Past Research

Strengthening the integration of TB and COVID-19 detection: A mixed methods study

2018 – 2021

This is one of 5 sub-studies that form ASSET, a 5-year research programme developing and evaluating health system strengthening interventions in sub-Saharan Africa. This sub-study aimed to identify problems in TB diagnosis based on high mortality from drug-sensitive TB in a district of KwaZulu-Natal, South Africa. The findings then informed intervention development to strengthen TB care. Due to the study’s timing, the intervention was adapted to include detection of COVID-19.

Clinics exposed to online learning supported by implementation team at the start of the intervention had an increase in TB testing and higher positive TB diagnosis.

Publications

A health systems intervention to strengthen the integration of tuberculosis and COVID-19 detection: Outcomes of a quasi-experimental study in a high burden tuberculosis district in KwaZulu Natal, South Africa (2023)

Applying learning health systems thinking in codeveloping integrated tuberculosis interventions in the contexts of COVID-19 (2022)

HeAlth System StrEngThening in four sub-Saharan African countries (ASSET) to achieve high-quality, evidence-informed surgical, maternal and newborn, and primary care: protocol for pre-implementation phase studies (2022)

Identifying contextual determinants of problems in tuberculosis care provision in South Africa: a theory-generating case study (2021)

Personal and occupational experiences of COVID-19 and their effects on South African health workers’ wellbeing (2021)

Comorbidities between tuberculosis and common mental disorders: a scoping review of epidemiological patterns and person-centred care interventions from low-to-middle income and BRICS countries (2020)

TRACE: TRAnsmission of COVID-19 in crowded Environments

2020 – 2021

This RCT aimed to measure the impact of an infection mitigation intervention on SARS-CoV-2 transmission in households of two densely populated, low socio-economic communities in Cape Town, South Africa. Participants were randomised to usual care or the STOPCOV intervention.

Household transmission mitigation was ineffective in this setting; however, Community Health Workers may have facilitated other important referrals.

PACK Child – Strengthening the quality of paediatric primary care: Process Evaluation of a health systems intervention in South Africa

2017 – 2019

The PACK Child pilot and process evaluation established how to optimise delivery and strengthen IMCI principles, and what factors are required to support effective and sustained uptake of the PACK Child into everyday practice. It took place in 10 primary care facilities in the Western Cape, South Africa.

PACK Child appears to be catalysing paediatric primary care to address the broader needs of children, including long-term health conditions and the identification of psychosocial problems.

Publications

Addressing the quality of paediatric primary care: health worker and caregiver perspectives from a process evaluation of PACK child, a health systems intervention in South Africa (2021)

Addressing the quality and scope of paediatric primary care in South Africa: evaluating contextual impacts of the introduction of the Practical Approach to Care Kit for children (PACK Child) (2020)

Strengthening the quality of paediatric primary care: protocol for the process evaluation of a health systems intervention in South Africa (2018)

Preliminary study for a PACK Child trial

2017

This study was done in preparation for the PACK Child trial. We conducted a limited survey on respiratory burden to establish the prevalence, diagnoses, and management of acute respiratory events among children in Cape Town, South Africa.

The survey confirmed there is room for a more systematic approach to the assessment of respiratory symptoms as might be achieved with PACK Child implementation and treatment algorithms, especially in nurse-led facilities.

Publications

PACK Child: the development of a practical guide to extend the scope of integrated primary care for children and young adolescents (2018)

PACK Brazil randomised controlled trial

2016 – 2018

The aim of this RCT was to determine the effectiveness of PACK Brazil Adult training versus the passive dissemination of the PACK Adult guide on the care process and clinical outcomes for people with chronic respiratory disease, cardiovascular disease or diabetes. It was a pragmatic, parallel-group, superiority cluster RCT conducted in Florianopolis, Brazil.

PACK training increased guideline-based treatment and spirometry for asthma only but did not affect COPD, or diagnosis rates.

Publications

Effects of PACK guide training on the management of asthma and chronic obstructive pulmonary disease by primary care clinicians: a pragmatic cluster randomised controlled trial in Florianópolis, Brazil (2019)

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 (2018)

CobALT Trial: Comorbid Affective disorders, AIDS/HIV, and Long Term health

2015 – 2018

This pragmatic cluster RCT evaluated the effectiveness of a collaborative care intervention for depression among adults receiving ART in primary health care facilities in the North West Province of South Africa.

The intervention showed no effect to strengthen collaborative care for depression. This highlighted structural barriers to the integration of mental health with HIV care in South Africa and revealed the extent of the treatment gap in the context of scaling-up mental health services.

Publications

Challenges and opportunities for implementation and dissemination of a task- sharing counselling intervention for depression at primary health care level in South Africa (2023)

A collaborative care package for depression comorbid with chronic physical conditions in South Africa (2022)

Predictors of receiving a diagnosis, referral and treatment of depression in people on antiretroviral therapy in South African primary care: a secondary analysis of data from a randomised trial (2020)

Collaborative care for the detection and management of depression among adults receiving antiretroviral therapy in South Africa: study protocol for the CobALT randomised controlled trial (2018)

The PRIME Trial: PRogramme for Improving Mental health carE

2011 – 2016

This was a multi-country initiative and 6-year programme which aimed to produce research evidence on the implementation and scaling-up of treatment programmes for mental disorders in low resource settings.

PRIME South Africa aimed to evaluate the real-world effectiveness of a collaborative task-sharing model on depression symptom reduction in patients receiving antihypertensive medication in primary care. It was a pragmatic cluster RCT conducted in the North West Province of the country.

The low exposure to the intervention highlighted the need to improve identification and referral of comorbid depression in primary health care clinics.

Publications