Current research

The PACK Child process evaluation
A central focus of the process evaluation was to identify contextually relevant strategies for successful implementation to inform wider implementation. This study commenced in October 2017 and consists of a three-phased approach in 10 clinics in the Western Cape Province. The process evaluation which includes non-clinical observations, manager interviews, observation of nurse-caregiver-child consultations, caregiver interviews, staff interviews and training observations is being conducted concurrently with the PACK Child pilot. The study will be completed in June 2019.


Murdoch J, Curran R, Bachmann M, et al. (in press) Strengthening the quality of paediatric primary care: protocol for the process evaluation of a health systems intervention in South Africa. BMJ Glob Health; 0:e000945. doi:10.1136/bmjgh-2018-000945
Preliminary study for a PACK Child trial

In preparation for the PACK Child randomized trial, a preliminary study focusing on a limited respiratory burden survey was conducted. The aim of the study is to establish the prevalence, diagnoses and management of acute respiratory events among children aged 0 to 13 years attending primary care clinics in Cape Town. This was a four-month study conducted in 2 clinics and 1 satellite clinic between March and August 2017. This study included a baseline questionnaire (carer reported events), reviewing of clinical records and a follow up telephonic questionnaire after four weeks. We interviewed 1049 children were screened, 165 were enrolled and 122 children were followed up after four months.

Person-Centred TB Study

The Person-Centered TB Study forms part of the Health System Strengthening in Sub-Saharan Africa (ASSET) project. ASSET is a National Institute for Health Research (NIHR) funded study working within four countries with King’s College London as the lead institution. The study commenced in March 2018 and will be completed in March 2021. The KTU in collaboration with the Center for Rural Health at the University of KwaZulu-Natal will be responsible for the design of the study and overseeing the data collection, data analysis and writing up. The project will be based at Amajuba District in KwaZulu-Natal. The focus of this study will be to determine if existing mental health interventions can be adapted to treat and support patients with co-morbid mental illness (depression, psychological distress and alcohol use disorders) and stigma amongst TB patients to improve treatment outcomes, patients’ experience of care, linkage to ongoing care programmes and strengthen implementation of TB infection control measures amongst the health workers who work for them.

The ASSET study is a mixed method study with three phases: Diagnostic, Adaptation/Implementation Phase and Evaluation Phase. The diagnostic phase includes a scoping review and situational analysis which will determine the feasibility of the settings and the adaptation required to reduce stigma in TB patients.

PACK Brazil randomised controlled trial

The PACK Brazil programme is being evaluated in the city of Florianopolis, Brazil in is a pragmatic, parallel-group, superiority cluster randomised trial. All municipal clinics in Florianópolis are eligible for inclusion in the trial, however, one small clinic with 600 registered patients was excluded to have equal numbers of clinics in each arm.

The aim of this trial is to determine the effectiveness of PACK Brazil Adult training compared to passive dissemination of the PACK Adult guide on the process of care and clinical outcomes for people with chronic respiratory diseases, cardiovascular diseases or diabetes in primary care. In intervention arm clinics, doctors and nurses received educational outreach training to use the PACK Adult guide. In control arm clinics, doctors and nurses received only the guide. Trial outcomes are being measured using patients’ electronic medical records 12 months after completion of basic training. All patients aged 35 years and over and with a diagnosis of hypertension (ICD-10 I10-I15), ischaemic heart disease (ICD-10 I20-I25), heart failure (ICD-10 I50), cerebrovascular disease (ICD-10 I60-I69), or diabetes mellitus (ICD-10 E10-E14, that is, including type 1 and type 2 diabetes) ever recorded since January 1st 2010, and who attended a participating clinic for any reason during the first year of the trial will be included.

Primary outcomes for the respiratory trial are appropriate prescribing, spirometry and diagnosis rates. Primary outcomes for the cardiovascular trial are testing for cardiovascular risk and diabetes, and systolic blood pressure. Educational outreach to primary care professionals could improve respiratory, cardiovascular and diabetes care in Brazil.



Bachmann MO, Bateman ED, Stelmach R, Cruz ÁA, Pacheco de Andrade M, Zonta R, Zepeda J, Natal S, Cornick R, Wattrus C, Anderson L, Lombard C, Fairall LR. Integrating primary care of chronic respiratory disease, cardiovascular disease and diabetes in Brazil: Practical Approach to Care Kit (PACK Brazil): study protocol for randomised controlled trials. J Thorac Dis. 2018 Jul;10(7):4667-4677. doi: 10.21037/jtd.2018.07.34.)