By Jacques Normand, Director, AIDS Research Program, National Institute on Drug Abuse, National Institutes of Health
Scientific evidence over the last 30 years has shown that a variety of strategies can be effective in reducing HIV transmission among injection drug users. Such strategies include drug treatment programmes, needle exchange programmes (as part of comprehensive HIV prevention), highly active antiretroviral therapy as HIV treatment and prevention, community outreach programs, education, testing and counseling, and sexual risk reduction programs. “Prevention and Treatment of HIV/AIDS among Drug Using Populations: A Global
Perspective,” describes comprehensive HIV prevention.
So now that science has told us what works, how do we implement these programmes on a scale large enough to really make a difference? For the answer, we look to implementation science, a multidisciplinary field that addresses how to scale up prevention, treatment and care services in diverse settings. Implementation science research can inform risk reduction approaches, particularly in low- and middle-income countries with a high burden of HIV disease among people who inject drugs. More specifically, this research can help to:
- illuminate discrepancies between expected results and observed outcomes across different settings
- improve the dissemination of effective interventions to reduce risk
- improve the transfer and scaling-up of interventions from one setting or population of injection drug users to another
- integrate prevention and risk reduction interventions into comprehensive strategies tailored to different geographical areas characterized by different epidemiological patterns, and
- inform choices between competing strategic approaches through comparative effectiveness studies.
Implementation science research also recognizes that structural factors in the environment such as economics, laws, policies, regulations, culture, gender, behavior and social circumstances can complicate the large-scale adoption of successful interventions. Implementation science research may be particularly useful in identifying such barriers and in testing possible approaches to counter them. For example, the lack of access to drug abuse and HIV treatment within societal systems where drug abusers find themselves – whether the criminal justice system, social services programmes, clinical or other settings–impedes people’s ability to get the help they need.
Those of us participating in the IAS conference in Rome can celebrate the expansion of scientific knowledge available to prevent and treat HIV/AIDS, even while we recognize that scientific advances in implementing effective interventions have not kept pace and that needed translation is a daunting challenge for many nations. By improving the operations and efficiency of organizing, delivering and expanding access to proven prevention, treatment and care services, implementation science research can help reduce HIV infection and related diseases on a significant and consequential scale.