Graduate students of public health from Aga Khan University and other universities have developed innovative, locally relevant implementation research projects to tackle the threat posed by infectious diseases such as malaria, tuberculosis and HIV/AIDS
These proposals were developed through a series of three workshops at Aga Khan University supported by the World Health Organization's Special Programme for Research and Training in Tropical Diseases (WHO-TDR). Participants of the
workshop included academics, researchers and government officers involved in public health programmes for neglected tropical diseases who developed and presented their proposals at the final session in January 2017.
Implementation Research (IR) looks at how on-the-ground problems and constraints can impact the success of health initiatives. Before the start of the workshop Implementation Research Training – Calling Time on Tropical Diseases, all participants were required to submit a concept note outlining how their proposal would improve the effectiveness of existing disease control programmes.
During the workshops, which took place over a year, facilitators from the AKU and WHO-TDR taught key concepts in IR and guided participants as they applied their learning to hone their proposals into full-scale projects.
Speaking about the goals of the workshop, Dr Shagufta Perveen, a senior instructor in research at the Department of Community Health Sciences, AKU, and the principal investigator for the IR training grant from the WHO, said: “Pakistan has large scale immunization programmes and a variety of dedicated centres to treat serious diseases such as tuberculosis and HIV/AIDS.
“Unfortunately, real world issues such as a lack of health awareness, poverty, inadequate training and social stigmas are limiting the success of these programmes. The participants of these workshops are students of public health, researcher-academicians and officials who are facing these problems on a daily basis and we’re pleased that the solutions they’ve designed are being incorporated into government programmes to make them more successful.”
The workshop has already delivered results with one of the TB proposals receiving grant funding from the WHO-TDR.
Tuberculosis team’s proposal
One of the workshop teams proposed using an SMS-based health awareness system to tackle the issue of TB patients who fail to take essential medication during their six-month-long course. Members of the team noted that patients with life-threatening TB often discontinue treatment due to unpleasant side-effects or make errors while taking the many drugs. As a result, less than half of TB patients are cured and the team identified a lack of timely communication as being one of the impediments to the programme’s success.
By collaborating with TB-DOTS centres in Pakistan and Afghanistan, the team will be able to access patients to get a deeper understanding of the reasons why they abandon treatment. The insights will then be used to refine a system to deliver scheduled SMS messages to patients that would provide reminders about the stages of treatment and reassure them that side-effects are not a cause for concern. Patients would be given a mobile phone and SIM card to enroll into the programme with researchers following up to understand if the system is boosting adherence to the medication schedule.
Health services for communities at risk of HIV/AIDS
Another project focused on boosting the utilisation of sexual health services by those at the highest risk of contracting HIV/AIDS, the transgender community. The transgender community in Pakistan is a marginalised community facing many stigmas that limit their employment opportunities, access to healthcare and ability to participate in normal social activities.
As a result, transgenders are more likely to become involved in high-risk activities such as prostitution where a lack of awareness about safe sex practices in society as a whole can lead to the transmission of the disease.
The group’s IR proposal involved working with the Sindh AIDS Control Programme and community outreach
facilities - Voluntary Counselling and Confidentiality Testing (VCCT) centres - to engage and train members of the transgender community who would lead efforts to refer at-risk people from the transgender community to these VCCTs. Alongside the training, researchers would also conduct a Knowledge Attitudes and Practice (KAP) assessment to gauge perceptions about the disease. The data would be used to enhance training and the facilities at VCCTs as well as to increase referrals to central lab and treatment centres.
Anum Chagani, an MPH student at Dow University of Health Sciences involved in the project, said: “Our study would engage the transgender community to assess their knowledge of HIV, better understand the barriers to care, and identify ways of improving their utilisation of VCCTs, which would in turn lead to earlier detection and treatment.”
