Yale University and the University of Malaya in Kuala Lumpur have received a five-year grant to establish the Malaysian Implementation Science Training (MIST) center to catalyze research and training with support from the Fogarty International Program at the National Institutes of Health.

The center began training the next generation of researchers in implementation science this summer, building on 15 years of research collaboration between the two universities to address critical issues around HIV, viral hepatitis, tuberculosis, and addiction.

“Yale is an international leader in implementation science, especially with the launch of the Center on Methods for Implementation and Prevention Science,” said Frederick L. Altice, MD, Professor of Medicine (infectious diseases) at Yale School of Medicine (YSM) and of epidemiology (microbial diseases) at Yale School of Public Health (YSPH). Altice is co-director of the MIST Center.

A goal of MIST is to train two current faculty members and two PhD students at the University of Malaya each year in implementation science methodology and research so that the university can emerge as a hub for implementation science training in Southeast Asia, said Adeeba Kamarulzaman, MBBS, Associate Professor (adjunct) of Medicine, YSM, and former Dean of the Faculty of Medicine and Professor of Medicine and Infectious Diseases at the University of Malaya. Kamarulzaman also serves as co-director of the MIST Center.

Faculty from YSM, YSPH, and the Center on Methods for Implementation and Prevention Science, (CMIPS), held a three-day MIST Summer Boot Camp in August with 194 registered attendees from Malaysia, Thailand, Philippines, and China. Lecturers included Sten H. Vermund, MD, PhD, Dean of YSPH and Anna M.R. Lauder Professor of Public Health; Frederick L. Altice; Luke Davis, MD, Associate Professor of Epidemiology (microbial diseases), YSPH and Associate Professor of Medicine (Pulmonary, Critical Care, and Sleep Medicine) at YSM; Ashley Hagaman, PhD, MPH, Assistant Professor of Public Health (social & behavioral sciences); Drew Cameron, PhD, Assistant Professor of Public Health (health policy & management), and Donna Spiegelman, ScD, Susan Dwight Bliss Professor of Biostatistics, YSPH, and inaugural director of CMIPS.

“The Yale faculty’s involvement in the program will continue to help nurture the MIST scholars for the remaining four years of the project, including the next four summer boot camps,” Altice said.

Implementation science is a relatively new discipline of research that studies methods and strategies that facilitate the uptake of evidence-based practices that improve health outcomes into routine use by practitioners and policymakers.

“The big problem is that there’s a ton of evidence-based practices, both for the treatment and prevention of diseases, but the odyssey from evidence to implementation takes, on average, about 17 years,” said Altice. Even then, “only 14% of existing, evidence-based practices get adopted,” he added.

According to Spiegelman, at CMIPS, “we've identified key strategic areas where the strength of the evidence is such that there should be little or no sickness or mortality from certain diseases that are virtually nearly fully preventable, such as HIV-AIDS, cervical cancer, colorectal cancer, and cardio-metabolic diseases – obesity, diabetes, and heart disease.” Spiegelman said. “So it's not about trying to figure out new ways to address these diseases; we have all the tools in place. The issues and the barriers all have to do with implementation and scale up.”

Altice explained that despite the availability of evidence-based HIV prevention using PrEP, pre-exposure prophylaxis, the question is, how to make it accessible. “For example, in Malaysia, where homosexuality is illegal both in secular and in Sharia law, accessing services can be challenging,” he said. “As part of implementation of PrEP, we're using a tool, mHealth, that can be a more anonymous way to communicate with people so that they can access information and services using the privacy of telehealth,” Altice explained. “In the absence of such a strategy, men who have sex with men may have to go to their primary doctor and discuss their risks with them in a setting where such stigma and discrimination abounds.”

Devising rigorous, rapid and relevant approaches to implement and scale-up evidence-based interventions is the work of MIST, which builds on over a decade of collaborative research and capacity- building between Yale University and the University of Malaysia.