Current Projects

Details of our projects can be accessed under these thematic areas.

Thematic area 1: Maternal, Family, Child Health, Nutrition (MFCHN)

Evaluation of the effectiveness of the South African Prevention of Mother - to - Child Transmission of HIV (PMTCT) Programme on Infant HIV, periodically at six weeks postpartum (data collection: 2010, 2011, 2012), and until 18 months of age (data collection: 2012-2014) (SAPMTCTE)

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

Co-investigators: South African 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 had successfully scaled up its PMTCT services. Interventions to prevent mother-to-child transmission of HIV were 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 were (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 was 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 were reported to all stakeholders to improve implementation of the national PMTCT programme.

The SAPMTCTE was 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

The 2010 situational assessment, conducted to document systems for early infant diagnosis at primary health care level, has been completed and can be obtained here. The 2010 survey has been completed. 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 here.

The 2011 SAPMTCTE-6weeks has been completed. 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 here

The 2012 survey has been completed and the report can be found here. The six weeks results were presented to the Minister of Health on the 28th August 2014. 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 and  results were released at the AIDS 2016 Conference.

Contact person
Prof. Ameena Goga
ameena.goga@mrc.ac.za

The following papers have been published as a result of our association with this work

Journal Articles

2014/15 Financial Year

  1. Goga AE, Dinh TH, Jackson DJ, Lombard C, Delaney KP, Puren A, Sherman G, Woldesenbet S, Ramokolo V, Crowley S, Doherty T, Chopra M, Shaffer N, Pillay Y. First population-level effectiveness evaluation of a national programme to prevent HIV transmission from mother to child, South Africa. Journal of Epidemiology and Community Health. 2015 Mar;69(3):240-8. Epub 2014 Nov 4. DOI: 10.1136/jech-2014-204535 [Original]
  2. Woldesenbet SA, Jackson D, Goga AE, Crowley S, Doherty T, Mogashoa MM, Dinh TH, Sherman GG. Missed opportunities for early infant HIV diagnosis: results of a National Study in South Africa. Journal of Acquired Immune Deficiency Syndromes. 2015 Mar 1;68(3):e26-32. Epub 2014 Dec 2. DOI: 10.1097/QAI.0000000000000460 [Original]

2015/16 Financial Year

  1. Dinh TH, Delaney KP, Goga A, Jackson D, Lombard C, Woldesenbet S, Mogashoa M, Pillay Y, Shaffer N. Impact of maternal HIV seroconversion during pregnancy on early Mother to Child Transmission of HIV (MTCT) measured at 4-8 weeks postpartum in South Africa 2011-2012: a National Population-Based Evaluation. PLoS One. 2015 May 5;10(5):e0125525. DOI: 10.1371/journal.pone.0125525 [Original]
  2. Woldesenbet S, Jackson D, Lombard C, Dinh TH, Puren A, Sherman G, Ramokolo V, Doherty T, Mogashoa M, Bhardwaj S, Chopra M, Shaffer N, Pillay Y, Goga A. Missed opportunities along the prevention of mother-to-child transmission services cascade in South Africa: uptake, determinants, and attributable risk (the SAPMTCTE). PLoS One. 2015 Jul 6;10(7):e0132425. DOI: 10.1371/journal.pone.0132425 [Original]

2016/17 Financial Year

  1. Goga AE, Dinh TH, Jackson DJ, Lombard CJ, Puren A, Sherman G, Ramokolo V, Woldesenbet S, Doherty T, Noveve N, Magasana V, Singh Y, Ramraj T, Bhardwaj S, Pillay Y; South Africa PMTCT Evaluation (SAPMCTE) Team. Population-level effectiveness of PMTCT Option A on early mother-to-child (MTCT) transmission of HIV in South Africa: implications for eliminating MTCT. Journal of Global Health. 2016 Dec;6(2):020405. Epub 2016 Sep 16. DOI: 10.7189/jogh.6.020405 [Original]
  2. Woldesenbet SA, Jackson DJ, Lombard CJ, Dinh TH, Ramokolo V, Doherty T, Sherman GG, Pillay Y, Goga AE. Structural level differences in the mother-to-child hiv transmission rate in South Africa: a multilevel assessment of individual-, health facility-, and provincial-level predictors of infant HIV transmission. Journal of Acquired Immune Deficiency Syndromes. 2017 Apr 15;74(5):523-530. Epub 2017 Jan 18. DOI: 10.1097/QAI.0000000000001289 [Original]

