it interacts with the execution of an intervention, a program is likely to underperform or fail. Research that incorporates an IS approach applies scientific evidence in a way that uses resources efficiently and sustainably to ensure successful programs and policies — a critical factor in achieving the ultimate goal of a world where HIV and AIDS are no longer a burden.

As I conclude my internship in the Implementation Science Branch, I now have a better understanding of where I see myself in global health. Implementation Science has given me the vocabulary to articulate the gap between research and action, a gap that I hope to bridge in my future career.