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22 September 2019
PLATFORM2013: TB/HIV Intervention Evaluation by the University of the Free State Print
Wednesday, 11 December 2013 10:02

The University of the Free State’s article in PLATFORM2013 describes the ‘Centre for Health Systems Research and Development’ (CHSR&D) public health evaluation of the cost-effectiveness of training and mentoring interventions to improve TB patients’ uptake of HIV testing in the Free State Province.

(Portrait: Vice-Rector Prof. Jonathan Jansen)

The VC places this research in context
“One of the most powerful “turns” in social and scientific research in recent times has been a concern with research that makes a difference,” said Vice-Rector Prof. Jonathan Jansen when discussing Research Uptake at the University of the Free State. “Whether it is evidence-based, policy- making or practitioner-led research or public interest research or impact evaluations, there is a determined push for research to speak directly to the most compelling problems facing the planet today. The TB/HIV co-epidemic represents a daunting challenge in our province, country and continent. The reported Public Health Evaluation to establish the best means to increase the rate of HIV testing by TB patients reflects a concerted and promising effort of university–government collaboration to act upon the evidenced imperative to better integrate disease control programmes.

The University of the Free State is at the centre of the global quest for greater relevance in the research enterprise. Our health systems research brings together theory, research and practice to address problems at the interface of trans-disciplinary (social science and medicine, for example) inquiry. Research that makes a difference is, and has to be, borderless. That is why so much of our research at the UFS is done with international partners from other parts of Africa, Asia, Europe and North America. Our emerging scholars are consciously placed alongside leading international researchers in their fields so that we can collaborate on common problems using conceptual and methodological tools that learn from each other. Research for the common good is not, of course, some mindless utilitarianism that reduces all research to toolboxes, instruments and methods. Our research remains both rich in theory and transformative in practice.”

TB/HIV co-infection
TB control is largely compounded by the HIV/AIDS epidemic, i.e. the “... most powerful factor ever known to favour the development of [TB]”. People living with HIV/AIDS who are co-infected with TB are about 21–34 times more likely to develop active TB disease. South Africa has a high TB/HIV co-infection rate of about 65%, yet the HIV status of around 20% of TB patients remains unknown. To date, relatively little work has focused on understanding why TB patients may not accept effective, integrated/collaborative TB/HIV services.

Monitoring the cost-effectiveness of training and mentoring interventions
In the public sector, primary health care (PHC) nurses and community health workers (CHWs) offer HIV counselling and testing (HCT) and other TB/HIV services at clinics on a daily basis. These two provider groups are therefore well positioned to alter the delivery of HCT services in order to improve patient participation, uptake and, ultimately, health outcomes. Funded by the Centers for Disease Control and Prevention (CDC) as a Public Health Evaluation (PHE), the CHSR&D is undertaking a quasi-experiment with a pre-post intervention design to increase the uptake of HCT by TB patients through implementing, evaluating and comparing the cost-effectiveness of different training and mentoring (T&M) interventions among PHC nurses and CHWs. The PHE is taking place in four local municipalities, randomly assigned to intervention and control. The project is conducted in close partnership with the TB and HIV & AIDS/STI and CDC directorates of Free State Department of Health (FSDoH).

Uptake of recommendations
An implementation science approach is followed to ensure uptake of recommendations by the provincial TB and HIV/AIDS programmes. Uptake is also encouraged by high-impact publications. A first round of research feedback workshops presented to FSDoH (district as well as provincial levels) included recommendations to:<

.    i)  intensify dissemination of information on the TB/HIV link;

.    ii)  support patients in the HCT decision-making process;

.    iii)  target males and newly diagnosed patients; and

.    iv)  improve both professional and lay healthworkers’ training and skills. It is especially in 
terms of the latter that the PHE is supporting FSDoH’s uptake of rigorous and context- specific evidence.

Measuring impact
Collaborating with University Research Co., LLC, National Institute for Communicable Diseases, and Right to Care as T&M partners, three different T&M interventions are in process in three municipalities respectively:

.    i)  T&M of professional nurses to implement provider-initiated HCT of TB patients;

.    ii)  T&M of CHWs to encourage and counsel TB patients to undergo HCT and administer and 
interpret rapid finger-prick HIV tests; and

.    iii)  T&M of both groups in an integrated team approach. Measuring the impact of the inter- 
ventions include: pre- and post-intervention interviews with nurses, CHWs and patients, respectively deployed at, linked to and treated at facilities selected for intervention and control; pre- and post-intervention collation of patient-specific TB, HIV and HCT statistics at clinics; and collection of information necessary to measure the comparative cost-effectiveness of the three intervention options.

Research Uptake
Once the most cost-effective model has been established, its wider dissemination in the province and further afield will be promoted, again following an implementation science approach to encourage uptake. The project aligns to the guiding principles of the UFS Research Strategy 2009– 2014 to focus on relevance, excellence and impact and to promote integration, collaboration and synergy for better performance.

Policy Influencers Targeted
·      The Provincial and National Departments of Health in South Africa.

·      The Center for Disease Control and Prevention in South Africa.

·      The National Institute for communicable diseases in South Africa.

·      Right to Care Right to Care, a non-profit organisation (Section 21) that supports and delivers prevention, care, and         treatment services for HIV and associated diseases.

Join the Research Uptake Conversation
If this piece of evidence-based development research from SSA is of use to you, please continue the Research Uptake Conversation by contacting the University of the Free State for more details.

Research page on the University of the Free State’s website: www.ufs.ac.za/content.aspx?cid=30

DRUSSA Research Uptake Leader at the University of the Free State
Prof. (RC) Corli Witthuhn
Vice-Rector
Research
witthuhnrc@ufs.ac.za

DRUSSA Research Uptake Champion at the University of the Free State
Dr Glen Taylor
Director of Research
Innovation and Business Development
TaylorGJ@ufs.ac.za

Researcher/writer
Prof. Christo Heunis
Associate Professor
Centre for Health Systems Research and Development
heunisj@ufs.ac.za

Communications Manager
Ms Lacea Loader
loader@ufs.ac.za

Read this article on pages 26 and 27 of PLATFORM2013 – a print and digital publication from the DRUSSA Universities in Sub-Saharan Africa [SSA] – aimed at accessibly communicating evidence-based development research with the goal of deepening its reach and impact in the region. 

Follow the PLATFORM2013 blog campaign daily until 16 January 2014. You’ll find the blog schedule on PLATFORM2013 articles from the DRUSSA Universities here

Twitter @DRUSSAfrica #PLATFORM2013 #ResearchUptake (Tweet about this on your twitter account)

...Back

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