Track D: Implementation Science Rapporteur Summary Nancy Padian, PhD University of California, United States IAS 2015 Vancouver, Canada

IAS and Implementation Science 2001: First meeting 2003, 2005, 2007: No specific track 2009: Operations Research Track 2011, 2013: Operations and Implementation Research 2015: Implementation Science

Guided by HIV Care Cascade

The NEW HIV Care Cascade 90 90 90

Seminal Trials at IAS 2015: Building Blocks of the New Cascade 90 HPTN 052 90 90

HIV Treatment AND Prevention VMMC PrEP TaSP 90 PREVENTION 90 90

HIV Cascade Within a Larger Context Cultural/Gender Norms Stigma/Discrimination Vulnerable Populations Health Systems Integration Decentralization Task-shifting Targeted resource allocation Integrated services Community mobilization Health Policy Project “HOT POPS” “HOT SPOTS” Policy and Governance Financing Drug Policy Human and healthcare rights Reprioritization Transitional financing

Key Interventions in the First 90 Community mobilization mHealth Self-testing Partner notification Reducing stigma Economics

The First 90: Testing Community Mobilization Strategies Crowdsourcing with MSM in China Tucker Hybrid mobile community HIV testing campaigns SEARCH Trial Mothers2mothers peer support for pregnant women Shimtz Community engagement & dialogue for PMTCT HIV testing uptake Kieffer Health Information to reduce sexual partner stigma & increase HIV testing Derksen

Community Mobilization SEARCH Local Council (LC) leaders/village elders from all villages helped design and implement community mobilization during the month prior to campaign Posters & pamphlets Church & Mosque announcements Radio announcements Outreach to social gathering places Census visits Local elected political leaders conducted mobilization in the weeks leading up to the campaign to ensure maximal participation And they did this by making announcements at churches and mosques, distributing posters and pamphlets and making radio announcements

Community Health Campaigns SEARCH

The First 90: Testing Community Mobilization Strategies Crowdsourcing with MSM in China Tucker Hybrid mobile community HIV testing campaigns SEARCH Trial Mothers2mothers peer support for pregnant women Shimtz Community engagement & dialogue for PMTCT HIV testing uptake Kieffer Health Information to reduce sexual partner stigma & increase HIV testing Derksen Targeted HIV Testing Interventions Recruit & retain men using gender specific outreach SEARCH study Distribution of rapid HIV self testing amongst FSW in Kenya Thirumurthy Targeted HIV testing of older children 5-15 years with unknown HIV status in Kenya Wagner and Zimbabwe Bandason Partner notification Golden

Vast majority of FSW distributed self-tests to primary partner and ≥1 client A remarkably high proportion of participants distributed self-tests to at least one sex client. Thirumurthy et al. Kenya

Key Interventions in the Second and Third 90s Streamlined ART initiation Integration, task shifting, decentralization mHealth Economics

The Second and Third 90: Care and Retention “Test and treat” reflecting the new cascade Universal home-based testing ANRS TasP 12249 Hybrid mobile testing SEARCH Same day, observed ART Pilcher Integration, Task shifting, and Decentralization Integration of ART into primary care Rawat Community based ART delivery and supportWilkinson, Grimsrud Mothers2mothers mentor modelsSchmitz Implementation challenges of taking mHealth to scaleLester, Mbuagbwa, Muessig

individual management group VS individual management ART adherence clubs are such an alternative model of care for ART delivery. They provide a quick service option for groups of stable patients. Instead of spending most of the day at the clinic for an ART refill with each individual patient seeing a clinician and waiting in the pharmacy queue. Stable patients are managed as a group 5 times a year. They meet than 45 minutes by a lay HCW – folders are not pulled, no individual adherence counselling is provided, pre-packed drugs are dispensed to the entire group. Club patients are seen individually for clinical review or through the model referral mechanisms if they become unwell. Club members are also allowed to send a friend or family member to collect their ART supply in the group for them. Adherence Clubs Group of ~30 stable patients Meet 5 times/year for <45 min Lay HCW led Receive pre-packed ART supply Once a year clinician review Allow treatment buddy collection Wilkinson, Grimsrud

Economic Incentives NO IMPACT: Return to school initiative in South Africa to support decreased HIV risk amongst school girls Karim IMPACT: Increase uptake of VMMC in Kenya using fixed incentives Thirumurthy Retention of HIV infected women in the PMTCT cascade in DRC to improve early infant diagnosis of HIV Yotebieng

Reproductive<-> HIV <-> Tuberculosis <-> Hepatitis C <-> NCDs<->

Track D: Rapporteur Team Izukanji Sikazwe Monika Roy Nancy Padian Euphemia Sibanda