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Current Projects  

  • Thematic area 1: Maternal and Child Health, Nutrition
  • Thematic area 2: Adolescent Health; Well-being; Sexual and Reproductive Health
  • Thematic area 3: Infectious and Non-Communicable Diseases
  • Thematic area 4: Social and Economic Policy and Health
  • Thematic area 5: Knowledge synthesis for strengthening health systems

Click on the thematic areas and project titles for the full description.

  • Thematic area 1
  • Thematic area 2
  • Thematic area 3
  • Thematic area 4
  • Thematic area 5
Evaluation of the effectiveness of the Prevention of Mother - to - Child Transmission of HIV (PMTCT) Programme on Infant HIV until 18 months postpartum in South Africa (SAPMTCTE)

PI: MRC: Prof. Ameena Goga co-PIs UWC: Prof Debra Jackson CDC: Dr Thu-Ha Dinh

Co-investigators: Medical Research Council:  Prof Carl Lombard, Dr Selamawit Woldesenbet, Ms Vundli Ramokolo  National Department of Health:  Dr Yogan Pillay, NICD/NHLS Prof Gayle Sherman, Prof Adrian Puren.

Overview
Within seven years of implementing the national PMTCT program, South Africa has successfully scaled up its PMTCT services. Interventions to prevent mother-to-child transmission of HIV are now offered in more than 95% of antenatal clinics and maternity institutions country-wide. In 2008, 2010 and 2013 the South African National Department of Health (NDOH) updated its PMTCT policy to include more efficacious interventions to reduce mother-to-child transmission of HIV. These efforts are to meet the National Strategic Plan (NSP 2012-2016) targets of reducing the MTCT rate of HIV to less than 2% by six weeks and < 5% by 18-months.

The South African PMTCT Evaluation was implemented in 2010, 2011 and 2012 to track population-level impact of the national PMTCT programme. These data are (delete of) critically important to monitor progress towards meeting the targets set in the South African National Strategic Plan (of reducing vertical transmission to less than 5% at 18 months by 2016), and the 4th and 6th millennium development goals (i.e. ‘reduce under-five mortality rate by two thirds, between 1990 and 2015, and halt the spread of HIV/AIDS’).

Aim
To periodically conduct facility-based surveys to monitor the effectiveness of the South African National PMTCT programme until 18 months postpartum.

Collaboration
The survey is a collaborative effort between the Medical Research Council, University of the Western Cape, National Department of Health, Centers for Disease Control and Prevention, Atlanta, NICD/NHLS, Wits Infant HIV Diagnostics, UNICEF and Provincial Departments of Health. All findings are reported to all stakeholders to improve implementation of the national PMTCT programme. A Steering Committee comprising all collaborative organisations oversees the survey and meets at least twice a year.

The SAPMTCTE is funded predominantly by the Centers for Disease Control and Prevention, Atlanta, with contributions from the National Department of Health, NICD/NHLS, Global Fund and UNICEF.

Project status
Prior to the 2010 survey a situational assessment was conducted to document systems for early infant diagnosis at primary health care level. The detailed report can be found at the following link.

The 2010 survey has been completed and results were presented at numerous conferences including SAAIDS 2011, IAS 2011, APHA 2011 and Perinatal priorities 2011. The detailed 2010 survey report can be found at the following link.

The 2011 SAPMTCTE-6weeks has been completed and results were released by the Minister of Health and at the International AIDS Conference 2012. The Executive Summary with preliminary 2011 results can be found at the following link.

The 2011 follow-up component was stopped after 9 months due to high (62%) loss to follow-up.

The 2012 survey started in November 2012 and the component measuring the effectiveness of the PMTCT programme by six weeks post-delivery was completed in May 2013. All HIV exposed infants were subsequently followed up at 3, 6, 9, 12, 15 and 18 months. The 18-month follow-up was completed by 12th September 2014. The six weeks results were presented to the Minister of Health on the 28th August 2014.  These results are currently embargoed until official release by the Minister of Health in November / December 2014. The 18-month results were released at the AIDS 2016 Conference (follow link).

Process evaluation of PMTCT Option B+

PI: Prof. Ameena Goga and Dr. Witness Chirinda

Overview
In 2015 South Africa adopted PMTCT Option B+ which recommends lifelong antiretroviral therapy for all pregnant and lactating women regardless of CD4 cell count.

