|Delayed Adoption of New Treatments in Developing
World Costs Lives
Implementation Studies Could Reduce Gap, According to NIH Scientists
Reducing the gap between the development of new drugs and treatments
and their implementation in the developing world could save thousands
of lives each day and make more effective use of the U.S. investment
in global health, according to scientists at the Fogarty International
Center, part of the National Institutes of Health.
In a paper published in the December 14 issue of Science magazine,
Fogarty’s director Roger I. Glass, M.D., Ph.D., addresses the causes
of this implementation research gap and suggests ways it can be
reduced. "Many evidence-based innovations fail to produce
results when transferred to communities in the global south, largely
because their implementation is untested, unsuitable, or incomplete," he
writes. "For example, rigorous studies have shown that appropriate
use of insecticide-treated bednets can prevent malaria, yet on
average fewer than 10 percent of children in 28 Sub-Saharan African
countries regularly sleep with this protection."
Effective implementation in resource-poor countries is an intractable
problem for a number of complex reasons, according to the paper.
First, scientists have been slow to view implementation as a dynamic,
adaptive, multi-scale phenomenon that can be addressed through
a research agenda. Second, people living in poverty face social
constraints and health threats that make prevention and treatment
more difficult, and are less likely to have regular access to quality
Even a small investment in implementation research could dramatically
improve the situation, the paper suggests, as well as significantly
increase the effectiveness of major U.S. investments in global
health. "Instead, planners often assume that clinical research
findings can be immediately translated into public health impact,
simply by issuing 'one-size-fits-all' clinical guidelines or best
practices without engaging in systematic study of how health outcomes
vary across community settings," according to Glass.
He calls on the research community to adopt three goals to improve
implementation in the developing world. First, scientists should
work to advance theoretical models and new analytic methods that
apply to resource-poor settings. Second, they should train a generation
of researchers in interdisciplinary, systems-oriented approaches
that will allow them to more effectively bridge the implementation
gap. Finally, researchers should collaborate more closely with
developing country governments, non-governmental organizations,
and local communities.
"While implementation experiments and computational modeling
may be more complex — in terms of study design and data analysis — than
the monitoring and observational studies currently funded by donors,
any inconvenience is outweighed by the profound ability of scientifically
rigorous findings to focus limited health resources and save more
lives," Glass concludes.
The complete article titled, "Implementation Science," is
authored by Fogarty scientists Temina Madon, Ph.D., Karen J. Hofman,
M.D., Linda Kupfer, Ph.D. and Roger I. Glass, M.D., Ph.D.
The Fogarty International Center, the international component
of the NIH, addresses global health challenges through innovative
and collaborative research and training programs and supports and
advances the NIH mission through international partnerships. For
more information, visit www.fic.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.