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Sustaining Global Capacity for Implementation Research for Health in Low- and Middle-Income Countries and Small Island Developing States

November 2 - 18, 2020
Virtual Workshop

Description

The National Heart, Lung, and Blood Institute (NHLBI) convened a virtual workshop with domestic and international experts in global health, research training and implementation research to explore challenges and opportunities for advancing implementation research training and capacity building in low-and middle-income countries (LMICs) and Small Island Developing States (SIDS).

Background

Noncommunicable diseases (NCDs), such as heart disease, diabetes, chronic respiratory disease, and cancer are the leading causes of death globally and are responsible for 7 out of 10 deaths worldwide. According to the Centers for Disease Control and Prevention, 85% of premature NCD deaths occur in LMICs. Changing social, economic, and structural factors have contributed to the rise of NCDs in LMICs and SIDS, which can perpetuate poverty and burden fragile health systems. Implementation research to address this crisis with evidence-based interventions is needed. Barriers and facilitators for implementation research training in LMICs and SIDS are not well understood. An NHLBI-supported workshop explored challenges and opportunities to develop and enhance implementation research capacity and training within the LMIC and SIDS settings.

Purpose and Objectives

The workshop’s purpose was to inform the ongoing implementation of the NHLBI Strategic Vision regarding 1) the development of a workforce and resources for global health research and 2) implementation research challenges for studying delivery of proven effective interventions in LMICs and SIDS.

The objectives were to: 1) convene an expert panel and 2) discuss challenges and opportunities for developing capacity and training in LMICs and SIDS.

During the six sessions of the workshop, scientific opportunities for building research capacity and training were highlighted. Sessions 2 – 5 included panel discussions on key topics that impact implementation research in LMICs and SIDS. The following summary highlights key themes.

Session 1: Opening Plenary

  • As the NCD burden in LMICs and SIDS continue to rise, the need for building implementation research capacity to support scale-up and spread of proven effective interventions is critical.
  • Keynote Speaker: Salim Yusuf, MD, DPhil, MRCP “Challenges in Building Clinical Research Capacity in LMIC Setting.”

Session 2: Current Research Capacity and Research Training in LMICs

  • While there are critical opportunities to advance the global health implementation research agenda, several areas of concern exist, like the political and economic infrastructure of LMIC health systems.
  • Strategies from previous research initiatives demonstrated the promise of research capacity to inform domestic and global health interventions and implementation scale-up in low-resource settings.

Session 3: Risk Factors for Heart, Lung, Blood, and Sleep Disorders: Clinical, Behavioral, and Social Determinants in LMICs

  • Health differences within countries might be more significant than across countries. Outcomes can vary greatly within countries, and risk factors may have different impacts depending on regional context.
  • These within-country challenges further complicate the wide-scale implementation of evidence-based guidelines and emphasize the need for implementation research across settings and environments using multidisciplinary approaches within a cultural context.

Session 4: Current Models of Successful and Sustainable Research Capacity Building Programs and Their Impact

  • Key elements for successful capacity building models include partnerships among trainees, institutions, academia, communities, and funding agencies; cultural validity; stakeholder engagement; sustainability; and multidisciplinary approach.
  • The importance of partnerships across the spectrum of stakeholders within capacity development efforts is crucial for success.
  • Early Stage Investigators (ESIs) were asked to submit innovative, feasible, and sustainable research capacity building models. Among the 11 meritorious abstracts submitted, three authors were chosen to join the Expert Panel and presented their abstracts in this session.

Session 5: Capacity Needed to Develop and Test Implementation Strategies

  • Importance of communication across stakeholders, including the individual/family/community, health care providers, the health system, and government.
  • Strategic partners are from both within and outside the health sector.
  • COVID-19 efforts were recognized as an opportunity to make new partnerships across disciplines where collaboration has been difficult.

Session 6: Current and Future Opportunities, Closing Plenary, Workshop Summary and Next Steps (Keynote)

  • Successful implementation research actively engages policymakers and community stakeholders in all phases of research, includes interdisciplinary teams, and supports pathways for capacity building.
  • Keynote Speaker: Agnes Binagwaho, MD, PhD "Information Sharing, Implementation Science Research and Capacity Building: Keys to Strengthening Health Systems."

Publication Plans:

The Expert Panelists and the Planning Committee plan to disseminate proceedings in a workshop report as a joint publication in a peer-reviewed journal, highlighting the lessons learned and scientific opportunities for developing and sustaining global capacity for implementation research in LMICs and SIDS.

