Operational research in malawi: making a difference with cotrimoxazole preventive therapy in patients with tuberculosis and HIV
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- 作者：Anthony D Harries (1) (2)
Rony Zachariah (3)
Rhehab Chimzizi (4)
Felix Salaniponi (5)
Francis Gausi (6)
Henry Kanyerere (6)
Erik J Schouten (7)
Andreas Jahn (8) (9)
Simon D Makombe (8)
Frank M Chimbwandira (8)
James Mpunga (6) - 关键词：Operational research ; cotrimoxazole preventive therapy ; tuberculosis ; HIV/AIDS ; Malawi ; Africa
- 刊名：BMC Public Health
- 出版年：2011
- 出版时间：December 2011
- 年：2011
- 卷：11
- 期：1
- 全文大小：226KB
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38. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/11/593/prepub - 作者单位：Anthony D Harries (1) (2)
Rony Zachariah (3)
Rhehab Chimzizi (4)
Felix Salaniponi (5)
Francis Gausi (6)
Henry Kanyerere (6)
Erik J Schouten (7)
Andreas Jahn (8) (9)
Simon D Makombe (8)
Frank M Chimbwandira (8)
James Mpunga (6)
1. International Union against Tuberculosis and Lung Disease, Paris, France
2. London School of Hygiene and Tropical Medicine, London, UK
3. Medecins sans Frontieres, Medical Department, Operational Research Unit, Brussels Operational Center, Luxembourg, Luxembourg
4. Management Sciences for Health, Accra, Ghana
5. KNCV Kenya Office, PO Box 27789, Nairobi, Kenya
6. National Tuberculosis Control Programme, Community Health Science Unit, Lilongwe, Malawi
7. Management Sciences for Health, Lilongwe, Malawi
8. Department of HIV and AIDS, Ministry of Health, Kragujevac, Malawi
9. ITECH, Malawi and University of Washington, Seattle, USA - ISSN：1471-2458
文摘
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.