“Implementation science is the study of methods to promote the adoption and integration of evidence-based practices, interventions, and policies into routine health care and public health settings to improve the impact on population health.” – National Institutes of Health.
The Global Implementation Science Lab work towards the development of effective and impactful solutions to global health challenges.
For the past two decades, we have helped lead a global team of scientists to successfully explore interventions that combine public health education and stewardship around Tuberculosis (TB), Coronavirus (COVID-19), respiratory infections, hypertension, and diabetes at the point of clinical care delivery. We also focus on combined strategies involving social inclusion, gender responsiveness, and poverty reduction in China, the Philippines, Indonesia, Pakistan, Nepal, Bangladesh, Uganda, Ghana, and Swaziland.
Our current projects in global health focus on clinical health interventions in antimicrobial resistance (AMR), TB, COVID-19, hypertension, and diabetes prevention and control in low- and middle-income countries (LMICs). Our research domain include: operational research, randomized controlled trials, and cohort studies; primary care reform and policy evaluation.
We warmly welcome inquiries about our work:
Director – Global Implementation Science Lab.
Associate Professor – Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Chair – Global Health Policy, Dalla Lana School of Public Health.
Secretary– General and Executive Board Member – The International Union Against Tuberculosis and Lung Diseases, Paris, France.
Fellow – Faculty of Public Health, UK; FFPH (distinction).
Visiting Senior Lecturer – Nuffield Centre for Internation Health and Development, University of Leeds, Leeds, UK.
Visiting Professor – Centre for Health Policy and Management (School of Health Care Management), Shandong University, Jinan, China.
Members – The International Union Against Tuberculosis and Lung Disease, American Thoracic Society, Health Systems Global.
As a physician, public health specialist, and public health researcher, I have trained and taught in China (including Hong Kong), the UK and Canada. For the past 20 years, I have helped lead a global team of scientists to successfully explore interventions that combine public health education and stewardship around TB, respiratory infections, hypertension and diabetes at the point of clinical care delivery. I also focus on combined strategies involving social inclusion, gender responsiveness and poverty reduction in China, the Philippines, Indonesia, Pakistan, Nepal, Bangladesh, Uganda, Ghana, and Swaziland.
Victoria Haldane (MPH) is currently a PhD student in Health Services Research at the Institute of Health, Policy, Management and Evaluation, University of Toronto. Her dissertation work, funded by the Canadian Institute of Health Research (CIHR) Doctoral Award (CGS-D), is a mixed methods process evaluation of an eHealth intervention to support persons living with tuberculosis adhere to their medications in Tibet, China. She is also a University of Toronto Global Scholar with the Dalla Lana School of Public Health. She holds a Masters in Public Health from Chinese University of Hong Kong and previously worked at National University of Singapore and Duke NUS Medical School. She is a founding member and Co-President 2020/2021 of Emerging Leaders for Environmental Sustainability in Healthcare (ELESH), intern at the Centre for Sustainable Health Systems and Planetary Health Alliance Campus Ambassador 2020/2021. Her research interests include implementation science, program evaluation for complex interventions, equitable access to care, health systems resilience and making our health systems better for people and the planet.
Zhitong Zhang is currently a Research Associate in the Dalla Lana School of Public Health, University of Toronto (from June 2019) and Visiting Senior Research Fellow in the School of Medicine, University of Leeds (from June 2018). He has been working as the manager and office director of the China Global Health Research and Development Center in Hong Kong sponsored by the Nuffield Centre for International Health and Development, and a trial coordinator in Shigatse Centre for Disease Control and Prevention in China since receiving his Master of Public Health degree in the Chinese University of Hong Kong in 2012. His main research interests are health policy evaluation and service delivery in primary care. He has participated in and have managed several projects including 1) cluster randomized controlled trials on cardiovascular diseases risk reduction in Zhejiang Province, China and antimicrobial stewardship in Guangxi and Guangdong Province, China; 2) individual randomized controlled trial to improve medication adherence of tuberculosis patients in Tibet, China; 3) survey on diagnosis and treatment experience of multi-drug resistant tuberculosis patients in Shandong Province, China, and 4) implementation research to improve COVID-19 patient management in China, Philippines and Sri Lanka.
