Global WACh

Implementation Science Cross-Cutting Methodology

The Challenge

Despite the availability of many effective interventions to improve the health of women, adolescents, and children, major gaps in coverage, quality, and equity in the implementation of these interventions persist globally. This results in a “know–do” gap that limits real-world impact of proven interventions, diminishes the return on investment of scientific discoveries, and slows progress towards a vision of “health for all”.

Across our scientific priority areas – Gut Health and Child Survival, Family Planning and Decision Support, and HIV and Co-infections Through the Lifecycle – our focus populations of women, adolescents, and children experience suboptimal health outcomes due to gaps in implementation.

The Response

Implementation science is the systematic study of methods to close the “know-do” gap. They promote the adoption, integration, and sustainability of evidence-based interventions in practice, with the goal of improving population health and advancing equity.

At Global WACh, implementation science expertise is embedded across research portfolios. We collaborate with our research partners to develop implementation studies, including embedding implementation research into clinical trials (known as hybrid studies), in order to enhance the likelihood that research findings are more easily translated into sustainable improvements in policy and practice. 

Global WACh investigators have expertise in implementation research topics such as mixed methods, randomized and non-randomized designs, operations research, quality improvement, dissemination science, co-design and participatory methods, costing, and digital tool integration.

We test implementation strategies that range from the individual through systems level; we elucidate and test mechanisms of action; we conduct dissemination activities and study impact. Our teams have tackled questions ranging from early introduction of new effective interventions through national scale up.

Research Studies

Technical Support to the Nigerian Institute of Medical Research (SARMAAN)

The SARMAAN project will establish an implementation science Technical Support Unit at the Global Center for the Integrated Health of Women, Adolescents, and Children (Global WACh), based at the University of Washington (UW). 

Sponsor:  The Royal Commonwealth Society for the Blind (Sightsaver)

Award Years:  04/01/2022 – 12/31/2027

Principal Investigator:  Arianna Means, UW

 

AMANI: Accelerating Maternal And Neonatal survIval

Maternal and perinatal death audit and response are evidence-based practices which result in meaningful reductions in maternal and newborn deaths through health system changes and improved quality of care. We propose a cluster randomized trial, called AMANI (Accelerating Maternal And Newborn survIval), to determine if a practice facilitation implementation strategy package, including enhanced mentorship and audit and feedback components, can improve implementation of the World Health Organization’s Maternal and Perinatal Death Surveillance and Response (MPDSR) technical guidelines. We aim to evaluate if the AMANI strategy package improves both implementation outcomes and patient-level mortality outcomes, the stability of these changes over time after practice facilitation ends, and potential mechanisms through which AMANI affects change, which can inform pragmatic delivery of the AMANI package by governments in the future.

Sponsor:  National Institute of Child Health and Human Development (R01HD116777)

Award Years:  01/01/2024 – 10/31/2028

Principal Investigator: Arianna Means, UW

Insight2Impact: Determinants of evidence use in public health policy making in low-and-middle-income countries: Translation into a researcher-friendly tool

The purpose of this project is to describe determinants of evidence use (e.g. adoption of EBIs) by public health policymakers in low-and-middle-income countries (LMICs) and develop a tool for researchers that can be utilized at the point of study design.

Sponsor:  Gates Foundation

Award Years:  12/01/2024 – 02/28/2026

Principal Investigator: Arianna Means, UW

 

Probiotics: regulatory systems

Enterics for Global Health (EFGH), Shigella surveillance study, Phase C

EFGH is a multi-year facility-based, cross-sectional multi-country surveillance and longitudinal study at seven sites in Africa, Asia, and Latin America focusing on children under 36 months of age presenting with moderate-to-severe diarrhea (MSD) to generate data and quickly implement rigorous/efficient Shigella vaccine trials, accelerating the time to vaccine availability for children in low-middle income countries.

During Phases A and B, the EFGH Consortium built a robust collaborative research infrastructure to facilitate shared scientific decision making and protocol standardization, and recently completed enrollment of 9,476 participants in August 2024.

Each of the seven EFGH Consortium implementing sites and the UW coordination body received direct funding from the Gates Foundation (“Phase C”) to support results dissemination, site-led secondary data analysis, and implementation science activities to assess vaccine demand and policy maker preferences to maximize likelihood of future Shigella vaccine uptake and adoption.

