Transcript 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
– 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 disrupted
3. Involvement of local health care providers:
capacity building and local interest
4. Synergy and coherence between projects
5. Integration within routine health services
6. Contribution to service delivery
Virtuous cycle
Global
priorities
Service
delivery
Research
questions
Research
Partnerships
Study designs
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•
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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
Proportion changed due to
toxicity
0.00
0.05
0.10
0.15
0.20
Sentinel surveillance informing policy
Kaplan-Meier failure estimate
d4T
AZT
NVP
EFV
0
6
12
18
Months on ART
24
30
36
Project-driven clinical questions
Field testing of TB diagnostics
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