Operations versus research: cohabitation or collaboration?

transcript

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

Sentinel surveillance informing policy0.

0 6 12 18 24 30 36

Months on ART

Kaplan-Meier failure estimate

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

Operations versus research: cohabitation or collaboration?

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