Aim
To document the processes and models used for PMTCT Option B+ implementation, to measure the effects of PMTCT Option B+ on health services for mothers and children and to evaluate early effectiveness of PMTCT Option B+ in the initial 1-2 years post-implementation.

Collaboration
National Department of Health, Centers for Disease Control and Prevention, UNICEF, National Institute for Communicable Diseases

Project status
Field work to commence mid-2017

Long-term health outcomes of mothers and infants enrolled in the 2012-13 SAPMTCT evaluation

PI: Prof. Ameena Goga and Dr. Witness Chirinda

Overview
The results from this study will supplement the 2012-14 SAPMTCT Evaluation 18-month results by providing additional data on longer-term (two to three years) maternal and infant outcome in the context of PMTCT Option B+. These data are critical for monitoring the impact of the national PMTCT programme and the fourth millennium development goal. Additionally, the 2012-14 national cohort only followed up HIV exposed infants. This work will also follow up a group of HIV unexposed infants, thus allowing comparative analyses between the two groups.

Aim
To assess the survival of mothers and their HIV exposed uninfected (HEU) or HIV unexposed infants, previously enrolled in the 2012-14 South African PMTCT Evaluation (SAPMTCTE) , at 2-3 years postpartum

Collaboration
UNICEF, National Department of Health

Project status
Data collection completed, analysis and write up in progress.

Very Early Infant Diagnosis Study

PI: University of Pretoria (UP) Dr Nicolette du Plessis MRC co-PI Prof Ameena Goga

Co-investigators: UP: Prof Theunis Avenant  NHLS/UP: Dr Ahmad HaeriMazanderani

Overview
This study focuses on the public health impact and feasibility of universal versus targeted very early infant diagnosis. The Mississippi baby, Visconti cohort and Berlin patient have raised optimism regarding the benefits of very early diagnosis and treatment initiation in functional HIV cure. Since the reported initial apparent functional cure in the Mississippi baby several debates about the optimal timing of early infant diagnosis have occurred in South Africa and Internationally.

The key questions are:

  • In the context of PMTCT Option B what testing approach should be used to identify HIV infected infants as early as possible so that treatment can be initiated?
  • What would be the impact and added benefit of universal versus targeted very early infant diagnosis?
  • If a targeted approach is used, which combination of criteria would have the highest sensitivity and positive predictive value for infant HIV infection?
  • What is the optimal treatment to use once a neonate has been identified as being HIV infected?
  • Can universal or targeted birth infant diagnosis be incorporated into routine health care settings?

In this study we test all participating HIV exposed infants for HIV infection within 72 hours of birth and initiate all HIV infected neonates on treatment.

Aim
To investigate the public health impact and feasibility of universal versus targeted very early infant diagnosis (VEID). Specifically we are investigating the impact of VEID on (i) early treatment initiation amongst HIV exposed infants and on (ii) infant outcomes at birth, 6 weeks, 10 weeks, 14 weeks, 6 months and 9 months and on the health system.

Collaboration
The study is a collaborative effort between the Medical Research Council, Department of Paediatrics and Child Health, Kalafong hospital, University of Pretoria, and Rahima Moosa Mother and Child Hospital (RMMH) University of Witwatersrand, National Health Laboratory system and National Department of Health.

Project status
Data collection started in August 2014 at Kalafong hospital and ended in December 2016. Data are currently being analysed .

   

Utility of routine PMTCT data for monitoring antenatal HIV prevalence

PI: Prof. Ameena Goga

Co-investigator: MRC: Duduzile Nsibande

Overview
This study aims to answer the following questions: Can routine PMTCT data be used for antenatal HIV surveillance in the South African context?  What value will such an approach add? Could such an approach replace the SAANCHSS?

Aim
The overall objective of the study is to assess the utility of PMTCT program (DHIS) data for HSS among pregnant women.

Collaboration
The study is a collaborative effort between the Medical Research Council, National Department of Health, CDC and NICD/NHLS and Epicentre.

Project status
The proposal has been approved by the MRC Ethics Committee, CDC and is supported by the National Department of Health. Ethics approval has been obtained from all provinces except Gauteng. The Steering Committee was established to guide and support the project. Provincial buy-in has been sought and letters of support have been sent to districts.  Epicentre, contracted to conduct field work is currently conducting field worker training and is supported by MRC and NICD. Data collection is scheduled to commence on the 15th February 2017. 

