In Malaysia, the HIV epidemic is concentrated in key populations, including men who have sex with men (MSM), people who inject drugs, and transgender women. Yet, delivery of the HIV prevention medication pre-exposure prophylaxis (PrEP) and other interventions remains suboptimal for these populations. In fact, fewer than five thousand of the two hundred twenty thousand MSM who would benefit from PrEP are currently receiving it under the existing healthcare delivery model. This gap in care drives the need for new, differentiated HIV delivery models.
Implementation science is crucial for achieving practical, effective, and long-lasting improvement in HIV outcomes. Simply put, implementation science bridges research with practice by studying how to better implement interventions in the real world. Like any science, training is a crucial step towards success.
The Malaysian Implementation Science Training (MIST) Program, a collaborative initiative between Yale University and Universiti Malaya, was created in response to this imperative. Led by Frederick L. Altice, Professor of Infectious Diseases and Public Health at Yale and Academic Icon Professor of Medicine at Universiti Malaya, the program prioritized a dialogue-rooted approach. Rather than imposing a predetermined agenda, the Yale team convened government, academic, and public health stakeholders in Malaysia to ask what was lacking and what solutions the local community envisioned. The process was grounded in the global health principle of subsidiarity, the idea that those closest to the challenge are best placed to design its response. Their efforts established local buy-in, community ownership, and shared passion among Malaysian researchers and practitioners.
MIST became the first implementation science program in the region, focused on training and capacity building. The program trained local participants at three levels. For faculty members and PhD students, training began with one year of instruction—one semester of distance-based learning and one semester of in-person courses at Yale, with tuition supported by grant funding. Each PhD student was also paired with a Yale mentor who guided their research and professional development. For real-world implementers, short-term training was offered through a three-day annual summer bootcamp.
The involvement of Yale faculty stemmed from a commitment to capacity-building rather than financial incentive. About a dozen Yale faculty members participated, devoting roughly five percent of their time despite often being unpaid beyond travel coverage. Altice took the minimal possible compensation.
Progress under the grant was tracked through quantitative and qualitative metrics. Initially, measures included time to complete PhDs, participant satisfaction, and the number of publications produced. Over time, the team realized that iterative feedback—holding biannual sessions to ask “what went well,” “what could have gone better,” and “what should be improved in the next six months”—offered a more meaningful way to ensure impact.
To make the program sustainable, Yale faculty trained Malaysian faculty in implementation science, with the goal of transitioning teaching responsibilities entirely to Universiti Malaya. “We looked across all public health courses and built in one or two lectures on implementation science across the core classes,” Altice said. The team also established new electives and embedded the discipline within the public health curriculum. This process allowed Malaysian faculty to become fluent in implementation science, integrate it into their system without constant Yale support and incrementally take ownership.
Although the MIST grant was terminated before the end of its five-year funding period, the team sued the federal government and successfully had the program reinstated. The grant also scored well for renewal, so it is anticipated to be funded for another five years. While awaiting the release of funds following a government shutdown, Universiti Malaya continued the work independently—fundraising locally and even sponsoring an implementation science pre-conference workshop, inviting scholars from Yale and other countries. This self-sufficiency demonstrates the success of MIST’s capacity-building model: even without external funding, Universiti Malaya sustained momentum, having now built both expertise and international recognition. The long-term goal now is for Universiti Malaya to become the primary recipient of future grants, leading training not only within Malaysia but across the region.
The broader implications of MIST extend beyond Malaysia. “My lens is always on how we can build a sustainable program that Yale feels comfortable transitioning to independence,” Altice said. “I don’t want to put something in place that will collapse when I leave.” This guiding principle—of subsidiarity, sustainability, and gradual transfer of leadership—embodies a model for global health that resists dependency and neo-colonial patterns of engagement. By embedding implementation science into Malaysian institutions and ensuring that local faculty and students are at the forefront, MIST demonstrates how partnerships between high- and low-income countries can foster equitable, lasting change.