Initiatives developed under the workshop are in line with the University’s commitment to the Sustainable Development Goals (SDGs). Targets on the eradication of water-borne and communicable diseases, and efforts to improve sexual health services fall under Goal 3 of the SDGs which cover steps to promote healthy lives and wellbeing for people of all ages.
Dr Robinah Najjemba, technical consultant for the WHO’s TDR, explained the value and relevance of such workshops. She said: “These workshops are based on the WHO-TDR’s Implementation Research Toolkit which contains key concepts that underpin the planning of research projects, analysis of qualitative and quantitative data, the dissemination of findings, and the monitoring and evaluation of programmes to ascertain a project’s impact. Overall, I’m impressed by the process, outcomes and innovations that this workshop has brought in. The evolution of teams from the first workshop and the innovative delivery methods contributed immensely to the success of the workshop.”
One of the participants of the workshop, Dr Afshan Khurshid, a coordinator for the TB-HIV programme in Sindh said: “Implementation research is a vital area that enables you to test new ideas and to thereby improve health service delivery. The feedback from facilitators and workshop participants right through the six modules was really enlightening.”
Dr Saqib Shaikh, a deputy programme manager for the Sindh AIDS Control Programme added: “We tackled on-the-ground problems that the programme has been experiencing at this workshop. It’s really useful to see the entire process of how research can inform policy and thereby improve the health of communities. I found the stakeholder analysis component of the workshop to be especially useful as one needs to work with supporters, opponents and fence-sitters to deliver high-profile projects.”
Only 43 out of 132 applications received funding from the WHO’s Special Programme for Research and Training in Tropical Diseases for short training grants. AKU was the only university in the WHO’s Eastern Mediterranean region selected to conduct workshops using the TDR IR toolkit.
The workshops were conducted by Dr Shagufta Perveen, who acted as principal facilitator, and were technically supported by Dr Shehla Zaidi, assistant professor at Aga Khan University, and Dr Margaret Gyapong, deputy director, Ghana Health Service, and an expert involved with the WHO-TDR programme.
Graduate students of public health from Aga Khan University and other universities have developed innovative, locally relevant implementation research projects to tackle the threat posed by infectious diseases such as malaria, tuberculosis and HIV/AIDS
These proposals were developed through a series of three workshops at Aga Khan University supported by the World Health Organization's Special Programme for Research and Training in Tropical Diseases (WHO-TDR). Participants of the
workshop included academics, researchers and government officers involved in public health programmes for neglected tropical diseases who developed and presented their proposals at the final session in January 2017.
Implementation Research (IR) looks at how on-the-ground problems and constraints can impact the success of health initiatives. Before the start of the workshop Implementation Research Training – Calling Time on Tropical Diseases, all participants were required to submit a concept note outlining how their proposal would improve the effectiveness of existing disease control programmes.
During the workshops, which took place over a year, facilitators from the AKU and WHO-TDR taught key concepts in IR and guided participants as they applied their learning to hone their proposals into full-scale projects.
Speaking about the goals of the workshop, Dr Shagufta Perveen, a senior instructor in research at the Department of Community Health Sciences, AKU, and the principal investigator for the IR training grant from the WHO, said: “Pakistan has large scale immunization programmes and a variety of dedicated centres to treat serious diseases such as tuberculosis and HIV/AIDS.
“Unfortunately, real world issues such as a lack of health awareness, poverty, inadequate training and social stigmas are limiting the success of these programmes. The participants of these workshops are students of public health, researcher-academicians and officials who are facing these problems on a daily basis and we’re pleased that the solutions they’ve designed are being incorporated into government programmes to make them more successful.”
The workshop has already delivered results with one of the TB proposals receiving grant funding from the WHO-TDR.
Tuberculosis team’s proposal
One of the workshop teams proposed using an SMS-based health awareness system to tackle the issue of TB patients who fail to take essential medication during their six-month-long course. Members of the team noted that patients with life-threatening TB often discontinue treatment due to unpleasant side-effects or make errors while taking the many drugs. As a result, less than half of TB patients are cured and the team identified a lack of timely communication as being one of the impediments to the programme’s success.
