Implementation Science for HIV and AIDS


Scott Geibel, Director of Project SOAR and Population Council associate, answers questions about how the project is using implementation science in generating, translating, and using evidence to improve programming.


What is the role of Project SOAR, given the current state of the HIV epidemic?
The current context is so different compared to when I started working on HIV as a Peace Corps Volunteer in Malawi from 1996 to 1998. Twenty years ago, the primary interventions were supporting district AIDS committees, training hospital staff in pre- and post-test counseling, and conducting a lot of condom demonstrations. One of the key questions we asked ourselves at this time was “are these interventions changing behavior and reducing new infections?” Unfortunately, the public health answer was “no,” and those strategies were not very effective. The late 1990s were tough years and many people I knew and worked with had died by the mid-2000s.


Now it’s a completely different environment within which Project SOAR is operating. We have an updated set of successful tools and approaches to prevent and treat HIV, which are making a real impact on the epidemic and people’s lives. Where Project SOAR comes in is understanding how programs and services can be optimally delivered, accessed, and utilized by those who need them most.


I’m very pleased that USAID’s [U. S. Agency for International Development’s] Office of HIV/AIDS Research highlighted Project SOAR’s activities on World AIDS Day as among their “top 10 accomplishments” for 2017. They recognized our work in using implementation science to investigate innovative approaches for achieving the 90-90-90 goals. They also recognized our partnership with UNAIDS, Global Network of People Living with HIV, the International Community of Women Living with HIV, and community stakeholders to update the People Living with HIV Stigma Index—a measurement and advocacy tool to document and reduce stigma.


How is SOAR contributing to achieving UNAIDS’ 90-90-90 goals?
Together with local partners, SOAR has developed a diverse portfolio of over 50 activities in more than 20 countries. These activities are focused on the different facets of 90-90-90: HIV testing so people know their status, linking people living with HIV to care and treatment, and achieving viral suppression through adherence to antiretroviral treatment.


To give you an example, some SOAR studies are looking at how the World Health Organization’s “treat all” (or “test and start”) strategy is being operationalized in three countries in Africa: Senegal, Nigeria, and Namibia. We know that test and start can be highly effective from a public health perspective. Yet there are many programmatic questions that remain, which SOAR aims to answer: How feasible is it to implement test and start in different settings? Are people adhering to treatment and being retained in care? What role can community platforms play in promoting HIV testing, and in fostering linkage to care and adherence to treatment? Are key populations, such as sex workers and men who have sex with men, being reached? How cost-effective are these services? How can stigma, inequitable gender norms, and gender-based violence—barriers to engagement in the care continuum—be addressed?


What is SOAR doing to ensure the findings are used to inform policy and programs?
We recognize that more needs to be done to close the research to practice gap. To this end we have implemented a number of strategies. First, we ask our research teams to describe how they are going to foster research utilization. This encourages our investigators to think about which policies or programs they aim to inform with the findings, who is responsible for making changes to these policies or programs, and how these decision-makers and other stakeholders should be engaged at the beginning and throughout the study in a meaningful way. Second, we produced a resource document, Project SOAR’s Approach to Research Utilization, to guide our teams on how to ensure research uptake. It includes a variety of tools and worksheets for planning and implementing the research utilization process. Third, we are disseminating and discussing findings with different audiences throughout the research cycle—not just waiting for the end of the study to write a manuscript for a peer-reviewed journal. These audiences include USAID, PEPFAR [U. S. President’s Emergency Plan for AIDS Relief] country teams, ministries of health, local implementing partners, and research participants. For example, we have recently discussed baseline test and start study results with these stakeholders in Namibia. Sharing data throughout the course of the study keeps stakeholders engaged and lays the groundwork for their use of the findings to inform programming.


What makes SOAR uniquely placed to “move the needle” in controlling the epidemic?
There are a number of factors that make SOAR a strong actor in conducting high quality research that feeds directly into shaping the HIV response. One is the Council has been managing large operations research programs for more than 30 years. Some of our colleagues literally wrote the guidebook on how to do HIV operations research. Another is that we have a deep bench of talent from which to draw—our partners have the necessary technical and geographical expertise that enables us to be responsive to USAID’s and PEPFAR’s research agenda and needs. And finally we work with local researchers and institutions as full partners, including shaping the study from the beginning; developing data collection instruments; strengthening capacity in research utilization; and disseminating findings to local, national, and global audiences through a variety of communication channels.