David W. Dick is a Postdoctoral Fellow and is developing mathematical models to build understanding of the Coivd-19 pandemic and the impact of public health interventions. He earned his PhD in Applied Mathematics from Western University researching the multi-scale evolution of HIV-1. David is interested in using a data driven approach, applying the tools of mathematical modelling to elucidate virus evolution and dynamics.
Qi (Mary) Ma is a Research Associate currently working at Dalla Lana School of Public Health, University of Toronto. She was first trained as a Molecular Biologist at the University of California San Diego (UCSD) where she specialized in Cancer Research in areas of small molecules and antibodies for drug discovery. Since completing her Master’s of Health Informatics degree from the University of Toronto, she want to combine her multidisciplinary studies in research, medicine, and information technology to Global Health research
1. Post-Doctoral Fellows in Implementation Science (2 Positions)
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2. Post-Doctoral Fellow for Epidemiological Analysis and Modelling (1 Position)
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Projects on Coronavirus 2019 (COVID-19)
Developing integrated guidelines for health care workers in hospital and primary healthcare facilities in response to COVID-19 pandemic in low- and middle-income countries (LMICs).
Our study aims to develop an integrated plan for HWCs in low-and middle-income countries (LMICs) to respond to the COVID-19 pandemic. Using lessons learned from the initial COVID-19 outbreak in Wuhan, China, we are collaborating with HCWs and non-governmental organizations (NGOs) in the Philippines and Sri Lanka to develop contextually specific guidelines and training modules for frontline HCWs responding to the COVID-19 pandemic.
With local researchers in the Philippines, we will first develop and pilot test guidelines and training videos. Next, in Sri Lanka, we will work with local researchers to adapt these materials to the local context. Through guidelines and training videos, our work aims to familiarize frontline HCWs with updated information so as to support them in operationalizing a contextually appropriate and robust COVID-19 response plan. Specific guidelines components include personal protection equipment (PPE) and infection prevention and control requirements, recommendations to improve hospital workflow, reduce nosocomial infections, and fear and stigma reduction among patients with suspected cases of COVID-19.
Our team consists of leading researchers from Canada, the Philippines, and Sri Lanka with previous infectious disease research and program implementation experience – this will enable us to quickly mobilize resources to create contextually appropriate and comprehensive guidelines and training materials to support frontline HCWs. This work is funded by the Canadian Institutes for Health Research (CIHR).
Progress (Updated on May 26, 2020)
• Guidelines developed for hospital and primary care facilities in the Philippines.
• Ethics approval received by all institutions for evaluation work in the Philippines.
Publications (Updated on May 26, 2020)
• Submitted for review.
PI: Xiaolin Wei, Dalla Lana School of Public Health, University of Toronto, Canada
Collaborators: Sudath Samaraweera, Warren Dodd, Lincoln Lau, Savithiri Ratnapalan, James Wallace, Peter Selby, Ross Upshur, Garry Aslanyan, Jia Xue, Victoria Haldane, Freida Chavez
Funding Agency: Canadian Institute for Health Research
Developing a preparedness plan for rapid integrated response to the 2019 novel Coronavirus outbreak in China involving with hospital and primary healthcare providers.
Early in the COVID-19 outbreak in China, Guangdong province reported the second highest incidences of confirmed COVID-19. At that time in China a major challenge to the COVID-19 response was transmission from individuals who were asymptomatic or had subclinical symptoms. Additionally, nosocomial transmission from symptomatic but unconfirmed COVID-19 patients to others posed a major public health challenge as symptoms may be difficult to be distinguished from the common seasonal flu, and available test kits (RT-PCR) used to confirm COVID-19 cases were in short supply. In response to these circumstances, this study aims to create a revised preparedness guideline for hospital and community health care workers to effectively manage the COVID-19 outbreak.