By collaborating with TB-DOTS centres in Pakistan and Afghanistan, the team will be able to access patients to get a deeper understanding of the reasons why they abandon treatment. The insights will then be used to refine a system to deliver scheduled SMS messages to patients that would provide reminders about the stages of treatment and reassure them that side-effects are not a cause for concern. Patients would be given a mobile phone and SIM card to enroll into the programme with researchers following up to understand if the system is boosting adherence to the medication schedule.
Health services for communities at risk of HIV/AIDS
Another project focused on boosting the utilisation of sexual health services by those at the highest risk of contracting HIV/AIDS, the transgender community. The transgender community in Pakistan is a marginalised community facing many stigmas that limit their employment opportunities, access to healthcare and ability to participate in normal social activities.
As a result, transgenders are more likely to become involved in high-risk activities such as prostitution where a lack of awareness about safe sex practices in society as a whole can lead to the transmission of the disease.
The group’s IR proposal involved working with the Sindh AIDS Control Programme and community outreach
facilities - Voluntary Counselling and Confidentiality Testing (VCCT) centres - to engage and train members of the transgender community who would lead efforts to refer at-risk people from the transgender community to these VCCTs. Alongside the training, researchers would also conduct a Knowledge Attitudes and Practice (KAP) assessment to gauge perceptions about the disease. The data would be used to enhance training and the facilities at VCCTs as well as to increase referrals to central lab and treatment centres.
Anum Chagani, an MPH student at Dow University of Health Sciences involved in the project, said: “Our study would engage the transgender community to assess their knowledge of HIV, better understand the barriers to care, and identify ways of improving their utilisation of VCCTs, which would in turn lead to earlier detection and treatment.”
Initiatives developed under the workshop are in line with the University’s commitment to the Sustainable Development Goals (SDGs). Targets on the eradication of water-borne and communicable diseases, and efforts to improve sexual health services fall under Goal 3 of the SDGs which cover steps to promote healthy lives and wellbeing for people of all ages.
Dr Robinah Najjemba, technical consultant for the WHO’s TDR, explained the value and relevance of such workshops. She said: “These workshops are based on the WHO-TDR’s Implementation Research Toolkit which contains key concepts that underpin the planning of research projects, analysis of qualitative and quantitative data, the dissemination of findings, and the monitoring and evaluation of programmes to ascertain a project’s impact. Overall, I’m impressed by the process, outcomes and innovations that this workshop has brought in. The evolution of teams from the first workshop and the innovative delivery methods contributed immensely to the success of the workshop.”
One of the participants of the workshop, Dr Afshan Khurshid, a coordinator for the TB-HIV programme in Sindh said: “Implementation research is a vital area that enables you to test new ideas and to thereby improve health service delivery. The feedback from facilitators and workshop participants right through the six modules was really enlightening.”
Dr Saqib Shaikh, a deputy programme manager for the Sindh AIDS Control Programme added: “We tackled on-the-ground problems that the programme has been experiencing at this workshop. It’s really useful to see the entire process of how research can inform policy and thereby improve the health of communities. I found the stakeholder analysis component of the workshop to be especially useful as one needs to work with supporters, opponents and fence-sitters to deliver high-profile projects.”
Only 43 out of 132 applications received funding from the WHO’s Special Programme for Research and Training in Tropical Diseases for short training grants. AKU was the only university in the WHO’s Eastern Mediterranean region selected to conduct workshops using the TDR IR toolkit.
The workshops were conducted by Dr Shagufta Perveen, who acted as principal facilitator, and were technically supported by Dr Shehla Zaidi, assistant professor at Aga Khan University, and Dr Margaret Gyapong, deputy director, Ghana Health Service, and an expert involved with the WHO-TDR programme.