Improving sample ascertainment, data quality and validity of national surveillance research on mother to child transmission of HIV (MTCT): Data collector insights and recommendations on field work and use of m-health technologies

PI: Prof. Ameena Goga and Dr. Nobubelo Ngandu

Overview
Data collection is no doubt a critical step to research and a key factor in determining the cost, quality, success and validity of any research project. The key to successful data collection is the data collector who plays a crucial but often underestimated role. This evaluation of data collector experiences is very well timed as it coincides with the recent growth of m-health which was adopted in the data collection for the SAPMTCTE surveys. It is therefore important to understand data collector insights and experiences with national surveillance, including how m-health impacts on the data collection process.

Aim
To document field work experiences (views and perceptions) of data collectors employed during the 2012-2014 SAPMTCTE survey.

Collaboration
UNICEF

Project status
Ethics approval obtained. Data collection to commence during the first quarter of 2017

Promoting sexual and reproductive health among adolescents in southern and eastern Africa - mobilizing schools, parents and communities (PREPARE project)

PI
Dr. Catherine Mathews

Aim
To develop, implement and evaluate an intervention for young adolescents aimed at preventing HIV, pregnancies and sexual risk behavior and reducing intimate partner violence (IPV).

Study methods
This is a cluster RCT in 42 high schools in the Western Cape. The outcomes focus on: sexual debut, condom use, number of sexual partners, IPV, conceptions in female participants.

Collaboration
The partners include: University of Cape Town, Muhimbili University College of Health Sciences, University of Limpopo, Makerere University, Maastricht University, University of Exeter, University of Oslo and the University of Bergen

Project status
Trial complete, primary outcomes published, further writing underway.

Contact person
Catherine Mathews (cathy.mathews@mrc.ac.za)
See also the project homepage: http://prepare.b.uib.no/

The development and implementation of an intervention to reduce gender based violence perpetrated against young women aged 16-24 in a peri-urban setting in South Africa: A community participation model

PI Dr. Yanga Zembe

Aim
To reduce the prevalence of gender-based violence among young women in a peri-urban community in the Western Cape, South Africa. The objectives are:

  1. To develop and implement an intervention to reduce male perpetrated GBV in the intimate relationships of young women aged 16-24, using community participation approaches;
  2. To measure the prevalence of GBV in the sexual relationships of young women aged 16-24 at baseline and 12 months; and
  3. To conduct a process evaluation that documents the experiences and challenges of engaging local communities in the design and implementation of anti-gender based violence intervention through community participation approaches.

Study design
This is a before - and after study design, using WHO violence against women instrument to measure physical and sexual partner violence at baseline and 12 months post intervention. A process evaluation of the development and implementation processes, using qualitative and quantitative methods is being conducted. The primary outcomes include: male perpetrated intimate partner violence in the past 12 months, and secondary outcomes refer to: relation power inequity and self-esteem.

Collaborations
Institute of Social Development, University of the Western Cape; Gender & Health Research Unit, MRC

Project status
Ongoing

Contact person
Yanga Zembe (yanga.zembe@mrc.ac.za)

Enhanced STI/HIV Partner Notification in South Africa

PI Dr. Catherine Mathews and Dr. Sarah Dewing

Aim
To test a theory-based approach to HIV risk reduction with enhanced partner notification counselling tailored for STI clinic patients in South Africa. Our study will test whether the effects of risk reduction counselling on contracting subsequent STI are enhanced by building skills for index patients to self-notify their current and recent sex partners.

Study methods 
This study is a three-arm randomized control trial at one primary healthcare clinic based in Cape Town, South Africa. Approximately 1050 participants will be randomized to receive one of three conditions: 1) 60 minute risk reduction and enhanced partner notification counselling, or 2) 60 minute risk reduction counselling, or 3) 20 minute STI and HIV education counselling.

Primary outcomes are 1) sexually transmitted infections and 2) partner notification. Secondary outcomes are 1) unprotected and protected sexual behaviours and 2) partner notification behaviours.

Collaboration 
This project is a collaboration between the Medical Research Council of South Africa, the University of Connecticut, the University of Cape Town and Cape Town City Health. The study is funded by the National Institutes of Health (NIH).

Project status 
Enrolment started early 2014. The project is scheduled to run over a four-year period.