2017/18 Financial Year

  1. Hamilton E, Bossiky B, Ditekemena J, Esiru G, Fwamba F, Goga AE, Kieffer MP, Tsague LD, Van De Ven R, Wafula R, Guay L. Using the PMTCT cascade to accelerate achievement of the global plan goals. Journal of Acquired Immune Deficiency Syndromes. 2017 May 1;75 Suppl 1:S27-S35. Epub 2017 Apr 12. DOI: 10.1097/QAI.0000000000001325 [Review]
  2. Sherman GG, Mazanderani AH, Barron P, Bhardwaj S, Niit R, Okobi M, Puren A, Jackson DJ, Goga AE. Toward elimination of mother-to-child transmission of HIV in South Africa: how best to monitor early infant infections within the prevention of mother-to-child transmission program. Journal of Global Health. 2017 Apr 12;7(1):010701. DOI: 10.7189/jogh.07.010701 [Original]
  3. Ramokolo V, Goga AE, Lombard C, Doherty T, Jackson DJ, Engebretsen IMS. In-utero ART exposure and birth and early growth outcomes among HIV-exposed uninfected infants attending immunization services: results from National PMTCT Surveillance, South Africa. Open Forum Infectious Diseases. 2017 Oct;4(4):ofx187-ofx. Epub 2017 Aug 30. DOI: 10.1093/ofid/ofx187 [Original]
  4. Ngandu NK, Van Malderen C, Goga A, Speybroeck N. Wealth-related inequality in early uptake of HIV testing among pregnant women: an analysis of data from a national cross-sectional survey, South Africa. BMJ Open. 2017 Jul;7(7):e013362. DOI: 10.1136/bmjopen-2016-013362 [Original]
  5. Goga A, Chirinda W, Ngandu NK, Ngoma K, Bhardwaj S, Feucht U, Davies N, Ntloana M, Mhlongo O, Silere-Maqetseba T, Moyo F, Sherman G. Closing the gaps to eliminate mother-to-child transmission of HIV (MTCT) in South Africa: Understanding MTCT case rates, factors that hinder the monitoring and attainment of targets, and potential game changers. South African Medical Journal. 2018 Mar 03;108(3 Suppl1):s17-s24. DOI: 10.7196/SAMJ.2017.v108i3b.12817 [Editorial]

2018/19 Financial Year

  1. Goga A. Birth HIV testing and paediatric treatment programmes. Lancet HIV. 2018 Dec;5(12):e675-e6. Epub 2018 Nov 8. DOI: 10.1016/s2352-3018(18)30291-1 [Letter]
  2. Goga A, Singh Y, Jackson D, Mukungunugwa S, Wafula R, Eliya M, Ng'ambi WF, Nabitaka L, Chirinda W, Bhardwaj S, Essajee S, Hayashi C, Pillay Y. How are countries in sub-Saharan African monitoring the impact of programmes to prevent vertical transmission of HIV? British Medical Journal. 2019 Mar 26;364:l660. Epub 2019 Mar 26. DOI: 10.1136/bmj.l660 [Original]
  3. Ramraj T, Goga AE, Larsen A, Ramokolo V, Bhardwaj S, Chirinda W, Jackson D, Nsibande D, Ayalew K, Pillay Y, Lombard CJ, Ngandu NK; South Africa PMTCT Evaluation (SAPMCTE) Team. Completeness of patient-held records: observations of the Road-to-Health Booklet from two national facility-based surveys at 6 weeks postpartum, South Africa. Journal of Global Health. 2018 Dec;8(2):020901. Epub 2018 Sep 15. DOI: 10.7189/jogh.08.020901 [Original]

Book Chapters

2017/18 Financial Year

  1. Goga A, Sherman G, Chirinda W, Ng`oma K, Bhardwaj S, Doherty T, Pilly Y, Barron P. Eliminating mother-to-child transmission of HIV in South Africa, 2002–2016: progress, challenges and the last mile plan. Chapter 13. In: Padarath A, Barron P (eds).  South African Health Review 2017. Durban: Health Systems Trust; 2017 Aug 23. P137-146, 20th edition. Epub 2017 May.
Long-term health outcomes of mothers and infants enrolled in the 2012-13 SAPMTCT evaluation: data collection 2016

PI: Prof. Ameena Goga and Dr. Witness Chirinda

Overview
There are few studies assessing the long-term outcomes, at approximately 3-4 years of age of HIV exposed and HIV unexposed children. These data are critical for monitoring the impact of the national PMTCT programme and the fourth millennium development goal.

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.

