Threats to public health posed by infectious diseases have arrived at a crossroads. On the one hand, discovery science has produced an array of highly efficacious and affordable treatments that work remarkably well when used. These efficacious interventions span prevention (e.g., vaccines) as well as treatment (e.g., antibiotics); range across all types of etiologies from protozoal (e.g., plasmodium spp.) to viral (e.g., influenza and HIV) and beyond (e.g., fungal, bacterial); target a diversity of settings from tertiary hospitals (e.g., nosocomial infections) to under resourced environments with collapsed health systems (e.g., cholera). On the other hand, however, these interventions have failed to yield anticipated gains in population health. Antiretroviral therapy for HIV in an often-invoked example. Today, HIV treatment costs less than 300 dollars per person per year, incurs minimally toxicities, reliably restores immunological function and normalizes lifespan in an otherwise uniformly lethal condition. Yet only 50% persons living with HIV in the US have suppressed plasma HIV RNA – and thereby derive full health benefits – while globally this number is closer to 35%. HIV is not the exception, but the norm and such shortfalls play out in numerous other conditions (e.g., tuberculosis, malaria, nosocomial infections).
Although the field of Dissemination & Implementation Research (D&I) has grown rapidly, at present the research community addressing infectious diseases lacks a cohesive, robust scientific workforce dedicated to closing this broad array of gaps between promise and reality. Indeed, novel methods in implementation science achieve impact in public health when investigators with content expertise apply them to address pressing problems in the real world. The proposed training program, therefore, seeks to meet this need. We will recruit from talented emerging investigators in infectious diseases, and offering a layer of additional training and mentorship in D&I research. Titled the “HIV, Infectious Diseases and Global Health Implementation Research Institute” (HIGH- IRI), the program is modeled on successful training programs led from Washington University in St. Louis over the last decade. HIGH-IRI will use a combination of in-residence training and longitudinal mentoring to offer leading-edge technical content, individualized professional guidance and a support network to scholars. The intended outcome is the creation of a D&I research community that complements the “native” etiology-specific scientific networks of scholars. We specifically seek to:
Aim 1: Deliver rigorous training and individualized mentoring to build expertise in D&I research methods in the field of Infectious Diseases. This program will target post-doctoral scholars (PhDs, MDs) and early career scientists pursuing independent research careers in infectious diseases. We will enroll 6-8 students each year for three years, and engage each class for 24 months. We plan a week of in-residence training in each of the two years. Mentorship will occur continuously throughout the year. Funding will be available for learners to cover effort or carry out research. We will assemble a world-class multidisciplinary team of faculty with complementary expertise in implementation research and infectious diseases. Content will undergo continuous updating and improvement.
Aim 2: Build a professional network of D&I researchers to provide additional career development opportunities for participants as well as collectively elevate implementation research in the larger infectious diseases research community. In addition to training,this program also aspires to build professional relationships designed to create impact beyond the lifespan of the two-year training program for two ends. First, building strong professional bonds between scholars and with faculty will augment opportunities and collaborations otherwise unavailable for career development of participants. In addition, this network of similarly oriented scientists will be positioned to create a larger “footprint” on the field of infectious diseases than if each were acting alone. We envision this cohort will in turn inspire and train a subsequent generation of IS researchers.
The field of infectious diseases is primed for a deeper embrace of D&I science and presents a number of interlinked and unique opportunities. First, investigators trained in D&I methods will find science motivated and informed by the principles of D&I to be of high impact in the field and advance their scholarship. In addition, implementation researchers are poised to influence the priorities and investments in field of infectious diseases more generally. Concepts such as context, adaptation, external validity that are at the center of the D&I conversation address the critical issues in the field. Perspectives drawing inspiration from organizational psychology, marketing, economics, sociology and beyond promise to enhance the value of science in infectious diseases for society. This program hopes to ultimately diminish the impact of infectious disease on human health through cultivating a generation of scientists with rigorous and relevant expertise in infectious diseases and D&I.