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

2. 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

3. Guided by HIV Care Cascade

4. The NEW HIV Care Cascade90 90 90

5. Seminal Trials at IAS 2015: Building Blocks of the New Cascade90
HPTN 052 90 90

6. HIV Treatment AND Prevention
VMMC
PrEP
TaSP 90
PREVENTION 90 90

7. 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

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

9. 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

10. 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

11. Community Health Campaigns
SEARCH

12. 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

13. 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

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

15. 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

16. 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

17. 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

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

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