Contact persons
Dr. Cathy Matthews (cathy.mathews@mrc.ac.za)

African Center for Collaborative Child Mental Health Implementation Research (ACCCR)

PI: Mary McKay
Capacity Development Leads: Arvin Bhana, Inge Petersen

Overview
The goal of this study is to fund an African Center for Collaborative Child mental health implementation Research (ACCCR), and an African Regional Trans-disciplinary Collaborative Center aimed at to reducing child mental health service and research gaps in Uganda, Ghana and Kenya through a population approach to child mental health.

Aim
 To build research capacity in African countries in child mental health implementation research

Collaboration
SAMRC; University of KwaZulu-Natal, New York University, Makerere University

Project Status
The project was initiated in May 2016 with a conference on evidence-based practice in child and adolescent well-being in Uganda and is funded for 5 years until 2021.

Contact person
Arvin Bhana (arvin.bhana@mrc.ac.za)
Project webpage under construction

VUKA Family Program (VUKA): Supporting Perinatally HIV-infected youth in South Africa.

PI: Mary McKay
Co-investigators: Arvin Bhana, Inge Petersen

Overview
VUKA is a family-based intervention programme that has evolved from previous work on family-strengthening approaches in South Africa and the USA to strengthen protective factors and reduce risk behaviours associated with HIV and AIDS.

Aim
The study aims to 1) increase understanding of behavioral and health risk in this emerging population, and 2) to examine the impact of the VUKA Family Program (VUKA) to promote youth overall health and mental health, and reduce behavioral risk.

Collaboration
University of New York; University of Columbia; University of KwaZulu-Natal, Department of Health (Regional).
 
Project Status
The project is in its fourth year of implementation and will end in 2017.

Contact person
Arvin Bhana (arvin.bhana@mrc.ac.za)

VUKA EKHAYA: A take-home family intervention to improve adherence and reduce behavioural risk among perinatally HIV-infected youth.

PI: Arvin Bhana
Co-PI: Latoya Small

Overview
VUKA EKHAYA is an adaptation of the VUKA Family Program to support the Health and Behavior of South African HIV+ Youth. It is a “take home” family Intervention to improve adherence and reduce Behavioral Risk among perinatally HIV Infected adolescent youth and hopes to reduce the implementation burden on health systems.

Aim
The proposed study aims to address the need for empirically informed, effective and scalable interventions that promote adherence to antiretroviral therapy (ART) and retention in care

Collaboration
Medical Research Council, University of KwaZulu-Natal, Department of Health (Regional),
 
Project Status
The project will commence in October 2016

Contact person
Arvin Bhana (arvin.bhana@mrc.ac.za)

Achieving Universal HIV care coverage among Children and Adolescents in South Africa (UHCASA)

PIs: Miss Darshini Govindasamy (lead PI), Prof Cathy Mathews (Co-PI)

Co-investigators: Dr. Giulia Ferrari, Prof Janet Seeley, Prof Lars Lindholm, Ms Emmanuelle Daviaud

Overview 
Currently, there is a high unmet need for HIV care among children and adolescents in South Africa, with less than 50% of young HIV-positive individuals who are eligible for antiretroviral therapy (ART) on treatment. To date, studies have highlighted the poor ART adherence levels and low retention in HIV care programmes among HIV-positive children and adolescents. Poor families have been the hardest hit by the HIV/AIDS epidemic and their access to healthcare is hindered by the specific socio-economic barriers they counter. Thus, there is an urgent need to expand HIV care coverage and reduce inequities in coverage. Understanding the resource implications of providing HIV care to children and adolescents could help inform decisions on strategies to scale-up HIV care for this vulnerable population in South Africa.

Aims
Phase 1: To estimate the health-related quality of life, wellbeing and HIV care provision among HIV-positive children and adolescents (5-19 years).

Phase 2: To use modelling to assess the optimal mix of interventions to expand HIV care coverage in the most cost-effective, equitable and affordable manner among HIV-positive children and adolescents (5-19 years).

Collaboration 
London School of Hygiene and Tropical Medicine, Umeå University, MATCH-KZN

Project Status
Proposal implementation of Phase 1 will commence in 2017.

