Early this year, not long after President Donald Trump took office, his administration started terminating grants awarded by the National Institutes of Health (NIH), disrupting studies and unmooring biomedical and public health research communities.
In this atmosphere of uncertainty, a group of implementation scientists – including Elvin Geng, MD, MPH, a professor at WashU Medicine, a secondary faculty member at WashU School of Public Health and a co-director of the School of Public Health’s Dissemination & Implementation Science Innovation Research Network (DISIRN) – set out to document the effects of the grant terminations on their field. Implementation science aims to accelerate the translation of research findings into practice by identifying and lowering the barriers to adopting evidence-based tools, technologies, strategies and interventions for disease control. In short, implementation scientists work to bring findings to bear.
Their analysis, published in the journal Implementation Science in May, showed that 52 implementation science grants were cut from February through April, totaling more than $165 million and affecting 51,381 study participants at 195 care-delivery sites in the U.S., Asia and Africa. Projects related to sexual and gender minority health, infectious diseases and health equity, among other areas of research, were shut down. Twelve of the 52 terminations were of training or career-development grants, damaging efforts to build capacity at a time when implementation scientists already are struggling to meet the growing demand for their expertise.
Geng’s area of research – the implementation of evidence-based HIV prevention and treatment strategies – was hard hit by the grant terminations. But the research cuts were only part of a larger move by the Trump administration away from HIV. In the early months of the presidency, the U.S. abruptly withdrew support for global HIV prevention and treatment programs, derailing what had been up to then a successful public health campaign to end the HIV epidemic worldwide.
I think the global public health community is incredibly resilient and committed and will get the train back on the tracks. We’ll arrive at our destination a little later than we would have, but I believe we’ll still get there.”
–Elvin Geng, MD, MPH
“We were – I’m not exaggerating – truly on the cusp of turning this global tide,” Geng said. “Progress has been uneven and some places, like St. Louis, still have a way to go and lots of opportunities for progress, but in some places of the world, we were within shooting range of ending HIV as a public health threat in the next five years.”
In 2014, the Joint United Nations Programme on HIV/AIDS (known as UNAIDS) set an ambitious goal of ending the HIV epidemic by 2030, and laid out a set of specific strategies and milestones to achieve it. Many places in the world were on track to meet the goal, including major cities such as London, New York and San Francisco, and countries including Botswana and Zambia. This progress was the result of political will in low- and middle-income countries, financial support from high-income countries, technological advances such as longer-acting pre-exposure prophylaxis, and the work of implementation scientists such as Geng, who figured out how to turn that money, will and technology into culturally acceptable, effective, scalable and sustainable programs that lowered infection rates and raised treatment rates overall, and particularly among high-risk populations.
“That sort of progress doesn’t just happen,” Geng said. “A lot of blood, sweat and tears go into figuring out how to make public health accessible and engaging to people, especially those who do not expect their needs and preferences to be met by the health system previously.
“The inequities in HIV are enormous,” he continued. “In America, the risk of a Black woman having HIV is 17 times higher than a white woman having HIV. It’s not twice. It’s not five times. It’s not even 10 times. It’s 17 times. NIH no longer wants to fund research focused on equity, but it just doesn’t make sense to work on HIV unless you work on equity.”
Despite the program cancellations and shifts in research priorities, Geng still thinks that an end to the HIV epidemic is achievable in the foreseeable future.
“For sure, the train is off the track. How do we get it back on? That’s still an open question,” said Geng. “But I’m hopeful. I think the global public health community is incredibly resilient and committed and will get the train back on the tracks. We’ll arrive at our destination a little later than we would have, but I believe we’ll still get there.”
Beidas RS, Aarons GA, Geng EH, Sales AE, Wensing M, Wilson P, Xu DR. Implementation science grant terminations in the United States. Implementation Science. May 6, 2025. DOI: 10.1186/s13012-025-01434-7
Writer
Tamara Schneider, PhD, MPH, is the senior science writer and assistant director of communications for WashU School of Public Health. She holds a bachelor’s degree in molecular biophysics & biochemistry and in sociology from Yale University, a master’s in public health from the University of California, Berkeley, and a PhD in biomedical science from the University of California, San Diego.