Contact person
Dr. Witness Chirinda (witness.chirinda@mrc.ac.za)

Very Early Infant Diagnosis Study: data collection: 2014-2016

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. Two PhD students have graduated and two papers have been accepted for publication thusfar.

Contact person
Prof. Ameena Goga (ameena.goga@mrc.ac.za)

Utility of routine PMTCT data for monitoring antenatal HIV prevalence: data collection: 2017

PI: Prof. Ameena Goga

SAMRC co-investigator: 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, Epicentre and UNAIDS.

Project status
Data collection has been completed. The detailed survey report can be found here. Research papers for peer reviewed publication are currently being drafted.

Contact person
Prof. Ameena Goga (ameena.goga@mrc.ac.za)

A proof of concept feasibility study of an outreach mentorship approach for disseminating the updated 2016 WHO HIV and Infant feeding guidelines: 2018

PI: Prof. Ameena Goga, Prof Tanya Doherty and Dr Christiane Horwood

Overview
In 2017 HIV and infant feeding guidance was updated in South Africa, in response to the 2016 WHO update..

Aim
We sought to determine whether a participatory mentorship approach to guidelines dissemination increases knowledge, attitude and skills of health workers.

Collaboration
UKZN, WHO, University of Bergen

Project status

Field work has been completed, Data management, analysis and write-up are currently underway.

Contact person
Prof. Ameena Goga (ameena.goga@mrc.ac.za),  Prof Tanya Doherty (Tanya.Doherty@mrc.ac.za)

Process evaluation of PMTCT Option B+: 2018

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 has been completedto commence mid-2017, Data management, analysis and write-up are currently underway.

Contact person
Prof. Ameena Goga (ameena.goga@mrc.ac.za)

Barriers to integrated family planning and HIV care services in South Africa: data collection 2017

PI: Dr Witness Chirinda

Overview
In South Africa, high rates of unplanned pregnancies remain a major public health concern.  Studies have reported prevalence of unplanned pregnancies ranging between 60-85% in HIV infected women and in the general population.  Integrating family planning into HIV service has been shown to; reduce rate of unplanned pregnancy; increase uptake, coverage and reach of FP; reach both men and women; increase ART uptake and adherence; and reduction of HIV-related stigma. Despite recognition that service integration is important for patient care and that integration reinforces HIV prevention and FP goals, the literature is unclear on how best to integrate SRH and HIV services, leaving service providers with uncertainty regarding the most effective model. In South Africa, little is known about the extent of service integration particularly at the level of policy making, and interventions are necessary to be targeted at this level.

Overall aim
This study aims to explore the (policy and operational) barriers to FP/HIV service integration and identify strategies to overcome them.

The key questions are:

  • What is the extend of FP/HIV care integration in selected contexts
  • What is the understanding of service integration among policy makers and programme managers?
  • What are the barriers to FP/HIV care service integration at policy and operational levels?
  • How can these barriers be overcome?

Collaboration
UNICEF

Project status
Data analysis in progress. An expert meeting to be held before end-June 2019

Contact person
Dr. Witness Chirinda (witness.chirinda@mrc.ac.za)

Preventing HIV incidence in pregnant and lactating young women: 2018 ongoing

PI: Prof. Ameena Goga

Overview
The project aims to explore how HIV incidence amongst pregnant and lactating women can be reduced. Specifically, we aimed to test the feasibility and effectiveness of Pre-exposure prophylaxis (PrEP) and reasons for withdrawal amongst HIV negative pregnant women enrolled in a PrEP study in KZN. Additionally, we sought to develop a risk score to identify young pregnant or lactating women at highest risk of HIV acquisition. Our deliverables include reports, peer reviewed publications, policy briefs, data that could guide policy makers on whether to invest in additional work to test the role of PrEP in HIV negative pregnant women.

Objectives

  1. To explore the acceptability and feasibility of PrEP, and reasons for study withdrawal amongst HIV negative pregnant or lactating women enrolled in CAP016: Immediate or Deferred Pre-exposure Prophylaxis for HIV Prevention: Safe Options for Pregnant and Lactating Women: An Open-Label Randomised Control Study, a study currently funded by the SAMRC and led by Prof Dhayendre Moodley, University of KwaZulu-Natal.
  2. To conduct a desk review on the legislative and regulatory framework around PrEP in pregnant and lactating women
  3. To develop a simple risk measurement tool to identify which young pregnant or lactating women are at risk of HIV infection
  4. To write a proposal to test an intervention aimed at reducing HIV incidence in young pregnant and lactating women

Collaboration
Prof Dhayendre Moodley, University of KwaZulu-Natal.