Contact person
Darshini Govindasamy (darshini.govindasamy@mrc.ac.za)

Funder: NRF Thuthuka grant, SAMRC Intramural Award

Impact Evaluation of the Global Fund Young Women and Girls (YW&G) Intervention in Ten South African Districts” (YW&G Evaluation)

PI Dr Catherine Mathews and Ms Darshini Govindasamy

Aim
To evaluate the impact of the Global Fund YW&G Intervention on HIV incidence among YW&G aged 15 to 24 years in the ten intervention districts. The Global Fund intervention for YW&G is one of the programmes designed to contribute to the South African government’s target of reducing HIV incidence among YW&G aged 10 to 24 years by 50% over a two-year period

The objectives are:  

  1. To determine at baseline, the HIV incidence among YW&G aged 15 to 24 years, the HIV incidence two years later, and the change in HIV incidence over the two-year period
  2. To measure exposure to and participation in the various components of the Global Fund Intervention among YW&G aged 15 to 24 years, and to investigate whether exposure and participation is associated with a reduction in HIV incidence and HIV risk behavior in the two-year survey
  3. To determine at baseline among YW&G, participation in education, school and employment, and their access to career development and economic opportunities (including support for small business development), social grants and student loans, and changes in their participation and access two years later
  4. To determine at baseline among YW&G resilience, social capital, social cohesion, social norms in relation to sexual relationships and gender power, and perceptions of parent and community support and protection, and changes two years later

Study methods 
We will conduct two sequential cross-sectional household surveys among YW&G, two years apart.

Collaboration 
Epicentre AIDS Risk Management (Pty) Limited
National Institute for Communicable Diseases
Brown University
University of Cape Town
Centers for Disease Control and Prevention
South African National AIDS Council
National Department of Health

Project status 
Protocol approval phase

Contact persons 
Cathy Mathews: Cathy.Mathews@mrc.ac.za 
Darshini Govindasamy: darshini.govindasamy@mrc.ac.za
Tracy McClinton Appollis: tracy.mcclintonappollis@mrc.ac.za

To document the rollout of decentralised management of DR-TB in South Africa 2014-2017

PI Dr. Marian Loveday

Aim
To determine the unintended consequences of the rollout of decentralised management of DR-TB in South Africa

Methods
A mixed method observational epidemiological study with an analytic and descriptive component

Project status
Data collection started in January 2015 and will continue until the end of 2017.

Collaboration 
Partners include National and Provincial Departments of Health

Contact person
Marian Loveday (marian.loveday@mrc.ac.za)

An exploratory study documenting pregnancy outcomes in women who are exposed to second-line TB treatment during their pregnancy

PI: Dr. Marian Loveday
Aim
To document the treatment and pregnancy outcomes of women treated for DR-TB during their pregnancy. 

Study methods
A retrospective record review.

Status
Data collection in process

Collaboration
Dr. Helen Cox from UCT
Dr. Jennifer Hughes from Medicines san Frontier (Khayelitsha, South Africa)

What is the post-treatment mortality after patients successfully complete their TB or MDR-TB treatment?

PI: Dr. Marian Loveday

Aim
To document the post-treatment mortality after patients successfully complete their TB or MDR-TB treatment

Study methods
A case-control study design: We will identify a similar number of patients with TB in Umzinyathi and Khayelitsha, matching for age and gender with MDR-TB patients in the same area.  Patients co-infected with HIV and with co-morbid conditions (eg. Diabetes) will be included.

Status
Finalising protocol

Collaboration
Dr. Helen Cox from UCT
Dr. Jennifer Hughes from Medicins san Frontier (Khayelitsha, South Africa)

Programme for Improving Mental Health Care (PRIME)

PI: Inge Petersen (South Africa)
Co-Is: Arvin Bhana, Lara Fairall

Overview
PRIME is a research programme consortium comprising universities and Ministries of Health in five developing countries (Ethiopia, India, Nepal, South African, Uganda)funded by DFiD. The goal of PRIME is generate international evidence on the development, implementation and scaling up of integrated treatment packages for priority mental disorders in primary and maternal health care settings in low resource contexts.

Aim
Develop, implement and scale up integrated treatment packages for priority mental disorders in primary and maternal health care settings in low resource contexts

Collaboration:
University of Cape Town is the Coordinating entity. University of KwaZulu-Natal; Knowledge Translation Unit, UCT, Medical Research Council, University of KwaZulu-Natal, University of Cape Town, Institute of Psychiatry, King’s College, London, London School of Hygiene and Tropical Medicine, Public Health Foundation, India, Transcultural Psychosocial Organization, Nepal,  Butabika National Mental Hospital, Uganda, World Health Organization, National Department of Health, North West Provincial Department of Health
 
Project Status
The project is meant to terminate in 2017 but has been extended for another two years by the funder until 2019.

