We invited a partner team to write a piece for you explaining the necessity to include communities throughout development work. Rather than just providing theory, we want to highlight the actual work we’re doing.
In 2024, the Centre of Excellence for Long-acting Therapeutics – Global Health (CELT Global Health) announced that global health agency Unitaid had granted us a major funding extension. The LONGEVITY project was underway, but we all believed it had further to go so Unitaid awarded us a £6 million grant extension.
LONGEVITY is an international consortium of experts spanning the entire journey from concept to clinical trials for long-acting preventative options for malaria and tuberculosis and a long-acting treatment option for hepatitis C virus. The consortium includes the expertise needed to ensure any medication to come from LONGEVITY will be prioritised to people in low- and middle- income countries (LMICs), where these diseases have the largest impact.
The grant extension allowed us to not only push LONGEVITY but explore further activities around long-acting therapeutics’ more general place in global health. Amongst these new pursuits was a partnership project between CELT Global Health, Liverpool School of Tropical Medicine (LSTM) and LVCT Health. Our plan was to use implementation research for greater understanding of in-country supply chains and linkages between country drug demands.
Overseen by LSTM, the Implementation Research project has been developing since that time, and we asked the team there if they would like to guest write a piece for us all about it. Please enjoy a reflection from Shahreen Chowdhury, one of the project leads from LSTM.
From innovation to implementation: Why long-acting therapeutics must be shaped with communities
Long-acting therapeutics are generating momentum in global health. They offer the possibility of reducing how often people need to take treatment, potentially improving adherence and easing pressure on health systems. For chronic infectious diseases such as tuberculosis, hepatitis C virus, HIV and malaria, this could be transformative, particularly in LMICs, where the burden of disease is high and health systems are often under strain.
However, innovation alone is not enough. The most promising products can succeed in clinical trials yet fall short in practice - if it doesn’t reach the people who need it, or isn’t trusted, wanted and used in ways that are sustainable. That is where implementation research matters. It asks key questions: not only ‘does this intervention work?’ but ‘how can it work in real-world settings, for people, within health systems?’
The project: Co-creating an equity and implementation resource to guide the development of long-acting therapeutics for low- and middle- income countries.
This project, led by LSTM, LVCT Health and CELT Global Health aims to co-create a practical resource to support the development and delivery of long-acting therapeutics in LMICs that can help developers apply implementation science earlier along the product development pipeline.
Who we LSTM and LVCT Health?
LSTM brings extensive experience in implementation research and applied social science, with a strong focus on how health innovations are translated into policy and practice. LVCT Health brings expertise in health systems strengthening, community engagement and translating evidence into practice across Kenya and the wider Africa region. Building on our experience and partnerships with key actors from community through to global levels we will work together to co-develop this resource.
What is the project and what are we trying to do?
This project asks:
How can long-acting therapeutics be developed and introduced in ways that are usable, equitable and responsive to the contexts where they will be delivered?
We have already conducted a systematic review and grey literature review to understand existing evidence, and we are now ready for the next study phase, where we will listen to, learn from and bring together key actors to understand perspectives of end users within the community, health workers across the health system and policy and product developers levels to answer our three main objectives, to:
- Synthesise evidence on how communities and health workers perceive these products
- Explore health system, provider and community readiness in Kenya and selected African settings
- Co-develop a practical resource that product developers and partners can use to assess readiness and strengthen engagement.
Why implementation science matters
Implementation science is often described as the study of how to integrate evidence-based interventions into real-world settings effectively. Communities are not passive recipients of innovation. Patients, caregivers, community leaders, and frontline providers hold essential knowledge about what is likely to work, for whom and under what conditions. We will explore questions on:
- Who is this product for? And who it may exclude?
- What would make it acceptable in people’s daily lives?
- What support will health workers need?
- What conditions need to be in place for safe, equitable delivery?
- How can communities influence decisions, rather than simply react to them?
- How do service users want to be engaged?
Our project aims to ensure that implementation thinking is embedded across the entire product development pathway - not added at the end. This means engaging early with critical questions about what a product looks like, how it will be delivered, what choices users will have, what kind of counselling and support are needed and whether health systems are ready to sustain it. We want to look more critically at what meaningful engagement requires, and how it can be built into long-acting therapeutics development from the outset.
The co-created resource will help product developers ask the right questions earlier, and in partnership with the people who will ultimately use and deliver these innovations.
How is the work being carried out, and what have we learned so far?
The project has three main phases.
Phase 1 (carried out during 2025)
Phase 1 has focused on learning from what already exists. This included a systematic review, a grey literature review, and informal consultations.
The systematic review of qualitative evidence examined community and health workforce perspectives on the acceptability and feasibility of long-acting therapeutics in LMICs. Out of 5,927 records identified, 48 studies met inclusion criteria and were included in the final synthesis. Looking across multiple health areas, including HIV prevention and contraception, we found that acceptability is socially embedded. Reduced dosing frequency, fewer clinic visits, and greater discretion can increase appeal of a new long-acting therapeutic compared with traditional forms of treatment. However, concerns about side effects, procedural fears, loss of control, and poor-quality counselling can constrain uptake. Feasibility depends on both the product itself, and workforce capacity, service integration, counselling quality, reliable supply chains, and supported options for discontinuation and switching.
The grey literature review identified existing resources mapped across stages of the long-acting therapeutics development pathway: discovery and early development, preclinical research, clinical research, regulatory review and policy enablement, and post-market surveillance and rollout. A key finding was that most existing resources focus on the later stages, especially rollout, regulation, and market shaping. There is less guidance on how to embed person-centred, participatory, and implementation science earlier in the pathway.
Phase 2 (2026)
Phase 2 builds on those findings through primary qualitative and participatory research. We will conduct key informant interviews with international, national, and county-level stakeholders, alongside participatory focus group discussions with communities and healthcare providers. This phase is designed to explore readiness from multiple perspectives: policy readiness, regulatory pathways, supply chains, workforce issues, stigma, gendered experiences and community perceptions of long-acting therapeutics.
The research is in partnership with LVCT Health, with a deeper dive in Kenya across three counties: Homa Bay, Kajiado, and Mombasa. These settings were selected to reflect variation in epidemiological profiles, cultural and geographic context, and health systems. We will be using participatory methods such as drug bag exercises, social mapping, vignettes and workshops to explore decision-making, delivery pathways, product preferences and how they shape acceptability and feasibility. We will include perspectives from regional stakeholders in countries such as Ethiopia, Ghana, and Zimbabwe, to understand wider implementation questions across the African sub-continent.
Phase 3 (2027)
Phase 3 will bring this learning together to co-develop a practical resource. Through participatory online workshops, we will work with stakeholders across LMICs to refine toolkit components, including tools and action-oriented guidance.
Why does this work matter for global health?
Long-acting therapeutics have significant potential to transform care through reducing treatment burden, improving adherence, and making care more manageable for patients while supporting stronger, more responsive health systems. However, without the right approach, these innovations risk low uptake, widening existing inequities, and missed opportunities to deliver meaningful impact. Promising interventions often fall short when social dynamics, health system constraints and local priorities are overlooked. By applying implementation science, with an equity lens, this work aims to help ensure these therapies are designed and delivered in ways that are usable, trusted and equitable.
Looking ahead
The next phases of the project will increase our understanding of how communities, providers, and policymakers perceive long-acting therapeutics and what needs to be in place for equitable adoption.
If long-acting therapeutics are to fulfill their potential in LMICs, this must be built not only on pharmacology and product pipelines, but on partnership, participation and trust.
The Implementation Research project is funded by global health agency Unitaid.