Project status

  • Research papers for peer reviewed publication on the secondary analysis and desk review have been drafted
  • A formative assessment on the feasibility and acceptability of PrEP amongst HIV negative pregnant women was conducted in 3 provinces (North West, Gauteng and Limpopo). Data for this work is being analysed to inform how the proposals are framed.
  • Two proposals are currently being written: (1) to understand perceptions of women and their partners currently enrolled in a PrEP study in KZN and (2) to explore the plausibility of on-demand PrEP in pregnant and lactating women

Contact person
Prof. Ameena Goga (ameena.goga@mrc.ac.za)

Evaluation of the Mphatlalatsane Initiative: An Integrated Quality Improvement Approach to Improve Sexual, Reproductive, Maternal and Neonatal Health Outcomes: 2018 ongoing

Co-PIs: Dr. Terusha Chetty (SAMRC); Prof. Helen Schneider (UWC)

Co-investigators: Yages Singh (SAMRC), Solange Mianda (UWC), Arrie Odendaal (SAMRC)

Overview
The National Department of Health (NDoH), in collaboration with the Clinton Health Access Initiative (CHAI), the SAMRC-University of Pretoria Maternal and Infant Health Strategies Unit and the University of Limpopo Trust is implementing an integrated sexual, reproductive, maternal and newborn health (SRMNH) initiative in three catchment areas within three provinces. The SAMRC will join this initiative as an independent research partners to evaluate the implementation and effectiveness of the SRMNH initiative, develop the knowledge network and fund research and innovations to improve SRMNH.

Overall aim
The Mphatlalatsane Initiative aims to improve sexual, reproductive, maternal and neonatal health outcomes in South Africa. It seeks to reduce unplanned pregnancies, maternal and neonatal mortality and stillbirths, to develop a replicable model for national scale-up through government adoption and funding, and to develop an investment case for SRMNH.

Evaluation

The evaluation is led by Prof. Ameena Goga, and will be conducted in collaboration with the University of the Western Cape - SAMRC extra-mural unit. The evaluation will investigate the impact of a system-level complex, patient-centered quality improvement intervention on sexual, reproductive, maternal and newborn healthcare outcomes and on patients’ experiences of care at selected catchment sites in South Africa

Knowledge network

The network aims to promote collaborative learning on all levels in the programme, as a means to disseminate evidence of effective interventions being implemented. Through this, the network aims to promote the translation of research into practice and policy. The Knowledge network is led by Arrie Odendaal.

Collaboration
The project partners are:

  • National Department of Health
  • Technical Advisors to National Department of Health (NDoH)
  • Clinton Health Access Initiative (CHAI)
  • SAMRC - University of Pretoria, Maternal & Infant Care Unit (MRC-UP)
  • University of Limpopo Trust-Limpopo Initiative for Newborn Care (ULT-LINC)
  • SAMRC - University of the Western Cape, School of Public Health (SAMRC-UWC)  

Funding for this initiative is provided by the ELMA Foundation and a large, anonymous donor, with in-kind support from the NDOH and South Africa Medical Research Council.

Project status
Preparatory activities commenced in 2017. The intervention activities will run from 2019 to 2021, with scale-up of successful interventions from 2021. The evaluation and Knowledge network protocols are being finalised. Field work has not yet started.

PHANGISA study: Key risk factors for peripartum and postpartum vertical HIV transmission in the context of PMTCT Option B+ in a rural district in South Africa

PI: Nobubelo Ngandu, Ameena Goga

Overview
The sub-regional variation in maternal HIV exposure and vertical transmission rates are the current stumbling blocks against progress towards meeting the targets for eliminating mother-to-child transmission of HIV (MTCT) at national level in South Africa. High impact and context-specific district-level interventions in districts with vertical HIV transmission higher than the national average are needed. Ehlanzeni district in Mpumalanga province is one of such high-risk regions. However, routine data is either incomplete or of poor quality making it difficult to accurately identify gaps and opportunities for improving HIV care to mother-infant pairs.

Aims
In order to design an effective intervention(s) to assist Ehlanzeni district lower its MTCT rate, we will measure the distribution and correlates of: Maternal viral load, Maternal HIV incidence, Infant prophylaxis uptake and Infant feeding practices. We will also explore the feasibility and acceptability of use of pre-exposure prophylaxis for mothers and use of neutralizing antibody-based immunotherapy for infants.