Contact person
Inge Petersen (peterseni@ukzn.ac.za) or administrator
Also see project webpage: www. prime.uct.ac.za

Task sharing mental health services within chronic care in South Africa (MHiNT)

PI: Deepa Rao; Inge Petersen
Co-investigators: Arvin Bhana, Lara Fairall, Crick Lund

Overview
In the context of the re‐engineered PHC system, including integrated chronic care in South Africa, the University of KwaZulu-Natal is collaborating with the University of Washington and I‐TECH South Africa to scale up the integration of mental health care into integrated chronic care at primary health care facilities in collaboration with the national and provincial DOH in North West, Mpumalanga and KwaZulu-Natal.

Aim
To scale up integrated mental health care into HIV and chronic care platforms at primary health care level

Collaboration
Department of Global Health, University of Washington, University of KwaZulu-Natal, I-TECH South Africa, University of Cape Town, Medical Research Council, Department of Health (National and Regional)

Project Status
The project was initiated in 2016 and is funded for 3 years until 2019

Funder
United States Centres for Disease Control and Prevention

Contact person
Inge Petersen (peterseni@ukzn.ac.za)

Comorbid Affective Disorders, AIDS/HIV, and Long Term Health (COBALT)

PIs: Inge Petersen, Lara Fairall, Grahame Thornicroft
Co-investigators: Arvin Bhana, Naomi Folb, Max Bachmann, Dan Chisholm, Tom Gaziano, Carl Lombard, Jill Haness-Hancock, Crick Lund, Paul McCrone, Martin Prince, Naomi Levitt

Overview
The COBALT study is a cluster randomised controlled trial at the level of health clinics in the North West
Province in South Africa (SA) to evaluate an intervention for HIV positive adults on antiretroviral treatment (ART) with depression. The relevance of this project to public health is that SA is home to the highest number of HIV positive people in the world and previous research indicates that depression is an important cause for non-adherence to ART. There is little evidence internationally, let alone in low resource settings, on cost-effective treatments in this patient population, or on their impact on HIV, on depression or on cardiovascular and metabolic disease outcomes.

 

Aim
To improve HIV outcomes and ART adherence through improved identification and management of depression, alcohol misuse and chronic diseases of lifestyle.

Collaboration
University of KwaZulu-Natal, University of Cape Town Lung Institute, Institute of Psychiatry, King’s College, London, Department of Health (National and Regional)

Project Status
The project is in its third year of implementation and will finish in 2018

Contact person
Inge Petersen (peterseni@ukzn.ac.za)

SMS-TEXT Adherence Support (STAR): A multi-stage process evaluation of a mobile-phone intervention to enhance adherence to diabetes treatment and care in Lilongwe, Malawi, Cape Town and Johannesburg

PI Dr. Natalie Leon

Aim
The StAR Diabetes (StAR2D) study aims  1. to inform the development of the SMS content and delivery mechanisms of a mobile-phone intervention that will be tested in a randomised controlled trial (RCT), to enhance adherence to diabetes treatment and care and 2. through a multi-stage process evaluation,  to evaluate the implementation of the RCT and the experience of stakeholders in the three sites in order to investigate contextual factors, possible causal pathways of the intervention and requirements for scaling and sustainability. There is also an economic evaluation component of this mHealth trial.

Study methods 
The formative and process evaluations are multi-method, mainly qualitative evaluations using focus groups, individual interviews, document reviews, literature reviews and observational methods.

Collaboration
Nuffield Department of Primary Care Health Sciences, University of Oxford, UK ; Chronic Diseases Initiative in Africa, University of Cape Town and Groote Schuur Hospital, Malawi Epidemiology and Intervention Research Unit,  University of Witwatersrand, Johannesburg. Funders are  MRC UK, SAMRC and Global Alliance for Chronic Disease.

Project status 
The formative and intervention development phase of the research was completed in Dec 2016. The trial and the first phase of the process evaluation is in progress. The economic evaluation, led by Ms Daviaud from SAMRC, is also in progress. 

