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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Operational research in malawi: Making a difference with cotrimoxazole preventive therapy in patients with tuberculosis and HIV
BMC Public Health, Volume 11, Article 593, Year 2011
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Description
Background: In Malawi, high case fatality rates in patients with tuberculosis, who were also co-infected with HIV, and high early death rates in people living with HIV during the initiation of antiretroviral treatment (ART) adversely impacted on treatment outcomes for the national tuberculosis and ART programmes respectively. This article i) discusses the operational research that was conducted in the country on cotrimoxazole preventive therapy, ii) outlines the steps that were taken to translate these findings into national policy and practice, iii) shows how the implementation of cotrimoxazole preventive therapy for both TB patients and HIV-infected patients starting ART was associated with reduced death rates, and iv) highlights lessons that can be learnt for other settings and interventions. Discussion. District and facility-based operational research was undertaken between 1999 and 2005 to assess the effectiveness of cotrimoxazole preventive therapy in reducing death rates in TB patients and subsequently in patients starting ART under routine programme conditions. Studies demonstrated significant reductions in case fatality in HIV-infected TB patients receiving cotrimoxazole and in HIV-infected patients about to start ART. Following the completion of research, the findings were rapidly disseminated nationally at stakeholder meetings convened by the Ministry of Health and internationally through conferences and peer-reviewed scientific publications. The Ministry of Health made policy changes based on the available evidence, following which there was countrywide distribution of the updated policy and guidelines. Policy was rapidly moved to practice with the development of monitoring tools, drug procurement and training packages. National programme performance improved which showed a significant decrease in case fatality rates in TB patients as well as a reduction in early death in people with HIV starting ART. Summary. Key lessons for moving this research endeavour through to policy and practice were the importance of placing operational research within the programme, defining relevant questions, obtaining "buy-in" from national programme staff at the beginning of projects and having key actors or "policy entrepreneurs" to push forward the policy-making process. Ultimately, any change in policy and practice has to benefit patients, and the ultimate judge of success is whether treatment outcomes improve or not. © 2011 Harries et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Harries, Anthony David
Unknown Affiliation
Zachariah, Rony R.Z.
Unknown Affiliation
Chimzizi, Rhehab B.
Unknown Affiliation
Salaniponi, Felix M.L.
Unknown Affiliation
Gausi, Francis K.
Unknown Affiliation
Kanyerere, Henry S.
Unknown Affiliation
Schouten, Erik J.
Unknown Affiliation
Jahn, Andreas
Unknown Affiliation
Makombe, Simon D.
Unknown Affiliation
Chimbwandira, Frank M.
Unknown Affiliation
Mpunga, James U.
Unknown Affiliation
Statistics
Citations: 28
Authors: 11
Affiliations: 9
Identifiers
Doi:
10.1186/1471-2458-11-593
e-ISSN:
14712458
Research Areas
Health System And Policy
Infectious Diseases
Study Locations
Malawi