The following abstract was presented at the Implementation Science and Global Health satellite meeting on March 17, 2010 at Bethesda, Maryland.
Philip Keiser, MD
Professor of Medicine
University of Texas Medical Branch
The rollout of anti-retroviral therapy by PEPFAR provides unique opportunities for implementation research. A public health approach developed by the World Health Organization is widely used by participating countries. The rapidity of the rollout however, has resulted in little validation of the implementation and dissemination methods utilized. Faculty of the Fogarty International Center at the University of Texas Medical Branch in Galveston has been actively involved in HIV care and research in East Africa. As part of the 2009 Fogarty Center supplemental funding, UTBM proposed to develop a curriculum in Implementation Science with a focus on East African countries. This presentation will describe the development process and content of the Global Health Implementation Science Curriculum at UTMB.
An online search of implementation research, operational research, and health services research was performed. Most publications discussed manufacturing, sales and organizational structure rather than medical science. Those describing implementation of medical care often lacked precise definitions of implementation and used the terms operations, dissemination and implementation interchangeably. Review of curricula from academic institutions with a global health emphasis found no suitable models for a curriculum. We chose to use develop a curriculum based on the National Institutes of Health definition of Implementation Research: “The use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings”. Faculty at UTMB with implementation experience in the US and resource-limited settings have been recruited to develop curriculum.
The implementation science curriculum consists of three components: a classroom based course, “Element of Implementation Science” and two field research electives. The “Elements” course covers the stages of implementation: 1) identification of best practices; 2) facilitating dissemination and uptake of these practices; and 3) identification of barriers of sustainability. Other topics include: 1) implementation drivers; 2) the role of purveyors; 3) systems transformation; and 4) policy and practice feedback. Evaluation methodologies covered include operations and health services research, impact evaluation and modeling of health delivery systems. The course is one term long and will be taught via didactic sessions and seminars. Practical examples of implementation research will focus the East African setting.
The electives are entitled “Intro to Fieldwork” and “Advanced Fieldwork” and are intended for 2nd year and 4th medical students respectively. In the intro course, 8-10 students will be placed at one of four sites in Kenya to work on an ongoing project and to observe local medical practices. In the Advanced elective, 4th year students will develop their own project with a mentor and spend 4-8 weeks in Kenya performing the study.
To date, approval has been obtained for the field work electives. The didactic class is currently under development. We expect to have approval for this by March 2010, and to begin enrolling students for fall term 2010.
Updated April 2010