HIV in Canada: A primer for service providers

Program Science

Key Points

  • Program science is the systematic application of scientific knowledge to improve the design, implementation and evaluation of programs.

Program science is a relatively new term that describes the systematic application of scientific knowledge to improve the design, implementation and evaluation of programs. Program science is becoming increasingly important for advancing the response to HIV in Canada and internationally. It is ideally suited to advance integrated approaches to HIV programming.

One aspect of program science is implementation research, which is concerned with the development and implementation of evidence-based interventions. Implementation research plays an important role in HIV program development by providing information about which interventions are effective and for whom. It can also provide information about how interventions can be adapted to new situations or communities. With implementation research the focus is on individual interventions.

However, program science extends beyond implementation research to also consider entire programs involving combinations of interventions for a particular population in a specific context. Various research methods are used to address questions related to holistic aspects of a program, including the following:

  • Strategic planning – On the basis of the particular context of the program, who should be targeted? When? For how long?
  • Program implementation – What is the optimal mix of interventions? How can synergy across interventions be maximized?
  • Program management – How can effective interventions be sustained? How should the program be modified as new knowledge emerges during implementation? What quality improvement processes are important?

Program science typically involves an ongoing process of engagement between researchers, policy makers, program planners, frontline workers and communities through which research is embedded into the design, implementation and continuous improvement of the overall program. Because the focus is on how an entire program impacts a population, program science typically involves consideration of overall health systems. Development and linkage of population-level databases (such as electronic health records) that provide information on testing and diagnosis of health problems, treatments prescribed, health-related outcomes and health-service usage can be important tools in program science.

The Seek and Treat for Optimal Prevention of HIV/AIDS (STOP) project in Vancouver and Prince George is one example of a recent program science initiative in Canada that illustrates many aspects of this approach to research and program development. The scientific theory of treatment as prevention was used in the project as a framework to address the continuum of HIV care. The project involved an analysis of regional epidemiological and health service access data to determine strategic priorities. An evaluation framework was created that included over 50 population-level indicators (such as number of new HIV diagnosis, number of people on HIV treatment, number of people accessing specific health services) that were monitored through provincial and regional tracking systems. Over 40 pilot projects and changes in practice or policy were implemented, regularly evaluated and modified on the basis of evaluation outcomes. On the basis of the results of the pilot project, an intensive future state planning process was completed to support sustained redesign of the system of care and services, including expansion of the program across the entire province.

Resources

Program Science 101REACH 2.0, Canadian Institutes of Health Research and the Ontario HIV Treatment Network

Program Science in Practice – REACH 2.0, Canadian Institutes of Health Research and the Ontario HIV Treatment Network

Sources

Blanchard JF, Sevgi OA. Program science: an initiative to improve the planning, implementation and evaluation of HIV/Sexually transmitted infection prevention programs. Sexually Transmitted Infections. 2011 Feb;87(1):2–3.

Parkhurst J, Weller I, Kemp J. Getting research into policy, or out of practice, in HIV? Lancet. 2010 Apr 24;375:1414–1415.

CATIE. Shifting the paradigm: The history of the Vancouver STOP HIV/AIDS Project. 2013. Available from: http://www.catie.ca/sites/default/files/stop_EN_2013_10_07.pdf