Advances in Global Implementation Science at NCI

Last month, the NCI Center for Global Health launched a consortium of four specialized implementation science centers in low- and middle-income countries (LMICs). Each center, funded for 5 years, will conduct research, engage with local stakeholders, and develop capacity for implementation science for cancer control in LMIC settings. These centers span the globe and include institutions in Kenya, Mexico, Nigeria, and South Africa. The research projects cut across different cancer sites (i.e., breast, colorectal, liver, and cervix and other HPV-related cancers) and engage a variety of implementation partners, including practitioners and policymakers. To address the need to expand capacity for implementation science for cancer control in LMICs, each center includes a research capacity-building core to provide training alongside their research projects. We’ll briefly walk through the focus of each of the centers below. You can see a list of all the centers and multiple principal investigators in the table. 

The BREAKTHROUGH Center, based at Kenyatta National Hospital in Kenya and Emory University, will focus on expanding screening and linkage to treatment for breast and cervical cancers through patient navigation and the integration of information technology and mobile health in primary care. The center will also build capacity for implementation mapping with healthcare workers and patients in collaboration with oncologists and implementation scientists and develop implementation research capacity for scientists at all career levels.

The Mexico-based center, LISTOS for Cancer Control, focuses on building implementation readiness for screening, timely diagnosis, and follow-up of colorectal and breast cancers. Building upon collaborations between the National Institute of Public Health of Mexico (INSP), the National Cancer Institute of Mexico (INCan), University of California San Francisco, and the University of Texas Health Science Center at Houston, the team will address readiness for implementation in healthcare systems that serve disadvantaged populations, namely, in a public insurance healthcare system and across health services available to the uninsured.

The Nigeria-based center, C3-RISE, focuses on the use of participatory implementation science strategies (namely, crowdsourcing) to scale up HPV and HBV vaccination. The center builds upon an existing collaboration with the Nigerian Institute of Medical Research (the Nigerian equivalent of the US NIH), which informed Nigerian health guidelines and resulted in the development of a WHO/TDR practical guide on crowdsourcing for health, as well as the training of many students and faculty. Investigators in both the United States, at Washington University in St. Louis, and Nigeria now seek to expand that implementation research capacity with a focus on adaptation and sustainment of cancer prevention.

The Empilisweni Center for Women’s Health focuses on the implementation and scale up of affordable HPV-based point-of-care screen-and-treat (POC-SAT) interventions in South Africa, in alignment with the WHO global strategy to eliminate cervical cancer. After decades of collaboration on clinical trials for these POC-SAT interventions under the Khayelitsha Cervical Cancer Screening Program, Columbia University Irving Medical Center and the University of Cape Town will build implementation research capacity to address scalable delivery and innovative financing strategies for cervical cancer prevention in South Africa.

Almost two years ago, we shared news about the NCI Center for Global Health’s new strategic plan and focus on implementation science, including several funding opportunities. Since then, we are excited to report that many global implementation science grants have been funded in LMICs, and opportunities continue to grow. (See here for both funded grants and funding opportunities.) Along with NCI’s existing strong domestic portfolio in implementation science, these global projects provide unique opportunities for understanding and evaluating implementation science strategies for cancer control across diverse settings.

As NCI’s global implementation science program continues to expand, and as the centers build implementation research capacity, we welcome your thoughts on research capacity needs and ideas or tools that can support those needs. One example of such a tool is a published collection of global implementation science case studies, supported by the NIH Fogarty International Center in collaboration with NCI. Do you have tools to share or ideas to support further research capacity building? Please feel free to email us or join a future Consortium for Cancer Implementation Science (CCIS) global action group meeting. And for more information about opportunities at CGH, please visit https://www.cancer.gov/about-nci/organization/cgh/research-training-programs.