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Background Despite significant progress in the field of implementation science (IS), current training programs are inadequate to meet the global need, especially in low-and middle-income countries (LMICs). Even when training opportunities exist, there is a “knowledge-practice gap,” where implementation research findings are not useful to practitioners in a field designed to bridge that gap. This is a critical challenge in LMICs where complex public health issues must be addressed. This paper describes results from a formal assessment of learning needs, priority topics, and delivery methods for LMIC stakeholders. Methods We first reviewed a sample of articles published recently in Implementation Science to identify IS stakeholders and assigned labels and definitions for groups with similar roles. We then employed a multi-step sampling approach and a random sampling strategy to recruit participants (n = 39) for a semi-structured interview that lasted 30–60 min. Stakeholders with inputs critical to developing training curricula were prioritized and selected for interviews. We created memos from audio-recorded interviews and used a deductively created codebook to conduct thematic analysis. We calculated kappa coefficients for each memo and used validation techniques to establish rigor including incorporating feedback from reviewers and member checking. Results Participants included program managers, researchers, and physicians working in over 20 countries, primarily LMICs. The majority had over 10 years of implementation experience but fewer than 5 years of IS experience. Three main themes emerged from the data, pertaining to past experience with IS, future IS training needs, and contextual issues. Most respondents (even with formal training) described their IS knowledge as basic or minimal. Preferences for future training were heterogeneous, but findings suggest that curricula must encompass a broader set of competencies than just IS, include mentorship/apprenticeship, and center the LMIC context. Conclusion While this work is the first systematic assessment of IS learning needs among LMIC stakeholders, findings reflect existing research in that current training opportunities may not meet the demand, trainings are too narrowly focused to meet the heterogeneous needs of stakeholders, and there is a need for a broader set of competencies that moves beyond only IS. Our research also demonstrates the timely and unique needs of developing appropriately scoped, accessible training and mentorship support within LMIC settings. Therefore, we propose the novel approach of intelligent swarming as a solution to help build IS capacity in LMICs through the lens of sustainability and equity.

From 2014 to 2019, the Wits–UNC (University of Witwatersrand and University of North Carolina at Chapel Hill) AIDS Implementation Science D43 Training Program laid critical academic foundation by creating a graduate degree program in implementation science (IS) for master’s- and doctoral-level students in the Department of Epidemiology and Biostatistics at the Wits School of Public Health. Before this collaboration, funded by the Fogarty International Center (FIC) at National Institutes of Health, no IS degree existed in Southern Africa. The FIC “D43” is an international research training grant mechanism to strengthen global health research expertise through education. Historically, students from low-resource settings have been trained in health sciences at universities in the United States or the United Kingdom. This is not scalable or sustainable and therefore this D43 focused on building capacity in South Africa where HIV-related challenges are located. Consequently, South Africans and other African international students were able to apply to the newly offered program, allowing training at significantly lower costs. IS allows a systematic assessment of factors affecting the implementation of HIV interventions and in developing strategies for addressing them. It guides the successful scale-up of effective programs and informs policy to improve programs. The training aims to assist in lowering the HIV incidence rate, suppressing viral load for those infected, and meeting the UN 2030 Agenda for Sustainable Development. A second cycle of funding from 2019 to 2024 will enable the infrastructure built in the first program to train South African HIV researchers and practitioners in the field who are unable to enroll in a formal academic program.

As one of the six consortia funded through the NIH Fogarty International Center, the University of North Carolina at Chapel Hill, Johns Hopkins University, Morehouse School of Medicine, and Tulane University (UJMT) Fogarty Global Health Fellows Program provides postdoctoral trainees and doctoral students support and training for yearlong research attachments at selected low- and middle-income countries. To understand the current impact of this global health research training opportunity, the UJMT consortium conducted a crowdsourcing contest to gather creative messages to promote and improve the impact of the program in partnership with Social Entrepreneurship to Spur Health. Between January and March 2019, the contest received a total of 47 submissions from 14 countries; 44 were found eligible. After judging, 19 (41.2%) submissions received a mean score of 7 or higher. We examined both textual and descriptive submissions for emergent themes and identified a range of facilitators who can be used to further improve the training programs; examples include exceptional mentorship, acquisition of research skills, career development, personal development, and multisite training opportunities. In conclusion, the crowdsourcing mentorship contest demonstrated the feasibility and acceptability of leveraging existing research networks for community engagement and how useful information can be effectively collected to highlight the effectiveness of a program and expand the reach.

As demand for global health research training continues to grow, many universities are striving to meet the needs of trainees in a manner complementary to research priorities of the institutions hosting trainees, while also increasing capacity for conducting research. We provide an overview of the first 4 years of the Global Health Program for Fellows and Scholars, a collaboration of 20 U.S. universities and institutions spread across 36 low- and middle-income countries funded through the National Institutes of Health Fogarty International Center. We highlight many aspects of our program development that may be of interest to other multinational consortia developing global health research training programs.

For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight P interaction =0.005), but more preterm birth ( P interaction =0.043), and no effect on perinatal death or high-level neonatal care >48 hours ( P interaction =0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks ( P interaction =0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes. Clinical Trial Registration— URL: https://www.isrctn.com . Unique identifier: ISRCTN71416914.

Objective To determine how frequently health care providers taking care of women with gestational diabetes mellitus (GDM) are screening for postpartum glucose tolerance and what practice approaches they are using to care for women with GDM. Methods A mailed survey assessed health care providers' knowledge of GDM and practice patterns. Factors influencing practice protocols for measuring glucose tolerance postpartum were identified. Results Of 1,002 eligible North Carolina health professionals, 399 responded (40%); 327 of these (82%) were providing prenatal and postpartum care and returned the completed surveys. Almost all providers (98%) screen for GDM, and the majority (97%) use the 50-gram one-hour glucose challenge test. Only 27% of respondents always screen for diabetes mellitus (DM) postpartum. The most common method for screening was the 75-gram two-hour glucose tolerance test (54%). The factors most commonly associated with failure to screen were patients lost to follow-up, patient inconvenience, and inconsistent screening guidelines. A majority (59%) stated that increased reimbursement would have little to no impact on their consistency in providing diabetic counseling. Conclusions The rate of postpartum glucose tolerance testing is low in this study of providers of postpartum care. Several modifiable barriers to screening were identified. There is a need for improved screening practices and early intervention that could help prevent the complications of DM and benefit subsequent pregnancies in this high risk population.

Objectives. Given the lack of screening mammography studies specific to women with disabilities, we compared reasons offered by women with and without disabilities for not scheduling routine screening visits. Methods. We surveyed women in the Carolina Mammography Registry aged 40 to 79 years (n = 2970), who had been screened from 2001 through 2003 and did not return for at least 3 years, to determine reasons for noncompliance. In addition to women without disabilities, women with visual, hearing, physical, and multiple (any combination of visual, hearing, and physical) limitations were included in our analyses. Results. The most common reasons cited by women both with and without disabilities for not returning for screening were lack of a breast problem, pain and expense associated with a mammogram, and lack of a physician recommendation. Women with disabilities were less likely to receive a physician recommendation. Conclusions. Women with disabilities are less likely than those without disabilities to receive a physician recommendation for screening mammography, and this is particularly the case among older women and those with multiple disabilities. There is a need for equitable preventive health care in this population.