Improving and harmonizing operational research in tuberculosis
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Improving and Harmonizing Operational Research in Tuberculosis. Anthony D Harries The Union, Paris, France. 1. Agree on what we are talking about. “What” is operational research. Research into strategies, interventions, tools or knowledge which can improve health care delivery.

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Improving and Harmonizing Operational Research in Tuberculosis

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Improving and harmonizing operational research in tuberculosis

Improving and Harmonizing Operational Researchin Tuberculosis

Anthony D Harries

The Union, Paris, France


1 agree on what we are talking about

1. Agree on what we are talking about


What is operational research

“What” is operational research

Research

into

strategies, interventions, tools or knowledge

which

can improve health care delivery


Guiding principles in setting operational research agendas

Guiding principles in setting operational research agendas

  • Define program / health system objectives

  • Identify constraints to meeting objectives

  • Ask research questions around constraints


Research questions

Research questions

Three themes:

  • Lack of knowledge?

  • Lack of a tool or intervention?

  • Inefficient use of a tool or intervention?


Theme inefficient use of a tool sputum smears for diagnosing ptb

Theme – “inefficient use of a tool”sputum smears for diagnosing PTB

  • Objective of NTP = high quality sputum smear diagnosis using three sputum smears per patient

  • Constraint = three smears per patient are demanding for the laboratory technicians

  • Research question = are two smears as efficient as three smears for diagnosing smear-positive pulmonary TB

  • Answer the question in a number of different ways


Research methodology

Research methodology

  • Descriptive or cross-sectional studies

  • Case-control studies

  • Cohort studies (prospective, retrospective)

Research is carried out within the routine system


What is not operational research

What is not operational research:

  • Basic science research

  • Randomised controlled clinical trials [RCT] – where research is conducted in a strictly controlled environment, with inclusion and exclusion criteria – efficacy is the end point


The need for rct and operational research

RCT

Provides information on

efficacy of intervention

in special groups of

patients

Operational Research

Provides information on

the effectiveness of the

intervention in the

heterogeneous world of

routine patient care

The need for RCT and Operational Research


Improving and harmonizing operational research in tuberculosis

Routine TB quarterly data monitoring system on cases and outcomes

Data used for operational research


2 recognise the challenges and barriers to operational research

2. Recognise the challenges and barriers to operational research


Improving and harmonizing operational research in tuberculosis

The first problem

The needs of Operational research:

Protocol development

Searching for funds

Collecting and analysing data

Writing the papers

Dealing with peer review revisions

TIME

There is no dedicated time available


Improving and harmonizing operational research in tuberculosis

The second problem

What data do I collect?

How do I collect data?

How do I make sense of the data?

How do I analyse the data?

I cannot write

I cannot get started

I have too many good ideas

I spend all my time re-writing

There is no logic to my thoughts

The editorial demands are too much

I don’t have the SKILLS to do research


Programme managers do not recognise the relevance of operational research

Programme managers do NOT recognise the relevance of operational research

The third problem


Improving and harmonizing operational research in tuberculosis

The fourth problem

Individuals return to RLS with MPH or PhD

Why are they not involved in operational research?

Appointed to senior-level management posts

No infrastructure for research

“I have no mentor”

No opportunities

No support for research back home


3 find real solutions

3. Find real solutions


1 involve programmes

1. Involve Programmes

  • Involve programme staff right at the start

  • Ensure that research questions are relevant to programme implementation and connected to health service delivery

  • Set up a good coordination mechanisms to provide clear strategy about setting of research priorities


Improving and harmonizing operational research in tuberculosis

International Expertise

WHO

The Union

LSTM / LSHTM / KNCV

Malawi Institutions

Medical School

NGOs

National AIDS Programme

NTP

Research Ideas

Malawi TB Programme Management Group

Implementation of research by the various groups


Improving and harmonizing operational research in tuberculosis

NTP programme investment

  • Appoint research officer, who can work alongside NTP manager

  • Support in-service training

  • Work with partners in developing research training workshops, writing skills workshop

  • Annual review meetings to present research

  • Emphasize publications in national and international journals


2 build the capacity

2. Build the capacity

  • Training symposia

  • Training courses

  • In-service training

  • Masters degrees

  • Doctorates

    BUT…………….


Japan international tb course 2001 2007

Japan International TB Course:2001 - 2007

  • 28 participants developed ORP

  • 11 (39%) started ORP on return to home

  • 1 wrote a paper

  • 0 published a paper

Ohkado A et al, IJTLD 2009 – in press


Union msf paradigm for operational research training course

Union / MSF paradigm for operational research training course

Purpose:

To develop the practical skills for conducting and publishing operational research

Approach:

Careful selection of participants

Need to achieve milestones to remain in the course

Target-oriented – success of the course judged on whether participants complete research and submit a scientific paper


Three modules

Three modules

  • Module 1:research questions, protocol development, ethics ( 5 days) – August 2009

  • Module 2:Data management and data analysis (5 days) – October 2009

  • Module 3:Paper writing, includes data presentation, interpretation and policy implications (5 days) – March 2010


Operational research fellows

Operational Research Fellows

  • Careful selection of fellows

  • Employed full-time / part-time through Union

  • Mentors identified

  • Attached to programmes or linked institutions

  • 12-month contracts

  • Deliverables= 2 papers submitted each year

  • Linkage to PhD programme (under development)


4 invest in research

4. Invest in Research


Ntp programme level

NTP Programme level

  • Clear objectives and activities around operational research

  • Clear targets – number of projects implemented, projects completed, papers written, papers published, program policy and practice changed

  • Well defined budget line including research allowances, internet connectivity, conference attendances


International support for research

International Support for Research

  • GFATM – 10% of country proposal can go for M&E and operational research

  • The Union – two mechanisms for support (Treat-TB and Centre for Operational Research)

  • The Wellcome Trust African Institutions Initiative (seven consortia of 18 African countries partnered with 6 Northern hemisphere countries)

  • European & Developing Countries Clinical Trials Partnership


5 develop partnerships and harmonize the efforts

5. Develop Partnerships and Harmonize the efforts


Improving and harmonizing operational research in tuberculosis

Schools of Tropical Medicine

LSTM, LSHTM

ITM

TB Associations

KNCV

WHO

NGOs

The Union

MSF

HIV Associations

IAS

Ministry of Health

NTP

Medical Colleges

Governmental Bodies

Local country (MRC)

CDC, USA

International Universities

Johns Hopkins


Harmonisation

Harmonisation

  • Should we develop an international TB operational research agenda?

  • Should we keep a database of what research is taking place, where and by whom?

  • Who should take the international lead?


Improving and harmonizing operational research in tuberculosis

“Learn by Doing”

Partner with colleagues and friends, and realise that we may not always have it initially correct


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