Sponsor:  Gates Foundation

Award Years:  10/30/2019 – 4/30/2027

UW Coordination Site Principal Investigator: Patricia Pavlinac, UW

Implementation Sites: Asociación Benefica Prisma (PRISMA), Aga Khan University, icddr,b, Center for Vaccine Development in Mali (CVD-Mali), Malawi-Liverpool-Wellcome Trust (MLW) Clinical Research Programme, Medical Research Council Unit – The Gambia (MRCG), Emory University, University of Maryland Baltimore, University of Virginia

 

Neglected Tropical Disease Community of Practice (Kikundi 2.0)

After three years of start-up investment and platform refinement, the shared vision of BMGF and all funded partners is to continue growth of the CoP and to shift its management to Africa. In the next phase of Kikundi, University of Global Health Equity (UGHE) will lead all aspects of Kikundi management and growth and be the primary grant holder. UW will partner with UGHE as a strong thought partner, co-collaborator, and co-implementer. In Kikundi 1.0, a collaborative and effective partnership was formed between these two institutions, which will be instrumental to the successful execution of Phase 2. UW will provide strategic partnership and will be the lead in developing and supporting NTD Progam Managers to participate in novel training opportunities and provide support for M&E of the platform.

Sponsor:  Gates Foundation

Award Years:  4/216/2024 – 3/31/2027

Principal Investigator: Arianna Means, UW

 

Lishe Salama

Scaling up integrated PrEP delivery in Kenyan maternal and child health clinics for pregnant and postpartum women (PrEPARE Scale Up)

Pregnancy is a high-risk time for acquiring HIV; pre-exposure prophylaxis (PrEP) is an effective, woman- controlled, evidence-based intervention that is recommended during pregnancy in high-risk settings. In Kenya, PrEP is being delivered in some regions during pregnancy and postpartum integrated into maternal and child health services, but scale-up has been sub-optimal. This project aims to develop a community of practice; then test a combination of community of practice, quality improvement, and a training toolkit, to enhance implementation and clinical outcomes; and identify patterns attributes associated with successful implementation.

Sponsor:  National Institute of Mental Health (R01MH135730)

Award Years:  01/01/2024 – 10/31/2028

Principal Investigators:  Anjuli Wagner, UW; John Kinuthia, Kenyatta National Hospital

 

Scale-up of an evidence-based Adolescent Transition Package to support transitional care among youth living with HIV (ATTACH Scale)

Ending the HIV epidemic for youth living with HIV (YLH) will require implementation and optimization of evidence-based interventions that address barriers to treatment. The proposed implementation study will test a youth-led data-driven implementation strategy to scale-up an evidence-based Adolescent Transition Package (ATP) aimed at improving transition processes and post-transition clinical outcomes for YLH in Kenya.

Sponsor:  National Institute of Mental Health (R01MH136897)

Award Years:  07/01/2024 – 06/30/2029

Principal Investigator:  Grace John-Stewart, UW

 

RISE: Dissemination & Engagement Core

“Researching Interventions and Implementation Strategies to Evaluate the Health and Development of Children with Perinatal HIV Exposure in Southern and Eastern Africa” (RISE), is designed to:

  1. Generate evidence on mechanisms underlying neurodevelopment disparities of CHEU compared to their peers born HIV-unexposed;
  2. Test a package of interventions offered in pregnancy through a child’s second year of life to optimize neurodevelopment;
  3. Validate a risk score designed to identify CHEU at risk for suboptimal neurodevelopment and use an implementation science approach to assess the acceptability and feasibility of introducing the risk score tool into routine child health visits; and
  4. Use routinely collected regional and national health data, as well as data around social determinants of health to quantify health and neurodevelopmental disparities between populations of CHEU and CHU to facilitate iterative data-driven improvement of maternal-child health policy and programming by addressing identified disparities.

It will be of significant public health importance to minimize the time from evidence generation from RISE Projects to policy and programming implementation. In order to close this “know-do” gap, the RISE Dissemination and Engagement Core will support three RISE Projects teams in Botswana, Kenya, South Africa and Zimbabwe to:

  • Engage key stakeholders in each country to map the network of partners and community collaborators (PCC) and their priorities for evidence in the care of CHEU, convening workshops with representatives of Ministries of Health and Education, local health institutions and non-governmental organizations, community gatekeepers, advocates for children HIV-exposed uninfected, and representatives of international organizations and NGOs (e.g. WHO, UNICEF, UNAIDS);
  • Develop a country-tailored dissemination toolkit for each RISE project, modifying the toolkit further by engaging PCC for additional input; and
  • Supporting RISE country teams to disseminate RISE Project research findings to national and subnational PCC, and to international organizations, with post-dissemination assessment of penetration and impact on policy and programming.