Collaboration

  • National department of Health
  • Ehlanzeni district PMTCT management
  • Right to Care (district partner)
  • Academy for Quality Healthcare (AQUAH) (district partner)
  • National Institute for Communicable diseases (NICD)/ National Health Laboratory Services (NHLS)
  • Montpellier University France
  • University of Bergen Norway
  • Queen Mary University of London UK
  • Zvitambo Institute for MCH Research Zimbabwe
  • Unviersity of Liverpool UK

Project status: Data collection in progress from September 2019 to December 2019

Contact
Dr. Nobubelo Ngandu (Nobubelo.Ngandu@mrc.ac.za),  ; Prof. Ameena Goga (Ameena.Goga@mrc.ac.za)

Thematic area 2: Adolescent Health; Well-being; Sexual and Reproductive Health

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/

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)

SMART Africa

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 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. SMART Africa is one of 11 NIMH global HUBS.

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

Informing wellbeing measurement  among young people in SSA for health economic policy evaluation

PI: Darshini Govindasamy (this study forms the basis of her PhD)

Co-investigators:  Ms Kealeboga Maruping, Prof Catherine Mathews, Dr Giulia Ferrari, Prof Janet Seeley

Background
Young people in SSA, particularly those living with HIV, are at high risk of poor mental health which is likely to compromise their wellbeing. Economic studies have shown that wellbeing during adolescence is a strong predictor of favourable gains in the short (educational attainment) and long-run (good mental health, employment). This suggests that intervening to improve wellbeing among young people might be a viable strategy to consider for enhancing their health and economic outcomes. In line with Sustainable Development Goal 3 (“Ensure healthy lives and promote well-being for all at all ages”), wellbeing has emerged as a major policy outcome for the assessment of social progress. To date, there is a gap in knowledge on appropriate wellbeing measures for young people in this region. If we can robustly measure wellbeing among young people then we could provide more accurate policy guidance on suitable interventions to promote long-run sustainable wellbeing among this population.

Aims
Aim 1
To understand the predictors and lived experiences among young people living with HIV (aged 15-24 yrs.) in sub-Saharan Africa.

Methods: Mixed-methods review.

Aim 2
To understand the  meaning and experiences of wellbeing among young people living with and without HIV in Umlazi, KwaZulu-Natal, South Africa

Methods: Qualitative research (“The Njabulo study”). Data collected via focus-group discussions and in-depth interviews with young people living with and without HIV (aged 15-24 yrs.) and key informant interviews with experts and healthcare workers.

Aim 3
To understand the impact of ART-scale up on youth (15-34 yrs.) wellbeing in South Africa

Methods: Construction of a panel dataset using data from the National Income Dynamics study (NIDS) and HIV data from the National Health Laboratory Services. Application of econometric techniques using a quasi-experimental framework.

Collaboration 
London School of Hygiene and Tropical Medicine.

Project Status
Write-up.

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

Funder: National Health Scholarship, National Research Foundation (NRF) Thuthuka grant, SAMRC Intramural MRC award

HERStory Study: 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

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)
Tracy McClinton Appollis: tracy.mcclintonappollis@mrc.ac.za

View more information on the HERStory Study

Thematic area 3: Communicable and Non-Communicable Diseases

What are the maternal treatment outcomes, pregnancy outcomes and infant outcomes in women treated for DR-TB during pregnancy.

PI: Dr. Marian Loveday

Aim
To document the treatment, pregnancy and outcomes of women treated for DR-TB during their pregnancy. 

Study methods
A descriptive cohort analysis

Status
Data collection in process

Collaboration

  • Dr. Jennifer Hughes from the Desmond Tutu TB Centre (DTCC)
  • Dr. James Seddon from Imperial College London and the Desmond Tutu TB Centre (DTCC)
  • Clinicians at King Dinuzulu Hospital, eThekweni, KwaZulu-Natal.

Nested study within the DR-TB during pregnancy study:
Title:
To explore plasma concentrations of second-line TB drugs in pregnant women and their infants

PI: Dr. Marian Loveday

Aim
To explore plasma concentrations of the second-line TB drugs in these women and their infants.

Study methods
All recruited participants who have not yet delivered will be screened for eligibility into the pharmacokinetic (PK) analysis to enhance the understanding of drug exposure in pregnant women on therapy for DR-TB. Two PK sampling occasions will be scheduled, the first will be prior to delivery preferably in the third trimester, on a date, which is convenient for the mother and the second at 6 weeks post-delivery to compare drug levels in the pregnant and non-pregnant state.

Status
Recruitment has started.

