Although significant resources have been invested in HIV programs, Uganda is still far from the universal access target of 80%. While the potential to turn the tide on the global epidemic has never been greater, success will require that evidence-based interventions become part of routine care. We believe that the most urgent question in HIV/AIDS today is how to implement and disseminate proven public health interventions. Engagement in care is the interface between patients and the public health system. Research on how to engage patients is required to optimally deliver care. Since the late 1980s, a number of large collaborations were developed in Uganda for research in HIV, tuberculosis, and malaria, and many of these have been highly successful. However, there has been insufficient focus on implementation science research to strengthen the response to the HIV epidemic. The tools to prevent HIV and to optimally provide HIV care and treatment are available and proven, and successful public health now depends on efficient and effective delivery- through patient engagement- across the cascade of care. We propose to use the implementation science framework to bring multi-disciplinary perspectives to bear on timely identification of HIV-infected individuals, accelerated linkage to care, appropriate initiation of antiretroviral therapy, and retention of HIV-infected patients in care. Medical care engagement and treatment adherence among HIV-infected individuals will allow antiretroviral medications to reach their optimal public health impact. Makerere University is the highest ranked university in East Africa and the medical school has been at the center of the response to HIV/AIDS for two decades. Makerere University College of Sciences (MakCHS) has collaborated with UCSF for over three decades on a range of scientific studies and is currently collaborating on a number of NIH funded research and training grants. We plan to leverage this foundation to create a world-class platform for implementation science to study the cascade of care. The goal of this planning grant is to develop an application for a comprehensive research training program in Implementation Science Research (ISR) focused on engagement in care at MakCHS. The training program will build on established HIV research and care programs to impact upon public health. The specific objectives of this planning grant are to: (1) formalize a planning committee to develop and submit a full application, (2) solidify ongoing collaborative research activities between MakCHS and UCSF and form new linkages, (3) conduct a systematic survey to assess existing research and training capacity in ISR at MakCHS, (4) define a pool of potential trainees that could be recruited for ISR training, and (5) develop a training plan tailored to identified needs. These objectives will be met through a series of planning exercises between investigators at MakCHS, UCSF, the Uganda MOH and other collaborating groups.
Engagement across the cascade of care from testing, linkage, treatment and retention for HIV infected patients in resource-limited settings is crucial for an efficient and effective response to the HIV epidemic. Implementation science provides a novel framework to systematically study the translation of scientific advancement into routine HIV service delivery in Uganda.