Sponsor: National Institute of Child Health and Human Development (U19HD118601)

Award Years: 09/17/2025 – 08/31/2030

Principal Investigators: Grace John-Stewart, UW; Dalton Wamalwa, University of Nairobi; Kathleen Powis, Botswana Harvard Partnership; Andrew Prendergast, Queen Mary University of London

 

RISE Project 3: Implementation outcomes and cost-effectiveness of developmental monitoring for children exposed to HIV (IMPLEMENT)

Our objective is to evaluate the implementation outcomes and cost-effectiveness of various developmental screening and intervention approaches in diverse high HIV prevalence regions, which we will achieve in the following aims: 1) Validate and pilot a predictive risk score tool and evaluate its implementation and usability compared to the GSED within routine MCH clinic visits in Kenya, Botswana, and South Africa; 2) Identify determinants of implementation, acceptability, feasibility, appropriateness, and cost of incorporating Project 2 (BONDS Study) neurodevelopment (ND) evaluation and interventions (Friendship Bench, optimal nutritional guidance, and parent-child play counseling) in Botswana, Kenya, and Zimbabwe. and 3) Determine the cost-effectiveness of universal versus HIV-exposure status-based screening, and the cost-effectiveness and budget impact of the Project 2 intervention bundle for ND within MCH care in contexts with different HIV prevalence. This study will provide critical, concrete guidance to policymakers to inform early, contextually specific policies for implementing ND screening, diagnostics, and therapeutics within programmatic settings with high HIV prevalence.

Sponsor: National Institute of Child Health and Human Development (U19HD118601)

Award Years: 09/17/2025 – 08/31/2030

Project Director: Anjuli Wagner, UW

A SMS-based Support Intervention to Enhance PrEP Adherence during Pregnancy and Breastfeeding (mWACh-PrEP)

We propose a randomized trial to determine the effect of the mWACh-PrEP tool on PrEP adherence during pregnancy through the postpartum period. We will also gather data on cost and delivery using the Proctor Implementation Outcomes Framework to expedite translation into routine practice. Our overarching hypothesis is that mWACh-PrEP will improve PrEP adherence among mothers at-risk for HIV, be acceptable to patients and providers, and be cost-effective.

Sponsor:  National Institute of Nursing Research (R01NR019220)

Award Years:  09/18/2020 – 06/30/2026 (extended)

Principal Investigator: Jillian Pintye, UW; John Kinuthia, Kenyatta National Hospital, UW

 

Integrating a transdiagnostic psychological intervention in the care for adolescents and youth with HIV in Kenya (PROACT)

The investigators at the University of Washington will contribute expertise on adolescents living with HIV in African contexts and implementation science theoretical frameworks that guide study activities, and will assist in the application of implementation science tools and analysis of implementation science outcome data. 

Sponsor: National Institute of Mental Health (R01MH133261)

Award Years: 08/01/2023 – 05/31/2028

Principal Investigator: Dalton Wamalwa, University of Nairobi

 

Integration of Stepped Care for Perinatal Mood and Anxiety Disorders Among Women Living with HIV in Kenya (IPMH)

Researchers from Kenyatta National Hospital and the University of Washington have identified three interventions to promote perinatal mental health: (1) universal mental health screening, (2) the Problem Management Plus (PM+) counseling intervention for women experiencing PMAD, and (3) telepsychiatry for women with severe symptoms or no response to PM+. They will combine these interventions in a stepped care model (named the Integrated Perinatal Mental Health Program), develop implementation strategies to support its integration into routine MCH care in Kenya, and evaluate effectiveness and implementation outcomes of the package in a cluster-randomized trial in 20 healthcare facilities in Western Kenya.

Sponsor: National Institute of Mental Health (RF1MH133266)

Award Years: 09/19/2023 – 07/31/2028

Principal Investigator: John Kinuthia, Kenyatta National Hospital, UW; Amritha Bhat, UW; Keshet Ronen, UW