Contact person 
Dr. Natalie Leon  (natalie.leon@mrc.ac.za)
Ms. Emmanuelle Daviaud (Emmanuelle.daviaud@mrc.ac.za)

The Cape Town iALARM Project: Using routine health information to align services and link and retain men in the HIV cascade

In South Africa, men are less likely than women to be tested for HIV and to access HIV prevention, treatment and care. This is due to a complex set of social and health systems factors. The iALARM study, headed by Dr Chris Colvin from UCT and Dr Mark Lurie from Brown University, USA, is a 5-year  NIH-funded, mixed method collaboration with co-investigators from a number of institutions, including Dr Natalie Leon from the Health Systems Research Unit at the SAMRC. The study attempts to address this problem pf poor linkage to care through two aims, to 1) understand the cultural, social and psychological factors that make it difficult for men to get HIV services and stay in care, and 2) help healthcare workers and managers from NGOs, city and provincial facilities work together to better support men in HIV care. iALARM aims to achieve this through a routine health information system intervention that will allow for better coordination between partners in the area working with HIV positive men. The intervention will integrate routine facility-level data with local-level cohort data of men moving through the HIV cascade in our study site. We use this information to better align services to link and retain men in HIV

The impact of the Child Support Grant on child outcomes

PI Dr. Wanga Zembe

Aim 
To assess the impact of the Child Support Grant (CSG) on child health outcomes.

Study 1
This is a mixed methods study conducted between 2006-2011 with a longitudinal cohort study design following mother and child pairs from birth to 2 years and a qualitative sub-study to understand caregivers’ experiences of the CSG. It was conducted in: rural Kwazulu-Natal (Rietvlei), peri-urban Western Cape (Paarl), urban Kwazulu-Natal (Umlazi, Durban).

Collaboration
The partners included: University of the Western Cape (School of Public Health) and Health Systems Trust.

Project status
Study completed. 3 papers published.

Study 2
This small study analysed cross-sectional data from a community-based cluster-randomised trial which evaluated a programme providing pregnancy and postnatal home visits by community health workers to encourage exclusive breastfeeding. The study assessed CSG take-up rates, reasons for non-application and non-receipt among caregivers of 12 week old infants in Umlazi township in Durban Kwazulu-Natal.

Collaboration: UWC School of Public Health

Project status: 1 paper has been published from this study

Study 3
PI: Dr Wanga Zembe, Ms Vundli Ramokolo, Prof Tanya Doherty, Prof David Sanders, Prof Rina Swart, Prof Rebecca Surender, Prof Gemma Wright

This is a qualitative study exploring CSG recipients’ experiences of utilising the CSG to access food for child beneficiaries under 5 in Mount Frere, Eastern Cape, and Langa, Western Cape.  In 2015 forty in-depth interviews and 7 focus group discussions were conducted with primary with recipient and non-recipient primary caregivers of children under 5, community members, and local shop owners in the two sites.

Collaboration: The Centre of Excellence for Food Security, UWC School of Public Health, University of Oxford, Southern African Social Policy Research Institute

Project status: Preliminary findings have been presented and discussed at internal academic forums. Planned dissemination of final findings and 2 research papers

Study 4
PI: Dr Wanga Zembe, Ms Vundli Ramokolo, Prof Tanya Doherty, Prof David Sanders, Prof Rina Swart

A longitudinal birth cohort study identifying women during pregnancy and following them up with their children from birth until 2 years to assess the nutritional status and dietary patterns of recipients and non-recipients of the CSG in Langa Township, Western Cape. This study builds upon the qualitative study outlined under Study 3. It is partially funded by the Centre of Excellence for Food Security and will run from 2016-2019.

The birth cohort commenced in March 2016. Fieldwork is in progress with the aim to recruit and follow up 500 mothers and their children.

Collaboration: The Centre of Excellence for Food Security, and UWC School of Public Health,

Contact person
Dr. Wanga Zembe (wanga.zembe@mrc.ac.za)

Ms Vundli Ramokolo (Vundli.ramokolo@mrc.ac.za)

Analysis of financial and human resource requirements for community-based services: comparing urban, rural and deep-rural settings

PI: Emmanuelle Daviaud
Co-Investigators: MRC: Donela Besada; Rural Health Advocacy Project: Daygan Eager

Aim
To compare resource requirements for community-based services between urban, rural and deep-rural settings to inform staffing norms and resource allocation. 

Study methods
Analysis in 2 districts in Gauteng and Kwazulu Natal with spread of different types of sub-districts. Travel and activity times collected through 10 days CHWs diaries. Profile of activity, and costs of implementation compared. The outcomes focus on: number of CHWs required per 6,000 population team in urban, rural and deep-rural settings and per standardised 100,000 population. Coverage level compared to 2012 model for NDoH (ref report 2012 model on website) and whether different per type of settings. Financial costs.

