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Operations versus research: cohabitation or collaboration?

Operations versus research: cohabitation or collaboration?. Gilles Van Cutsem MD, DTMH, MPH Medecins Sans Frontieres. Key characteristics. Clear agenda informed by global priorities Enhanced monitoring and evaluation: Strong district-level coordination

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Operations versus research: cohabitation or collaboration?

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  1. Operations versus research: cohabitation or collaboration? Gilles Van Cutsem MD, DTMH, MPH Medecins Sans Frontieres

  2. 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

  3. Guiding principles • Relevance and benefit to the community • Patient care is not disrupted • Involvement of local health care providers: capacity building and local interest • Synergy and coherence between projects • Integration within routine health services • Contribution to service delivery

  4. Virtuous cycle

  5. 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

  6. 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

  7. First description of ART at PHC in Africa • Use of enhanced routine data • Observational cohort – quantitative • Model of care - descriptive

  8. Advocacy for new models of care

  9. Kaplan-Meier failure estimate 0.20 d4T 0.15 0.10 AZT Proportion changed due to toxicity NVP 0.05 EFV 0.00 0 6 12 18 24 30 36 Months on ART Sentinel surveillance informing policy

  10. Project-driven clinical questions

  11. Field testing of TB diagnostics

  12. Large research projects • Tuberculosis drug resistance survey • Randomized controlled trial of isoniazid vs placebo

  13. 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

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