NHLBI Contact:

Makeda Williams PhD, MPH
Center for Translation Research and Implementation Science
National Heart, Lung, and Blood Institute
National Institutes of Health
willimak@mail.nih.gov

 

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Recap

In this recording of the November 2, 2020 keynote session of the workshop, Salim Yusuf, MD, DPhil, MRCP, Professor, Division of Cardiology, Department of Medicine, McMaster University, Canada discussed the importance of conducting clinical and population research in LMICs; challenges in health research and health in LMICs; regional, cultural and international barriers to health research; and potential opportunities and successful examples of research capacity building initiatives in LMICs. Professor Yusuf emphasized the need for developing research career opportunities and implementing a “coordinated, tailored and evolving strategy” for building research capacity in LMICs.

In this recording of the November 18, 2020 keynote session of the workshop, Agnes Binagwaho, MD, PhD, Vice Chancellor, University of Global Health Equity, Rwanda, discussed the status of implementation research in LMICs, the challenges faced, and mechanisms to overcome challenges. She discussed the need for implementation research to implement evidence-based interventions, examined challenges preventing IR in LMICs, explored how sustainable implementation research could be incorporated into the health sector of LMICs, and provided an example of an implementation research project in the LMIC context. Professor Binagwaho highlighted transferable lessons for conducting implementation research in LMICs, and how these implementation research lessons can strengthen health systems.

 

Agenda

8 AM to 9:45 AM US Eastern Time
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Session 1: Opening Plenary

Session Moderator:

  • Makeda J. Williams, PhD, MPH, Global Health Program Director, National Heart, Lung, and Blood Institute, National Institutes of Health, USA 

Welcome and Workshop Overview:

  • George Mensah, MD, FACC, FCP(SA) Hon, Director, Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, USA 

Opening Remarks:

  • Roger Glass, MD, PhD, Director, Fogarty International Center, National Institutes of Health, USA 

Keynote Presentation: 

  • Introduction of Keynote Speaker
    • George Mensah, MD, FACC, FCP(SA) Hon, Director, Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, USA
  • “Challenges in Building Clinical Research Capacity in LMIC Setting”
    • Keynote Speaker: Salim Yusuf, MD, DPhil, MRCP, Professor, Division of Cardiology, Department of Medicine, McMaster University, Canada
  • Open Discussion
    • Moderator: Catherine Stoney, PhD, FABMR, FAPA, Deputy Director, Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, USA

10 AM to 12 PM US Eastern Time
-
Session 2: Burden of Disease and Current Research Capacity and Research Training in LMICs

Session Moderator:

  • Cheryl Anne Boyce, PhD, Chief, Implementation Science Branch, Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, USA

Panel Members:

  • Chair: Agnes Binagwaho, MD, PhD, Vice Chancellor, University of Global Health Equity, Rwanda
  • Panel Experts:
    • Karen Sliwa-Hahnle, MD, PhD, FESC, FACC, FAHA, DTM & H, Director of the Hatter Institute for Cardiovascular Research in Africa and President of World Heart Federation, University of Cape Town, South Africa
    • David Peters, MD, DrPH, Edgar Berman Professor and Chair, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, USA
    • Judith Wasserheit, MD, MPH, Chair, Department of Global Health, University of Washington, USA
    • Gerald Bloomfield, MD, MPH, Associate Professor, Medicine and Global Health, Global Health Institute, Duke University, USA
    • RADM Nancy Knight, MD, Director, Division of Global Health Protection, Centers for Disease Control and Prevention, USA
    • Girardin Jean-Louis, PhD, Professor of Population Health and Professor of Psychiatry, New York University School of Medicine, USA

8 AM to 10 AM US Eastern Time
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Session 3: Risk Factors for HLBS: Clinical, Behavioral, and Social Determinants (SD) in LMICs

Session Moderator:

  • Marishka Brown, PhD, Program Director, National Center on Sleep Disorders Research, National Heart, Lung, and Blood Institute, National Institutes of Health, USA

Panel Members:

  • Chair: K. Srinath Reddy, MD, DM, MSc, President, Public Health Foundation of India
  • Panel Experts:
    • Archana Shrestha, PhD, MPH, Associate Professor, Department of Public Health, Kathmandu University School of Medical Sciences, Nepal 
    • Karen Emmons, PhD, Professor of Social and Behavioral Sciences, Department of Social and Behavioral Sciences, Harvard H.T. Chan School of Public Health, Harvard University, USA
    • Ivor Benjamin, MD, FAHA, FACC, Director, Cardiovascular Center; Professor, Medicine, Physiology, Pharmacology and Toxicology, Cell Biology, Neurobiology and Anatomy, and Surgery, Medical College of Wisconsin, USA
    • K.M. Venkat Narayan, MD, MSc, MBA, Ruth and O.C. Hubert Professor of Global Health and Epidemiology, Rollins School of Public Health, Emory University, USA
    • Adolfo Rubenstein, MD, MSc, PhD, Director, Center for Implementation and Innovation in Health Policies, Buenos Aires, Argentina

2 PM to 4:15 PM US Eastern Time
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Session 4: Current Models of Successful and Sustainable Research Capacity Building Programs and Their Impact