Collaboration

Prof Gary Maartens, Prof Helen Mclleron, Dr Richard Court: UCT

Survival and TB recurrence after successful drug-susceptible- and rifampicin-resistant TB treatment

PI: Dr. Marian Loveday

Aim
To document survival and the recurrence of TB after successful drug-susceptible- and rifampicin-resistant TB treatment

Study methods
A mixed methods cohort 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
Data collection has commenced

Collaboration
Mr Johnny Daniels and Dr. Erika Mohr from Medicins san Frontier (Khayelitsha, South Africa)
Dr. Helen Cox and Dr. Andrew Boulle from UCT

Exploring opportunities and models for improved integration and health service delivery at a community and primary health care level in eThekweni metro, KwaZulu-Natal, South Africa

PI: Dr. Marian Loveday

Aims
The aims of the implementation component are:

  • To develop and implement a targeted screening approach for diabetes, hypertension, and other diseases and conditions utilizing existing community-based and facility-based health service infrastructure in eThekwini, using an improved diagnostic algorithm aligned with national guidelines. This builds on existing screening efforts against other diseases such as tuberculosis.
  • To develop an algorithm alongside our partners that is based on peer-reviewed evidence and in line national guidelines. Subsequently, implement it for treatment, support, and education for these patients and their families. Work with public health and where appropriate private health delivery partners to implement and improve this program in subsequent years in a large, targeted area of the municipality.
  • To support the National health services integration initiative by sharing practical operational research in a timely manner, avoiding duplication or parallel, “vertical” disease efforts (HIV, TB, hypertension, diabetes, etc.), improving existing and new health worker capacity in public and private sectors, and implementing a clear sustainability plan at the end of the grant period

The aims of the evaluation component:

  1. Document the opportunities and models for improved integration and health service delivery implemented by AA&D and local partners at PHC facilities, schools and in the community.
  2. Through the lens of a non-communicable disease (NCD) diabetes and an infectious disease TB document the functioning of the different levels of the health system, the interface and relationship between these layers and the inputs needed to optimize health system functionality across all levels.
  3. Document the strategies and interventions required to improve integration and for effective patient-centered services including active case finding, linkage to care, effective education and quality management of both non-communicable and infectious diseases.
  4. Monitor the integration of both non-communicable and infectious disease services at a community level, together with the linkages to PHC facility level care. 
  5. Using the platform created for the Zero TB Cities Initiative, pilot a program of decentralized, community-based screening and referral for diabetes, hypertension and other conditions (as the basis for using this approach for integrated PHC delivery).
  6. Monitor the impact of the introduction of new, complex interventions at a district level and how these impact on and are integrated into existing services. This may include the provision of MDR-TB services, Test and Treat and adolescent HIV prevention.

Study methods
Implementation research

Status
Ongoing

Collaboration
Advance Access & Delivery (AA&D)
eThekweni Metro Health Services
Provincial TB and NCD directorates

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)

Southern African Research Consortium for Mental Health INTgration (S-MHiNT)

PIs: Arvin Bhana, Inge Petersen, Deepa Rao

Co-Investigators
Max Bachmann, Ruanne V Barnabas, Joy N Baumgartner, Lara Fairall, Sylvia Kaaya, Joȁo L Manuel, James T Pfeiffer, Kenneth Sherr, Jurgen Unutzer, Bradley Wagenaar

Overview
In this project, we will study how to smoothly scale up treatment of mental health issues in primary care settings, by navigating bottlenecks in primary care systems. We will also work to train others in researching these models of scale up. Our work benefits people who live in under resourced settings and suffer from mental health and other chronic health issues.

Aim

Aim 1. To establish and engage a trans-disciplinary research consortium of academics, government representatives and non-governmental organizations in South Africa, Mozambique and Tanzania to address the burden of common mental disorders in primary health care settings.

Aim 2. To examine multi-level influences on the uptake, implementation, effectiveness and sustainability of an existing scale-up of an integrated mental health package for chronic disorders at primary health care level in two different districts in South Africa which have different resource capacities.

Aim 3. To build implementation science and dissemination research (ISDR) capacity in South Africa, Mozambique and Tanzania, recruiting service providers, managers and policy makers as trainees, providing real-world opportunities, mentorship and necessary knowledge to conduct optimal scale-up of evidence-based integrated mental health care.

Collaboration
University of KwaZulu-Natal, University of Washington, Beira Operations Research Center (CIOB), Health Alliance International (HAI), Muhambili University of Health and Allied Sciences, Dar es Salaam, Tanzania.

Project Status
S-MhINT had a launch meeting in December 2018 and is part of 5 ‘new’ NIMH HUBS globally. The project has funding over a period of 5 years.

