In 2019, Limakatso Lebina began testing a new screening method for tuberculosis (TB) in hopes of finding more of the 150,000 people in South Africa who are diagnosed too late or not at all each year. Instead of only testing patients who showed at least one of the classic symptoms of TB, healthcare workers started to also screen people who were at high-risk for TB, such as those with HIV, regardless of whether they had any TB symptoms. With the expanded screening parameters, more people were diagnosed with TB during the trial period. The study results were published in 2023. That same year, the South African national guidelines on TB screening were updated to reflect the findings. It was the first time in Limakatso’s 15-year career that her research was translated into policy so swiftly.

"It encouraged me because it showed it is possible to move from research output to key implementation if there's a strong partnership between the researchers and the policymakers," said Limakatso, associate professor and director for clinical trials at the Africa Health Research Institute in South Africa.

Four years ago, Limakatso built the clinical trials platform at the Africa Health Research Institute where she now supervises the 80-person unit running trials mainly on HIV and TB. The trials platform is unique because it gives scientists access to a rural population - Mtubatuba, a town in a coastal province in South Africa, and its surrounding areas - where new health interventions have been sparse. But she is also invested in what happens after the research is completed, so much so that she has a second job in implementation science, in which she earned her PhD.

It usually takes several more years for the fruits of most research work to get turned into policy and be implemented into the real world, if it happens at all. The biggest reason for that prolonged delay is the lack of communication between researchers and policymakers as the research is being conducted, says Limakatso. Policymakers may not only be unfamiliar with the science but introducing any changes to something as complex as the health system is never an easy feat.

For example, Limakatso is currently working out how novel TB vaccines can be rolled out in South Africa by the time the vaccine trials conclude in a few years. There are eight different potential models on how to bring the vaccine to the people, with each one leading to discussions about inevitable tradeoffs. Should the vaccine be delivered in schools to better reach children or primary healthcare centers to target people with HIV? Could they afford to do both? Integrating vaccination into an existing program, like giving it when people come in for hypertension checkups, would be cheaper, but healthcare workers would then have to spend more time with each patient, ultimately reducing the number of patients they could see in one day.

Figuring out how to best fit all these puzzle pieces together in a strategic way is what drew Limakatso to implementation science.

"It is very demanding," Limakatso said about being just one person working across two research disciplines, "but I also feel like I'm living the dream I've been dreaming about, and I can't part with either one."