Session Moderator:

  • Shimian Zou, PhD, Program Director and HIV/AIDS Coordinator, Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, National Institutes of Health, USA

Panel Members:

  • Chair: Julie Makani, MD, PhD, FCRP, Associate Professor, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences
  • Panel Experts:
    • Mark Huffman, MD, MPH, Quentin D. Young Professor of Health Policy and Associate Professor of Preventive Medicine and Medicine-Cardiology, Northwestern University, USA
    • Guerda Nicolas, PhD, Professor, Department of Educational and Psychological Studies, School of Education and Human Development, University of Miami, USA
    • Brian Oldenburg, B.Sc, MPsychol, PhD, Chair, Non-Communicable Diseases Unit and Director of the WHO Collaborating Centre for Implementation Research and Prevention and Control of NCDs, The University of Melbourne, Australia
    • Ghada El-Hajj Fuleihan, MD, MPH, Professor of Medicine, American University of Beirut, Lebanon
    • Jaime Miranda, MD, MSc, PhD, FFPH, Director, CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Peru
    • Anushka Patel, MBBS, SM, PhD, FRACP, FCSANZ, Vice Principal Director & Chief Scientist, The George Institute for Global Health, Australia
    • Three Early Stage Investigators

8 AM to 10 AM US Eastern Time
-
Session 5: Infrastructure Needed to Develop and Test Implementation Strategies

Session Moderator:

  • LeShawndra Price, PhD, Director, Office of Research Training and Special Programs, National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA

Panel Members:

  • Chair: Margaret Lartey, MBChB, MSc, MPH, FGCPS, FWACP, Dean, School of Medicine and Dentistry, University of Ghana
  • Panel Experts:
    • Lara Dugas, PhD, MPH, Associate Professor, Department of Public Health Sciences, Loyola University Chicago School of Medicine, USA
    • RADM Nancy Knight, MD, Director, Division of Global Health Protection, Centers for Disease Control and Prevention, USA
    • Corrado Cancedda, MD, PhD, Professor, Center for Global Health, Perelman School of Medicine, University of Pennsylvania, USA
    • Olugbenga Ogedegbe, MD, MPH, FACP, Professor of Population Health & Medicine, Chief Division of Health & Behavior and Director Center for Healthful Behavior Change in the Department of Population Health, New York University School of Medicine, USA
    • Archana Shrestha, PhD, MPH, Associate Professor, Department of Public Health, Kathmandu University School of Medical Sciences, Nepal
    • Ghada El-Hajj Fuleihan, MD, MPH, Professor of Medicine, American University of Beirut, Lebanon

9 AM to 11:55 AM US Eastern Time
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Session 6: Current and Future Opportunities, Closing Plenary, Workshop Summary and Next Steps

Session Moderator:

  • Kathleen Fenton, MD, MS, Deputy Branch Chief, Advanced Technologies and Surgery Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, USA

Panel Members:

  • Chair: Rajendra Koju, MD, Dean, Kathmandu University School of Medical Sciences, Nepal
  • Panel Experts:
    • Agnes Binagwaho, MD, PhD, Vice Chancellor, University of Global Health Equity, Rwanda
    • Judith Wasserheit, MD, MPH, Chair, Department of Global Health, University of Washington, USA
    • Pablo Perel, MD, MSc, PhD, Director of Center for Global Non-Communicable Diseases and Professor of Clinical Epidemiology, London School of Hygiene and Tropical Medicine, UK
    • Peter Kilmarx, MD, Deputy Director, Fogarty International Center, National Institutes of Health, USA
    • Cudjoe Bennett, DrPH, MPH, Senior Research and Knowledge Management Advisor, Office of Maternal and Child Health and Nutrition, United States Agency for International Development, USA

Closing Plenary

Keynote Presentation:

  • Introduction of Keynote Speaker
    • LeShawndra Price, PhD, Director, Office of Research Training and Special Programs, National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA
  • "Information Sharing, Implementation Science Research and Capacity Building: Keys to Strengthening Health Systems"
    • Keynote Speaker: Agnes Binagwaho, MD, PhD, Vice Chancellor, University of Global Health Equity, Rwanda
  • Open Discussion
    • Moderator: Catherine Stoney, PhD, FABMR, FAPA, Deputy Director, Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, USA

Workshop Summary and Next Steps

  • Overall Workshop Summary:
    • Michael Engelgau, MD, MS, Visiting Scientist and Former Deputy Director, Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, USA
  • Next Steps and Actions:
    • Makeda J. Williams, PhD, MPH, Global Health Program Director, National Heart, Lung, and Blood Institute, National Institutes of Health, USA
  • Closing Remarks and Workshop Adjournment:
    • George Mensah, MD, FACC, FCP(SA) Hon, Director, Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, USA