This is being conducted in two communities in Guangdong in both urban and rural settings. We developed a concise guideline and job aids to provide contextually relevant information on patient triage, treatment, infection control, communication, as well as guidance on health promotion and psychological interventions. This guidance was based on Chinese national clinical guidelines and WHO technical guidance for COVID-19 case investigation, clinical care and community management for health workers in hospitals, primary care facilities and communities. This work is funded by the Bill & Melinda Gates Foundation.
Progress (Updated on 25 May 2020)
• Guidelines developed for hospital and primary care facilities
• Questionnaires developed for baseline survey
Funding Agency: Bill & Melinda Gates Foundation
Projects on Anti-Microbial Resistance (AMR) and Primary Care
Antibiotic stewardship program in primary care facilities to reduce inappropriate antibiotic prescriptions for acute respiratory tract infections: a clustered randomized controlled trial and follow-up study in rural China.
Antibiotic resistance is accelerated by the misuse and overuse of antibiotics, as well as poor infection prevention and control. In China, the Chinese Ministry of Health (MOH) has issued policies to regulate the use of antibiotics; however, these policies have not been effectively enforced in rural primary care facilities. The misuse of antibiotics continues to be a challenge in rural areas where health workers often lack the training and medical knowledge to prescribe antibiotics appropriately and government policies are not actively followed.
Shaoguan is one of the poorest cities in Guangdong province, China. Primary care in rural areas is provided by public township hospitals and private village clinics. Each township hospital covers 50,000 to 100,000 people and typically has less than 100 beds and 20-40 family physicians. We aim to improve the current practice of antibiotic prescribing by establishing an antibiotic stewardship program in primary care facilities in Shaoguan for family physicians and patients and their caregivers. The intervention strategies include training sessions, peer-review meetings, improving electronic medical records, and a smart phone application to facilitation and improve health education.
This study is a parallel-group, cluster-randomised, controlled, superiority trial with blinded outcome evaluation but unblinded treatment, and one of the first trials to evaluate the effectiveness of an antibiotic stewardship program in primary care setting in a low-and middle-income country (LMIC).
- (Updated on 25 May 2020)
- Trial registered on 18 August 2019
- Ethics approval obtained from the Ethics Committee of the First Affiliated Hospital of Guangzhou Medical University on 18 November 2019
- Ethics approval from the University of Toronto Office of Research Ethics on 6 February 2020.
- Trainings have been conducted in 17 intervention township hospitals.
- One-year trial period has formally started since March 1, 2020.
Publication (Updated on 25 May 2020)
An antibiotic stewardship programme to reduce inappropriate antibiotic prescribing for acute respiratory infections in rural Chinese primary care facilities: study protocol for a clustered randomised controlled trial.
• Xiaolin Wei, Dalla Lana School of Public Health, University of Toronto, Canada.
• Chao Zhuo, Guangzhou Institute of Respiratory Health, China.
Funding Agency: China Primary Care Foundation
Promoting treatment supporters for patients who have type 2 diabetes and hypertension.
Diabetes and hypertension are major risk factors for Cardiovascular Diseases (CVDs). Despite an increase in the availability of effective treatments, a majority of persons living with diabetes and hypertension do not have adequate blood pressure and glucose control. One of the major contributors is poor treatment adherence. This study aims to evaluate the impact treatment adherence has on patients with both diabetes and hypertension on CVD events and its clinical outcomes in Canada.
In this population-based retrospective cohort study, we identify 15,642 patients aged 18 years or older that were diagnosed with both diabetes and hypertension, and prescribed anti-diabetic and antihypertensive medications. Based on their estimated refill dates, these patients were first categorized as low- or high-drug adherence patients.
Because CVD events may include coronary heart disease, stroke, or heart failure and the causes of death are not available for our study population, CVD death is computed using the most recent systolic blood pressure distributions and the population attributable risks. Our primary outcome is the association between drug adherence and the risk of an acute severe CVD and mortality. Our secondary outcome is the association between drug adherence and intermediate clinical outcomes including: diastolic and systolic blood pressures, glycosylated hemoglobin, low-density lipoprotein cholesterol, and total cholesterol.