Collaboration
The project is a partnership with the Rural Health Advocacy Project, Rural Health Project, University of the Witswatersrand.

Project status
Data collection and analysis completed and writing underway.

Contact person
Emmanuelle Daviaud : Emmanuelle.Daviaud@mrc.ac.za

Community health worker investment case

PI: Dr. Karen Hoffmann, PRICELESS
Co-PIs: MRC: Emmanuelle Daviaud, Donela Besada; UWC: Helen Schneider
Co-Investigator: PRICELESS: Pratik Panchal

Aim
To develop an investment case covering the costs and benefits of community-based care delivered by Community Health Workers in the context of the Ward-based Outreach teams.  Study requested by the NDoH.

Methods
The study builds on previous study to develop costing of CBS.  It analyses benefits by looking at the following categories: mother and child, HIV, TB and Chronic diseases by assessing reduction in morbidity and DALYS averted through the intervention of CHWs, and the consequent savings to health system.  With an intersectoral view, it assesses the social and economic benefits of increased employment amongst low skilled population.

Collaboration: PRICELESS at the University of the Witwatersrand, SAMRC and UWC School of Public Health

Project status
Data collection and analysis underway.

Contact person
Emmanuelle Daviaud : Emmanuelle.Daviaud@mrc.ac.za

 

Assessing the effects of interventions to improve Health Information Systems (HIS): A systematic Review

PI Dr. Natalie Leon

Aim
To systematically review evidence on effectiveness routine health information interventions aimed at improving health information systems, health systems functioning and health outcomes. The objective is to document the evidence-base on HIS strengthening in order to inform policy and practice in health systems strengthening.

Study methods 
Evidence synthesis approach: EPOC Systematic review.

Collaboration
A project commissioned by Alliance for Health Policy and Systems Research. Collaboration with Public Health Dept, University of Ghana.

Project status 
EPOC Protocol published; abstract and title screening is in progress

Contact person                       
Dr. Natalie Leon  (natalie.leon@mrc.ac.za)

South African Initiative for Systematic Reviews on Health Policies and Systems (SAI)

PI Dr. Karen Daniels

Aim
SAI aims to develop institutional capacity in LMICs to conduct and to promote the translation of evidence syntheses into practice. We focus on health policy and systems issues that are policy-relevant at the national level in South Africa, but that could also be relevant to the needs of other countries in the region or in similar settings in other parts of the world. Our work comprises conducting systematic reviews and producing rapid evidence syntheses to knowledge users across departments of health and civil society.  

Collaboration
SAI is partnering with senior researchers in South Africa from Cochrane South Africa, the University of the Witwatersrand, and the University of Stellenbosch. We also directly and actively engage with policy makers within the South African Department of Health at local government (municipal), provincial and national levels. SAI is funded by the Alliance for Health Policy and Systems Research based at the World Health Organisation (http://www.who.int/alliance-hpsr/en/).

Project status 
This multi-year project (June 2013 - December 2017) commenced with a priority setting exercise involving leading academics and policy makers primarily in South Africa but also extending to other countries in sub-Saharan Africa. This exercise resulted in identifying priority health systems and policy research questions, and informed the focus and design of the four systematic reviews that are conducted by the SAI (see below). We recently began with our rapid evidence synthesis service, and have produced two such syntheses to date.

The full reviews are:
Review 1
Community-based interventions to improve access to medicines for patients with chronic life-long conditions in resource-constrained settings and hard-to-reach population groups: A scoping review

  • The review is registered with the EPPI Centre

Review 2
Assessing the effects of interventions to improve routine health information systems for health systems management

  • The review is registered with Cochrane Effective Practice and Organisation of Care (EPOC) Review Group

Review 3
Healthcare workers’ perceptions and experience on using mHealth technologies to deliver primary healthcare services: qualitative evidence synthesis

  • The review is registered with Cochrane Effective Practice and Organisation of Care (EPOC) Review Group

Review 4
Contracting out to improve the use of service and health outcomes in low- and middle-income countries

  • The review is registered with Cochrane Effective Practice and Organisation of Care (EPOC) Review Group

Contact person 
Arrie Odendaal (willem.odendaal@mrc.ac.za) 
We welcome interaction and feedback around our work. We also welcome requests to be involved in systematic reviews of health systems and policy questions, and invite knowledge users to make use of our rapid evidence synthesis service.

 

 


 

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