Is implementation science necessary for effective public and global health?

Written by Lorcan O’Byrne, medical student, University College Dublin and participant in the Institute for Public Health Summer Research Program

Since the foundation of the evidence-based program movement in the early 1990s there has been relentless unease related to the science to service gap, the progression of research from bench to bedside, and the quality rift resulting from this research to practice gap.

Programs focused on delivery of research to practice are known as implementation practice. Research into the appropriate delivery of such programs is known as implementation science. Dr. Elvin Geng, Associate Professor at University of California San Francisco, an expert in this field, chose not to lecture on the basics of implementation science during his seminar series presentation. Instead, he presented an informed argument aimed to appeal to our common sense – his argument: is implementation science necessary for effective public and global health?

Antiretroviral therapy (ART) has been critical in reducing the number of deaths from HIV/AIDS. Globally, 1.2 million deaths in 2016 were averted as a result of ART. Without this therapy, global deaths from AIDS would be more than double their current annual figures. Although the effectiveness of ART can’t be denied, Dr. Geng argues that these figures should be higher. How? Informed research and appropriate implementation.

International guidelines on who qualifies to receive ART and when ART therapy can be initiated continue to lag behind present-day best practice. Implementation practice will exist whether or not there is evidence, with implementation ‘research’ being seen as something extra done downstream that would slow the process of the ‘spread’. The practice of directly-observed HIV therapy in the form of accompagnateurs, is an example of an implementation program initiated without prior research into its efficacy. This form of therapy has led to many being refused ART simply because they may not have somebody to monitor their ART dosing. Dr. Geng presents us with a stark statistic: If 10-20% of eligible patients who presented were never started on ART from 2006 – 2016, three million deaths are likely to have occurred internationally.

The lesson I take from this example is that for effective public and global health progress to be made, neither research nor clinical practice can afford to exist in a vacuum. They must move forward in a collaborative manner. The bridge from ‘bench to bedside’ is implementation. We can no longer afford to negate the effects of unsuccessful implementation practices and must strive to support and be conscious of implementation research, whether approaching from a research or medical perspective.

Learn more about dissemination and implementation in this video created by the Institute for Public Health in 2016.