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

Thematic area 4: Social and Economic Policy and Health

Study 1: Uptake of the Child Support Grant at 12 weeks

This 2015 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 2: The relationship between the CSG, children’s diets and nutrition, and food security in poor households.

PI: Dr Wanga Zembe, Dr 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: Findings have been presented and discussed at internal academic forums and international conferences. One research paper published, one article still pending publication.

Study 3: A birth cohort assessing the utilisation of the CSG and its link to dietary diversity, and child growth

PI: Dr Wanga Zembe, Dr 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)
Dr Vundli Ramokolo (Vundli.ramokolo@mrc.ac.za)

Study 4: Social protection, youth economic empowerment and social support for adolescent girls and young women at risk of poor health and wellbeing

PI: Wanga Zembe

Co-Investigators: Lieve Vanleeuw; Yanga Zembe

A two-year mixed-methods research project that aims to assess (i) the levels of social support, economic empowerment and social protection available to adolescent girls and young women (AGYW), and (ii) the impact thereof on health and wellbeing of AGYW.

The main outcomes of the project are:

  1. Synthesized evidence on best practice models regarding social protection, economic empowerment and social support interventions that can protect and improve the health and wellbeing of AGYW in LMIC settings.
  2. Empirical evidence on the correlation between social protection, economic empowerment, and social support resources, interventions and programmes to proximal indicators associated with vulnerability, poor health and wellbeing among AGYW in South Africa.
  3. Knowledge on gaps, opportunities and acceptability of expanded state-provided social protection and economic empowerment interventions to protect and promote health and wellbeing in AGYW in South Africa.
  4. Recommendations for an integrated package of financial, economic and social support interventions to protect and promote the health and wellbeing of AGYW based on outcomes 1, 2 and 3.

Project status: The rapid review has been completed and a progress report for year 1 has been submitted to funders. In the 2019/2020 financial year the qualitative component of the project will commence, as well as secondary analysis of data and engagement with stakeholders.

Contact person

Wanga Zembe (wanga.zembe@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. Final report published and paper under review.

Contact person
Emmanuelle Daviaud (Emmanuelle.Daviaud@mrc.ac.za)

Community health worker investment case

PI: Emmanuelle Daviaud

Co-PIs: Donela Besada, PRICELESS

Co-Investigators: PRICELESS: Pratik Panchal and Karen Hoffman; UWC: David Sanders; CASE: Debbie Budlender

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, chronic diseases, and palliative care 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 completed. Final report published and peer reviewed paper underway.

Contact person
Emmanuelle Daviaud (Emmanuelle.Daviaud@mrc.ac.za)

Implementation evaluation of strengthening health system resilience in four-sub districts in the Western Cape through multi-sectoral collaboration

PI:  Donela Besada

Co-PI: Emmanuelle Daviaud

Aim: To assess the utility of the resilience framework developed by the World Bank to support the Western Cape Government to identify the extent of their resilience and areas of weakness which could be addressed through priority actions and will document the operationalization of local integrated interventions.

Methods: A qualitative approach using key informant interviews with government, NGO and community stakeholders and key personnel as well as policy document review. Key informant interviews used to describe the set-up of the project, including a focus on governance issues and the processes for reaching agreements between the multi-sectoral actors, its integration into existing policies, and the adaptation of governance over time. The evaluation was carried out in 4-sub-districts of the Western Cape, including Drakenstein, Saldanha Bay, Manenberg and Khayelitsha/Site B.

Collaboration:
Western Cape Department of Health, World Bank

Project status:
Project completed and final report developed

Contact person: Donela Besada (Donnela.Besada@mrc.ac.za)

An Evaluation of the Health Systems Costs of Mental Health Services and Programmes in South Africa

PI: Professor Crick Lund, UCT

Co-PI: MRC: Donela Besada; UCT: Sumaiyah Docrat

Aim
To quantify public health system expenditure on mental health services, by service level and Province, for the 2016/17 financial year, and; to document and evaluate the resources and constraints of the mental health system in South Africa; in order to inform a rational approach to planning effectively for mental health service scale-up. 

Methods
This study employed a cross-sectional, accounting-based, aggregate costing approach using primary and secondary data sources. The cost analysis was conducted from the provider perspective. Three data collection tools, designed purposively for three categories of respondents: (1) Provincial Departments of Health (PDOH); (2) Regional, Tertiary, Central and Specialized Hospitals, and; (3) Primary Health Care (PHC) facilities and District Hospitals (District health system)  were developed to collect data on patient loads and other health system inputs including available HR, infrastructure, and drug supply. Secondary data sources included the District Health Information System (DHIS) to validate inpatient/outpatient loads and the Health Systems Trust District Health Barometer (HST-DHB) for hospital-level indicators of expenditure per patient day equivalent (PDE) for all categories of hospitals and PHC facilities.

