Post on 19-Jan-2016
description
Operations versus research: cohabitation or collaboration?
Gilles Van Cutsem MD, DTMH, MPHMedecins Sans Frontieres
Key characteristics• Clear agenda informed by global priorities• Enhanced monitoring and evaluation:
– Strong district-level coordination– Ongoing supervision, mentoring and training– Communication between M&E, clinicians, and management
• Partnership with government health services• Strong academic collaborations (UCT, US, …)• Balancing exercise between service delivery
and research priorities
Guiding principles
1. Relevance and benefit to the community 2. Patient care is not disrupted3. Involvement of local health care providers:
capacity building and local interest 4. Synergy and coherence between projects5. Integration within routine health services6. Contribution to service delivery
Virtuous cycle
Study designs
• Observational cohorts (prospective)• Retrospective cohort (folder reviews)• Model descriptions• Validation and field-testing of diagnostics• Pragmatic trials• Other nested within cohort:
– PK– Cost-efficiency
How is this different from usual?
• ‘Real world’ setting – generalizability• Constant interaction between operations and
research > one informs the other.• NGO & public health sector: no publication
pressure as opposed to academic > less conflict of interest between service delivery and research demands
• Research as a second job: capacity problem
•First description of ART at PHC in Africa•Use of enhanced routine data•Observational cohort – quantitative •Model of care - descriptive
Advocacy for new models of care
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Months on ART
Kaplan-Meier failure estimate
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Project-driven clinical questions
Field testing of TB diagnostics
Feasibility, impact and cost-efficiency of decentralizing molecular testing for detection of tuberculosis and rifampicin resistance using XpertTM MTB/Rif
Large research projects
• Tuberculosis drug resistance survey• Randomized controlled trial of isoniazid
vs placebo
Ubuntu Clinic Research Committee
• Protect services from research chaos• Composed of MoH, NGO, academia• Evaluate impact on service delivery & overall
cohesion (guiding principles)• Empower ‘coal-face’ workers to have their say
in what is happening in their clinic