Unique training improving HIV and TB care in Pakistan
What is the connection between the smart phone application WhatsApp and improving diagnosis and treatment of HIV and tuberculosis? If you’re in the eastern Mediterranean region, it’s the new approach to implementation research training supported by TDR.
Teams of public health master’s and PhD students, professional scientists and programme managers/implementers from Pakistan’s Ministry of Health have been learning together for the past year how to write an implementation research (IR) proposal and get it funded.
“Implementation research is quite new to Pakistan,” says Dr Shagufta Perveen, a senior instructor in the department of Community Health Sciences at the Aga Khan University (AKU). “Academicians do a lot of research for their scholarly achievement and career progression,” she says. “But there is often no government programme prepared to implement the interventions effectively. The knowledge and skills needed to identify, prioritize and address implementation bottlenecks are very limited.”
Innovative training approach
Implementation research, Perveen knew, had the potential to bridge that gap. To effect lasting change, she proposed a unique learning model: a series of 3 workshops targeting both public health students and professionals, including researchers, academics, programme managers and implementers. Aimed at encouraging collaboration, the workshops forced participants to consider problems in a real-world context. This first-ever training on IR in the region was funded by a TDR IMPACT grant.
Participants started by listening to the heads of different disease control programmes talk about their key research needs. They then got an overview of how implementation research could identify barriers and test alternatives. Asked to come up with an IR question, many of the students stumbled at first. “They were identifying management problems, not IR problems,” says Perveen, “so we tried to have them really internalize the concept of IR.”
Guided by TDR’s IR toolkit, the workshops covered six modules over the course of a year: contextualization of IR issues; proposal development; planning and preparation; data analysis, collection and presentation; dissemination of research findings; and monitoring and evaluation.
Concept notes were written and teams lined up – each with 1 to 2 students, 1 researcher-academician, and 1 to 2 managers of disease control programmes. Six formal teams were formed – 2 focusing on tuberculosis; 1 on nutrition; 1 on malaria; 1 on HIV; and 1 on polio.
“Eventually, these students will be the professionals,” says Perveen, “so it’s critical that they begin thinking about IR and hone the skills they’ll need to conduct it.” One of the most important of those skills is proposal writing, and that was the focus of the second workshop, held in August, 2016. The 5 teams that were able to develop full proposals for submission to funding agencies and ethical review committees qualified for the third workshop, which focused on strengthening data analysis, and provided additional training in dissemination and monitoring and evaluation.
Meeting the challenges of HIV and tuberculosis head-on
“This project is helping us understand the research process,” says Anum Chagani, an MPH student at Dow University of Health Sciences. “It is also helping us apply what we’ve learned in the real world.” As a member of the HIV team, Chagani helped develop a proposal to improve the utilization of voluntary confidential counseling and testing (VCCT) among transgender persons, one of several high-risk populations in whom Pakistan’s HIV epidemic is concentrated.
“The centers are open for all genders, but as they are stigmatized, transgender persons typically do not utilize this service,” said Chagani. “Our study engages the transgender community to assess their knowledge of HIV, better understand the barriers to care, and identify ways of improving their utilization of VCCT, which should in turn lead to earlier detection and treatment.”
“These are students who just months ago had never heard of implementation research. Now they’re able to approach the funding agencies with a proposal and even win grants.”
Dr Shagufta Perveen, Aga Khan University
“The HIV team performed very well,” says Perveen, adding that the idea for focusing on the transgender community came from Pakistan’s National AIDS Programme itself. Similarly, when a representative of the National TB Control Programme highlighted the high rate of tobacco smoking among pulmonary tuberculosis (TB) patients, members of the TB team pointed out that this data wasn’t included in the government’s disease register.
“So we proposed a smoking cessation intervention for adoption by the national TB control programme,” said Tahir Khan, an MPH student also at Dow University of Health Sciences. Khan called the workshops “an amazing learning experience” and said that he was certain that the skills he had acquired, including the ability develop a research question and to draft a proposal, would allow him “to bring about real change.”
Grounding the knowledge in the local systems
“Now the momentum is there,” says Perveen. “Every team has a WhatsApp group, and whenever they face a conceptual problem in IR, they contact me, and we always follow up.”
In the end, 2 teams submitted proposals for TDR grants offered in 2016, and 1 of them, the TB team, was awarded funding. “It’s a real success story,” Perveen says with a smile. “These are public health students who just months ago had never heard of IR. Now they’re able to approach the funding agencies with a proposal and even win grants.”
By involving health professionals as co-facilitators, the workshops also helped train 13 faculty members from AKU and Dow University of Health Sciences. “The region is hungry for this,” she says. “I really hope that AKU can become an IR hub in the region and that we can facilitate this this type of research throughout the region.”
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