Preliminary findings of this study:
- For patients taking multiple CVD medications, the low- and high- drug adherence groups differed in their CVD events and occurrence. Results showed that the high-drug adherence taking multiple medications had significantly reduced risks of an acute severe CVD event and mortality.
- Preliminary results showed that patients with high-drug adherence are associated with significantly improved clinical outcomes.
- These findings can help identify drug adherence challenges in persons living with diabetes and hypertension in primary care settings. Our findings can also be used to develop intervention strategies to promote drug adherence for persons living with comorbidities.
- Completed risk survival analysis to evaluate the hazard ratio between adherence and the incidence of acute severe CVD and mortality after adjusting for potential covariates. The interactions of adherence to multiple medications are included as a block in the Cox model to examine the combined benefits of adherence.
- Multivariable linear regression models were used to analyze the associations between adherence and intermediate clinical outcomes.
PI: Xiaolin Wei, Dalla Lana School of Public Health, University of Toronto, Canada.
Funding Agency: Diabetes Action Canada
Project on Tuberculosis (TB)
Using electronic monitors and a smartphone application to improve treatment adherence of new pulmonary tuberculosis patients in Tibet, China.
Non-adherence to tuberculosis (TB) treatment is a major concern in Tibet, China due to a sparse population density, severe weather conditions, long travel distances to treatment facilities, and shortage of human resources to enable implementation of directly observed treatment (DOT). Patients often self-administer their TB treatments or receive inadequate medical supervision from health care workers. To better support patients in completing their TB treatment, the Shigatse Centre for Disease Control has looked to technology as a way to strengthen communication between persons affected by TB and health care providers.
This study has three key components: 1) electronic medication monitor pillboxes (e-monitors), 2) a smartphone application (i.e. WeChat) and 3) a family member or relative to provide support to patients affected by TB during treatment (“Family Treatment Supporter”).
The e-monitors track TB medication adherence and remind patients to take their medications through a recorded human voice alert. Medication adherence data generated from these e-monitors are then transmitted to a cloud server and are accessible to healthcare providers in real-time to track medication adherence history.
WeChat is a free mobile application widely used in China. In our study, we use WeChat to form chat groups to ensure patients affected by TB and their Family Treatment Supporter can access the healthcare team. Through this chat group, patients and Family Treatment Supporters can ask questions about TB treatments, checkups, or any concerns that they might have. When necessary, WeChat can also be used for Video Observed Treatment (VOT) when DOT is not feasible.
To evaluate effectiveness of this project, we conduct a prospective, unblinded, pragmatic, individual randomized controlled trial. This is complemented by a mixed-methods process evaluation to understand what worked, what did not, and why, in the implementation of the intervention to better contextualize and interpret these trial findings.
- (Updated on 25 May 2020)
- Trial registered on 9 November 2018
- Ethics approval obtained from the Ethics Review Committee of the Tibet Centre for Disease Control and Prevention on 3 August 2018.
- Ethics approval from Office of Research Ethics at the University of Toronto on 14 September 2018.
- 124 patients have been recruited in three countries for this trial as of December 2018.
Publication: (Updated on 25 May 2020)
Protocol for a randomised controlled trial to evaluate the effectiveness of improving tuberculosis patients’ treatment adherence via electronic monitors and an app versus usual care in Tibet.
PI: Xiaolin Wei, Dalla Lana School of Public Health, University of Toronto, Canada
• Jun Hu, Shigatse Centre for Disease Control and Prevention & Shandong Disease Control and Prevention, China.
• Ross Upshur, Dalla Lana School of Public Health, University of Toronto, Canada.
• Xiaoqiu Liu, China National Centre for Disease Control and Prevention,
• Joseph Paul Hicks, Nuffield Centre for International Health and Development, University of Leeds, UK.
Dr. Xiaolin Wei
University of Toronto
Dalla Lana School of Public Health
582-155 College Street, Toronto
ON M5T 3M7, Canada
Phone: 416 978 2020