Operations versus research: cohabitation or collaboration?
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Operations versus research: cohabitation or collaboration?
Gilles Van Cutsem MD, DTMH, MPHMedecins Sans Frontieres
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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
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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
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Virtuous cycle
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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
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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
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•First description of ART at PHC in Africa•Use of enhanced routine data•Observational cohort – quantitative •Model of care - descriptive
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Advocacy for new models of care
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Project-driven clinical questions
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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
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Large research projects
• Tuberculosis drug resistance survey• Randomized controlled trial of isoniazid
vs placebo
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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