Editor’s Note
Implementation Science is a relatively new and increasingly recognized field of research. Its purpose is to translate the possibilities outlined in theory into practical applications in the real world, addressing the challenges of implementing validated intervention measures. At the 2023 APACC conference, Dr. Dong Hsu, from the School of Public Health Management and the Global Health Research Center, Southern Medical University, China, delivered an insightful presentation titled “Implementation of Clinical Practice Guidelines”. In our interview, Dr. Dong Hsu further elaborated on the definition and research value of Implementation Science and shared his team’s research findings in areas such as HIV screening and health management.
Infectious Disease Frontier: Implementation Science is a relatively new discipline. Could you please introduce it briefly?
Dr. Dong Hsu: Hello, everyone. I am Dr. Dong Hsu from the School of Health Management at Southern Medical University,China, and our team is known as the Acacia Lab for Implementation Science. Our primary research focus is Implementation Science. Implementation Science is an emerging discipline aimed at promoting the real-world application of evidence-based practices. It primarily examines the challenges and solutions encountered in the dissemination, adoption, evaluation, improvement, and sustainability of evidence-based practices or new technologies. We are aware that many evidence-based practices proven to be effective in medical practice are not adopted, implemented, or sustained in clinical settings. Therefore, our research involves analyzing the issues encountered during the implementation of these practices and developing corresponding implementation strategies to overcome barriers, thus advancing the implementation of evidence-based practices.
Infectious Disease Frontier: Could you briefly introduce your team’s recent research achievements in the field of HIV?
Dr. Dong Hsu: Personally, my research primarily focuses on non-communicable disease management. However, some of our team members and collaborators have conducted research related to HIV from the perspective of Implementation Science. Let me briefly introduce two relevant studies. The first one is about HIV testing among men who have sex with men (MSM). To encourage this group to undergo HIV testing, we need innovative interventions or implementation strategies to promote evidence-based practices (i.e., HIV testing). We know that MSM often use social networking platforms to connect with others, and they often request HIV test reports from potential partners to reduce their risk of HIV infection. Dr. Chun Hao’s research at Sun Yat-sen University is quite intriguing. Together with the community, they developed an online HIV test result exchange mechanism. In this mechanism, an unverified individual must provide a testing report issued by the Disease Control and Prevention Center (CDC) before receiving the testing report from the other community. Through a randomized controlled trial, this study validated the exchange mechanism as an implementation strategy to promote HIV testing among MSM.
Another interesting implementation study is the “pay-it-forward” research mentioned by Dr. Dan Wu from Nanjing Medical University in his conference presentation. Dr. Wu’s research promotes HPV vaccination through a pay-it-forward approach. Previously, Dr. Cheng Wang from Southern Medical University’s Dermatology Hospital, Dr. Joe Tucker from the University of North Carolina, and Dr. Weiming Tang’s team also used the pay-it-forward model to encourage sexually transmitted disease testing among high-risk populations. The pay-it-forward model involves the project team initially raising some startup funds, allowing participants to receive free sexual health counseling and testing. After receiving these services, participants can choose whether to donate to cover the costs of testing for others. Donations are voluntary, and the funds raised are used to provide free sexual health counseling and testing to more people. Pay-it-forward can also be considered an implementation strategy, and this model can promote sexual health testing among HIV-positive individuals and other high-risk populations.
Additionally, Dr. Huanyuan Luo, a postdoctoral researcher at Acacia Lab, used the “audit and feedback” strategy, a widely used implementation strategy, in a project related to Chlamydia prevention at Southern Medical University’s Dermatology Hospital. The key aspect of this intervention is to provide constructive feedback to clinical doctors and public health workers to enhance their compliance with guidelines. Although audit and feedback have been used in over a hundred randomized controlled trials worldwide, the progress in this field has stagnated after more than thirty studies. The challenge lies in the broad nature of audit and feedback, with varying intervention elements and levels. Stronger evidence is needed to determine the most effective combination of implementation strategies. In summary, Dr. Luo’s research optimizes the audit and feedback strategy through innovative research design, aiming to develop and validate the most effective implementation strategy. Additionally, Dr. Luo and Dr. Siyuan Liu are conducting research on using brief verbal interventions to promote influenza vaccination. Through a randomized controlled trial, they are examining whether mentioning the option of getting a flu vaccine during vaccination appointments by nurses can increase vaccination rates. Our team is committed to finding simple and feasible interventions to promote the implementation of various evidence-based practices.