Collaboration:
National and Provincial Departments of Health

Project Status
Data collection completed and final report developed. Paper currently under review

Contact person:
Donela Besada (Donnela.Besada@mrc.ac.za)

Development of an Investment Case for Mental Health in South Africa

PI: Professor Crick Lund

Co-PI: Donela Besada (SAMRC) and Sumaiyah Docrat (UCT)

Aim
To develop an investment case for mental health to determine the costs and returns of a prioritized package of system and service-level interventions to reach important targets related to South African mental health services.

Study methods
The study will involve a mixed method approach including qualitative interviews with key stakeholders to identify the priorities on a package of interventions for the South African mental health system, a review of the evidence base for known interventions for mental health, calculating the total budget needed to implement the package of prioritized investments and carrying out an economic evaluation to estimate the returns on these investments linked to key outcomes.

Collaboration
National and Provincial Departments of Health

Project status
Proposal development and ethics underway

Contact person
Donela Besada (Donnela.Besada@mrc.ac.za)

Economic Analysis of courier services to collect and transport samples-National Health Laboratory Services

PI: Geetesh Solanki

Co-PI: Emmanuelle Daviaud

Aim
To assess the comparative cost of in-sourcing, out-sourcing or a mixed system for the courier services for the transportation of samples for the NHLS

Study methods
A mixed method costing approach will be applied. A micro-costing approach will be used to cost in-sourcing options for test sample collection and transportation, and a total costs from invoices of existing out-sourced services will be used to cost the  outsourced services. For comparison purposes, the unit cost will be summarized as a cost per kilometer across both in-sourcing or mixed options.

Collaboration

NHLS

Project status
Contract in process of being signed, work to commence shortly.

Contact person
Emmanuelle Daviaud (Emmanuelle.Daviaud@mrc.ac.za)

Time Analysis to Improve Workforce Planning for HIV Services  

PI: Emmanuelle Daviaud

Co-PI: Donnela Besada

Aim
The purpose of this exercise is to provide additional understanding of HIV service workload requirements to further inform workforce planning, in line with Government of South Africa (GoSA) issuance of PEPFAR Supplemental Staffing Guidelines to all Provinces and adoption of the national Ward Based Primary Health Care Outreach Team (WBPHCOT) policy. In 2018, PEPFAR supported the application of the Prioritization and Optimization Analysis (POA) approach to identify the optimal allocation of PEPFAR supplemental health workers. The POA analysis applied South Africa Workload Indicators of Staffing Need (WISN) data along with PEPFAR programmatic and budget data to generate estimates. The analysis identified the need to better understand workload requirements across cadres and area of HIV service to further verify staffing requirements and allocation of PEPFAR- supplemental staff. The time and motion analysis will provide up-to-date calculation of staff time by cadre for each area of HIV service delivery.

Methods:
The analysis will use a mixed-method approach combining an observational time and motion time study (using a random work sampling approach) with self-administered time-based diaries (time analysis). The analytics from this exercise will be used solely by PEPFAR and the National Department of Health (NDOH) to:

  • Improve estimates of cadre workload
  • Improve data to derive estimates of workforce needs and allocation decisions
  • Inform cadre performance standards for HIV

Collaboration
PEPFAR, USAID, Open Development, HRH 2030, Chemonics, NDOH

Project status
Contract in process of finalization

Contact person
Emmanuelle Daviaud

Thematic area 5: Knowledge synthesis for strengthening health systems

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; data extraction 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. Natalie Leon

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. We also form part of the Global Evidence Synthesis Initiative (GESI) network.

Project status 
This multi-year project started in June 2013, commencing 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 full systematic reviews that are conducted by the SAI. We also recently began with our rapid evidence synthesis service. Through this service, we directly engage decision makers within Provincial Departments of Health. Our engagement is focused on understanding what urgent health systems’ decisions they are having to take, and how we can support their decision making through producing rapid evidence syntheses. For further information on what rapid evidence syntheses are, see the Rapid reviews to strengthen health policy and systems: a practical guide, 2017 that can be downloaded from: http://www.who.int/alliance-hpsr/resources/publications/rapid-review-guide/en/

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.

Past Projects

View a list of past projects.

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