The primary focus of the Knowledge Translation Unit’s research work is to test the effectiveness, acceptability and cost-effectiveness of our programmes on the quality of care and outcomes for patients. We employ mixed methods approaches, conducting qualitative and economic evaluations alongside pragmatic trials completed in real world settings. The outcomes of these evaluations have contributed to the uptake of our programmes at a provincial and national level within South Africa, and elsewhere.
To date, we have completed and published three large randomised controlled trials involving between 15 and 40 clinics and 2,000 to 15,500 patients (1, 2, 3). These trials have demonstrated multiple, modest, but consistent and reproducible, positive effects on the quality of care provided by clinics which have received our interventions. These benefits extend to health outcomes, and we have shown positive effects on weight gain among HIV positive patients, gains in CD4 counts and even reduced mortality among some patient subgroups. The qualitative evaluations have shown that this combination of simplified guidelines, on-site interactive training and task-shifting prescribing is highly valued by nurses, doctors and managers working in resource-constrained primary care settings (4, 5). The economic evaluations have shown increased utilisation of primary care associated with increased costs, which are partially offset by reductions in the number and length of hospital admissions (6, 7).
Other research has used data collected for the trials to estimate the effectiveness of antiretroviral treatment on mortality, TB incidence and outcomes (8, 9] . We have also collaborated with other researchers to model waiting times for ART and survey reasons for encounter among people attending primary care clinics in South Africa (10).
The trials of our programmes are ongoing. Data collection for the trial evaluating the effectiveness of Primary Care 101 on the quality of non-communicable disease care is now complete and the findings have been submitted for publication. Data collection for the PRIME and COBALT trials began in April 2015 and is due to be completed in November 2017. An e-version of PACK has been evaluated and roll-out is due to start in July 2016. A package for undergraduate medical students has been implemented and evaluated at the University of Stellenbosch.
- Fairall L, Zwarenstein M, Bateman ED, Bachmann OM, Lombard C, Majara B, Joubert G, English RG, Bheekie A, van Rensburg HCJ, Mayers P, Peters AC, Chapman RD. Educational outreach to nurses improves tuberculosis case detection and primary care of respiratory illness: a pragmatic cluster randomized controlled trial BMJ. 2005; 331:750-754
- Zwarenstein M, Fairall LR, Lombard C, Mayers P, Bheekie A, English RG, et al. Outreach education for integration of HIV/AIDS care, antiretroviral treatment, and tuberculosis care in primary care clinics in South Africa: PALSA PLUS pragmatic cluster randomised trial. BMJ. 2011;342:d2022.
- Fairall, Lara, Max O Bachmann, Carl Lombard, Venessa Timmerman, Kerry Uebel, Merrick Zwarenstein, Andrew Boulle, et al. Task Shifting of Antiretroviral Treatment from Doctors to Primary-care Nurses in South Africa (STRETCH): a Pragmatic, Parallel, Cluster-randomised Trial. Lancet 380, no. 9845 (September 8, 2012): 889–898. doi:10.1016/S0140-6736(12)60730-2.
- Stein, J., S. Lewin, L. Fairall, P. Mayers, R. English, A. Bheekie, E. Bateman, and M. Zwarenstein. Building Capacity for Antiretroviral Delivery in South Africa: A Qualitative Evaluation of the PALSA PLUS Nurse Training Programme. BMC Health Services Research 8, no. 1 (November 18, 2008): 240. doi:10.1186/1472-6963-8-240.
- Georgeu, Daniella, Christopher J. Colvin, Simon Lewin, Lara Fairall, Max O. Bachmann, Kerry Uebel, Merrick Zwarenstein, Beverly Draper, and Eric D. Bateman. Implementing Nurse-initiated and Managed Antiretroviral Treatment (NIMART) in South Africa: a Qualitative Process Evaluation of the STRETCH Trial. Implementation Science 7, no. 1 (July 16, 2012): 66. doi:10.1186/1748-5908-7-66.
- Fairall, Lara, Max O Bachmann, Merrick Zwarenstein, Eric D Bateman, Louis W Niessen, Carl Lombard, Bosielo Majara, et al. Cost-effectiveness of Educational Outreach to Primary Care Nurses to Increase Tuberculosis Case Detection and Improve Respiratory Care: Economic Evaluation Alongside a Randomised Trial. Tropical Medicine & International Health: TM & IH 15, no. 3 (March 2010): 277–286. doi:10.1111/j.1365-3156.2009.02455.x.
- Barton GR, Fairall L, Bachmann MO, Uebel K, Timmerman V, Lombard C, et al. Cost-effectiveness of nurse-led versus doctor-led antiretroviral treatment in South Africa: pragmatic cluster randomised trial. Tropical Medicine & International Health. 2013 Jun;18(6):769–77.
- Fairall, Lara R, Max O Bachmann, Goedele M C Louwagie, Cloete van Vuuren, Perpetual Chikobvu, Dewald Steyn, Gillian H Staniland, et al. Effectiveness of Antiretroviral Treatment in a South African Program: a Cohort Study. Archives of Internal Medicine 168, no. 1 (January 14, 2008): 86–93. doi:10.1001/archinternmed.2007.10.
- Cornell, Morna, Anna Grimsrud, Lara Fairall, Matthew P Fox, Gilles van Cutsem, Janet Giddy, Robin Wood, et al. Temporal Changes in Programme Outcomes Among Adult Patients Initiating Antiretroviral Therapy Across South Africa, 2002-2007. AIDS (London, England) 24, no. 14 (September 10, 2010): 2263–2270. doi:10.1097/QAD.0b013e32833d45c5.
- Mash, Bob, Lara Fairall, Olubunmi Adejayan, Omozuanvbo Ikpefan, Jyoti Kumari, Shaheed Mathee, Ronit Okun, and Willy Yogolelo. A Morbidity Survey of South African Primary Care. PLoS ONE 7, no. 3 (March 16, 2012): e32358. doi:10.1371/journal.pone.0032358.