These are some of our team members’ or collaborators’ implementation studies related to infectious diseases. However, our current focus is more on non-communicable diseases. In the future, we may concentrate on AIDS patients with concurrent chronic diseases such as diabetes, hypertension, and depression, exploring how to promote the adoption, implementation, and sustainability of optimal clinical and public health practices for such populations. This may become our future research focus. Of course, Acacia Lab is more focused on implementation research related to non-communicable diseases, especially the implementation of clinical practice guidelines in this context. I believe these projects can also offer valuable insights into infectious disease research.
Infectious Disease Frontier: Could you share your views on the management of HIV-infected individuals?
Dr. Dong Hsu: I believe that managing the health of this population differs significantly from managing the health of other groups. In the management of chronic diseases, common conditions like diabetes and hypertension often do not carry a significant stigma. However, in the field of AIDS, the stigma surrounding patients is still quite severe to this day. Moreover, this group may also encompass some sexual minority communities, which can subject them to additional social pressures. Therefore, I consider eliminating stigma to be a crucial aspect of managing the health of these individuals. It’s essential to help patients integrate into the community and actively participate in their own health management.
The term “management” itself can be debated because it implies one community must accept the direction and control of another. In a recent speech, an expert also raised similar questions: how should we communicate with specific groups using language that is acceptable to them? I was inspired after listening to that presentation. I believe that the future direction of research in China should take this into account. To promote the so-called management of certain groups, we need to co-produce interventions with these communities. This is particularly important for marginalized groups. In terms of terminology and language, we should reform based on the needs of the relevant communities.
In fact, the mechanism of HIV test result exchange we mentioned earlier did not originate solely from us researchers. When Dr. Chun Hao communicated with the community, it was the community that expressed this need and provided innovative intervention methods. The role of us researchers is to refine the community’s management model, design comprehensive and feasible research plans, and then verify their effectiveness. Currently, healthcare management in our country is mainly top-down, with many patient demands left unaddressed. In future practices, I believe that we should engage in thorough communication and negotiation with the beneficiaries, working together to devise feasible intervention measures. As for the specific management model, I believe I don’t have sufficient experience in the field of AIDS to provide comprehensive recommendations at this moment.
Infectious Disease Frontier: How can management of HIV-infected individuals be approached beyond medical aspects?
Dr. Dong Hsu: HIV infection has become a manageable chronic disease, and patients can achieve lifelong survival through medication. I am more familiar with non-communicable diseases, and my experience in chronic infectious diseases is relatively limited. However, some of our team members are dedicated to research in the field of chronic infectious diseases, including HIV infection. In the past, we’ve seen many non-medical management measures in the management of non-communicable diseases. Common patients with conditions like diabetes and hypertension need to engage in self-improvement and self-management in their daily lives, independently of medical interventions. Similarly, at this conference, we’ve seen numerous reports discussing how to utilize non-medical resources to manage HIV-infected individuals. For instance, in terms of medication adherence, some methods may seem straightforward to healthcare providers, but patient compliance can be low. This raises the question of how to enhance patients’ self-management abilities. Many international studies emphasize promoting patient community support outside of healthcare institutions. As mentioned earlier, the pay-it-forward model is one example. It serves not only as an economic incentive but also as community support, simultaneously enhancing patients’ decision-making regarding their own health.
In essence, these management strategies revolve around patient-centered services or, more appropriately, people-centered services. We must view patient groups as complete individuals and jointly make decisions with them. While considering social and medical factors, we should enhance their self-management abilities. In the management of chronic diseases, relying solely on medical resources is insufficient. In the future, we need to leverage community and individual initiatives to improve patient management.
TAG: APACC 2023, Interview, HIV/AIDS, Health Management
