Reciprocal innovation in implementation science and global health: reflections from the EXTRA-CVD (extending the HIV treatment cascade for cardiovascular disease prevention) study.
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2026-03
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Reciprocal innovation, a model of sustained, multidirectional exchange in which health strategies are adapted, revisited, and refined across contexts, offers a compelling framework to rethink how implementation science can support global health equity by enabling dynamic, multidirectional learning across different contexts. Drawing on the EXTRA-CVD trial, a nurse-led cardiovascular disease prevention intervention designed to extend the HIV treatment cascade in United States (U.S.) HIV clinics, which adapted strategies informed by implementation research in Kenya and the U.S. Veterans Affairs health system, this perspective examines how reciprocal innovation can begin to emerge within existing research structures, as well as where opportunities for deeper exchange remain limited. We identify four operational domains of reciprocal innovation: care delivery strategies, end-user engagement, research methodologies, and research leadership and partnership. Across these domains, we describe how cross-context learning shaped intervention adaptation and site-level implementation in EXTRA-CVD, as well as missed opportunities where more intentional feedback, shared leadership, and methodological exchange could have strengthened multidirectional learning. Taken together, this work highlights both the potential and the practical challenges of reciprocal innovation in implementation research, emphasizing its role in moving beyond unidirectional knowledge transfer toward iterative, context-responsive learning. By embedding structures for iterative feedback, equity-centered governance, and multidirectional learning systems within research and implementation systems, future global partnerships can foster more inclusive, responsive, and sustainable health interventions.
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Leung, Claudia L, Hayden B Bosworth, Allison R Webel, Angela Aifah, Constantine Akwanalo, Gerald S Bloomfield, Emily W Choi, Barbara M Gripshover, et al. (2026). Reciprocal innovation in implementation science and global health: reflections from the EXTRA-CVD (extending the HIV treatment cascade for cardiovascular disease prevention) study. BMC global and public health, 4(1). p. 28. 10.1186/s44263-026-00257-y Retrieved from https://hdl.handle.net/10161/34912.
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Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
Gerald Bloomfield
Gerald Bloomfield, MD, MPH, joined the faculty in Medicine and Global Health after completing his Cardiovascular Medicine fellowship training at Duke University Medical Center and Duke Clinical Research Institute. Bloomfield also completed the Duke Global Health Residency/Fellowship Pathway and a Fogarty International Clinical Research Fellowship. He received his medical education, internal medicine residency and Master of Public Health degree from Johns Hopkins University. Bloomfield leads a longstanding research and capacity building program on cardiovascular global health which includes work in under-resourced communities in the US and a number of low- and middle-income country settings.
Charles Muiruri
Dr. Muiruri is a health services researcher, Assistant Professor in the Duke Department of Population Health Sciences, Assistant Research Professor in the Global Health Institute, and Adjunct lecturer at the Kilimanjaro Christian Medical University College, Moshi Tanzania.
Broadly, his research seeks to improve the quality of healthcare and reduce disparities for persons with multiple chronic conditions both in and outside the United States. His current work focuses on prevention of nonAIDS comorbidities among people living with HIV. His current projects funded by NIAID, NHLBI and NIMHD focus on improving the quality of cardiovascular disease prevention and care among people living with HIV in North Carolina and Tanzania.
Areas of Expertise: Mixed methods, Qualitative methods, Applied Econometrics in Health services Research, Preference research, Implementation Science, Global Health, Health Policy
Nwora Lance Okeke
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