|Developing a Stakeholder Engagement and Science Communication Plan for research findings of a Rapid Diagnostic Tests for Malaria study|
|Thursday, 20 November 2014 11:44|
This, the third blog in our Stakeholder Engagement series (see the first and second blog here), highlights the work of the MSF/Epicentre Mbarara Research Centre of Mbarara University of Science and Technology in Uganda. The Centre developed, implemented and evaluated a Stakeholder Engagement and Science Communication plan aimed at promoting Research Uptake for the results of its study on using Rapid Diagnostic Tests for Malaria.
Malaria is a disease that affects mainly poor countries. Its diagnosis and treatment is key to solving part of the high burden in countries where resources are limited. The millions of people who die from malaria on an annual basis has raised attention. Initially a disease for the poor and most commonly found in developing countries, globalization has resulted in malaria also becoming a concern to Western travellers when visiting countries where malaria is endemic.
Malaria rapid diagnostic tests (RDTs) rely on the detection of plasmodial antigens or protein circulating in the blood. The vast majority of RDTs currently on the market detect the histidine-rich protein II (HRP2) and/or the plasmodium lactate dehydrogenase (pLDH). The HRP2 is produced by Plasmodium falciparum and allows for the detection of this species only. The pLDH is produced by all four human malaria species (P. falciparum, P. vivax, P. Ovalae and P. malariae) and thus allows the detection of all Plasmodium spp.
The study evaluated the performance of two HRP2 and one pLDH malaria RDTs in high- and low intensity malaria-transmission settings to understand if and how much time was required to produce a negative result after parasite clearance. To estimate the time it takes for a test to become negative after treatment for malaria we compared the RDTs results of more than 5000 children from two settings in Uganda - Kazo (a high malaria-transmission setting) and Mbarara (a low malaria-transmission setting) - using blood smear microscopy. The median time it took for the tests to become negative was 35 to 42 days for the HRP2-test and 2 days for the pLDH-test. This shows that the “HRP2” test, which is currently the most frequently used, may return false positive results for several weeks after the patient has been cured from the malaria infection.
The consequences are twofold: the incorrect management of fevers that could lead to death and also the overuse of antimalarial drugs which leads to drug resistance. Practitioners need to be able to balance the use of diagnostic tests which may result in over-treating patients, and using tests which will not pick up cases with low parasitaemia. The transmission intensity should be a factor in the choice of RDT.
The research findings indicated that a change in diagnosis protocols is required.
The process of developing a stakeholder engagement plan started with their identification and characterisation, which then allowed us to build a plan for communication with messages to target each stakeholder group. The table below shows the stakeholders identified as interested and affected by results of this research.
Having identified the stakeholders, we categorised them using a stakeholder characterisation matrix. This helped us to consider the nature of various stakeholder groups as well as the impact on the implementation of our research findings. Although the community and the patients represent the end-users, we decided not to consider them in the analysis and just to focus on the key influencing stakeholders, including MSF (Medecins sans Frontieres, study sponsor), the (WHO) World Health Organization, the Ugandan Ministry of Health (MoH), the rapid test manufacturers and distributors, politicians and the media. This analysis allowed us to clarify their potential interest in our research. From our analysis, it was clear that the MSF was the main stakeholder. We then had to reassess our relationship with the other stakeholders in order to define our communication approach towards them. With these roles in mind we reviewed the stakeholder interests, resources and position on our research.
Stakeholder engagement and communication objectives
The main challenge was to ensure that the proposed messages were in keeping with the stakeholder’s roles and responsibilities as far as malaria is concerned. For example, while researchers who validate the integrity of our research findings would understand the scientific message, politicians may be more interested in the impact of our research on their constituency, their budget and the implications for potential re-election. The strategy thus had to be specific to each target audience and the communication plan as detailed as possible. The challenge here was to present the same findings in different registers: political, for humanitarian purposes and for business. The table below shows the key messages identified for different stakeholders.
To reach these audiences the research information was re-purposed to be presented at a public function at which the identified stakeholders were present, and to consolidate the messaging it was decided to use the public media as well. Thus for example a press release was put out entitled “New Research From Uganda Could Prevent Faulty Malaria Diagnoses And Save Lives”. The press release was embargoed until World Malaria day, and was hooked to the key stakeholder event, in the expectation the message would likely to be disseminated in the media.
The main lesson learnt from conducting a research uptake communication and engagement process is the need to include in the project team’s mind-set a research-oriented and a stakeholder-oriented perspective that would include politicians and others who may have little interest or knowledge about the value of scientific evidence but would like have reliable information for managing their communities’ interests. From the beginning of the research we needed to know who should be influenced by our findings and how we would reach them. Although science communication is usually not part of a research plan, this exercise showed how critical it is to have a stakeholder engagement and communication plan if the intention is to have an impact where the research is being done. Reflecting on the analysis of stakeholders helped to broaden the spectrum of the end-users of our research findings. Thus messages need to be tailored to their target audiences. As researchers we are used to writing academic journal articles and making presentations to the scientific community. However, here we needed to influence people based in Geneva (WHO) as well as politicians based in Uganda who have many different challenges to deal with at the same time. They have to choose how to allocate limited resources and respond to each demand within a larger context.
Since the end of the study the findings have also been disseminated to the academic community. The study findings have been presented in several scientific conferences worldwide (Uganda, South Africa, USA, Cameroon, Mozambique, and France) and have been well received. The research addressed an important concern that has been observed by clinicians working in high malaria endemic settings.
The presentation of our results to different audiences that have included our sponsor, the press and the Ministry of Health has been beneficial in term of research uptake. Firstly MSF has taken up those results and changed their policy of ordering pLDH rapid tests instead of HRP2 as they recently did to control the malaria epidemy in Democratic Republic of Congo. At a national level level the MoH of Uganda has included the pLDH test as an alternative test to HRP2 one in their recent malaria policy, thanks to our results. Though we still have a long way to go in term of advocacy to have these tests implemented in all countries where malaria is endemic we have to appreciate that more needs to be done and that it is challenging. Most of the countries don’t have a clear mapping of their high and low malaria endemic regions and may not know where to use which test. They will have to choose between reducing the number of patients diagnosed with malaria while they don’t have the disease but taking the risk of missing some cases of malaria in people who have a low number of parasites.
However life is about choice…
We want to thank DRUSSA for their great support on conducting this case study but especially helping us to find the right message for the right people !!!
Associate Prof Yap Boum II. Epicentre Mbarara Research Centre, Mbarara University of Sciences and Technology, Mbarara Uganda
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