Operational Research in the 21 st Century

International Union Against Tuberculosis and Lung Disease (The Union) World’s oldest humanitarian organization dealing with health founded in Paris in 1920 Mission to bring innovation, expertise, solutions and support to address health challenges in low- and middle-income populations. Three pillars: Technical support Research Training

TREAT TB Overview  Technology, Research, Education and Technical Assistance for TB – “TREAT TB”  USAID Cooperative Agreement with the International Union Against Tuberculosis and Lung Disease ( )  Aims to contribute to new knowledge through:  Field evaluations of diagnostic tools  Clinical trials of priority research questions  Targeted operational research benefitting global, regional and country TB control efforts

Outline  Definition and outputs of operational research  Capacity building at programme level  Capacity building at individual level  Approaches to OR training  Classical OR training  Virtual OR training  E-tools for OR training  Conclusion

Operational Research

Research into strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness, or performance of the health system. Operational Research

New knowledge gained from an OR study leads to  Improved tools and management of clinical, laboratory or health services  New strategies or interventions for specific health settings or populations  Evidence that can be used to write new policies

Strengthening OR at Programme Level

Operational Research Situational Analysis Program Priority Setting OR Programme Evaluation (including peer review) Training Leadership & Management Ethics Support Impact Assessment Framework Policy Transfer Analysis &

Operational Research Situational Analysis Program Priority Setting OR Programme Evaluation (including peer review) Training Leadership & Management Ethics Support Impact Assessment Framework Policy Transfer Analysis &

Strengthening OR at Individual Level

Stages of Operational Research

Classical Approaches to OR Training

Union’s Centre for Operational Research Three 5-day modules over a 9 month period  Module 1: participants develop research question and full research protocol  Module 2: participants learn about and create data entry system  Module 3: participants develop their completed research effort in a scientific paper which is submitted to a peer-reviewed journal

ORAP in South Africa  Pairs health services workers new to OR with experienced academic health professionals  Teaches participants how to design and implement an OR study  Trains participants in scientific manuscript writing  Provide one-on-one mentoring through every stage of the research

TB CARE-supported OR in Ethiopia  Teams of trainees from different regions – representing universities, health services and Regional Health Bureau  Group protocol based on regional health priority  Each regional team led by Ethiopian research mentor  Additional back up and support provided by international facilitators

Virtual Training

Why Virtual Training  Training schedule can be disruptive to work and family life  Costly to bring participants to central location  Limited availability of international experts to provide input/facilitation

TREAT TB Virtual Learning Programme for Operational Research  Combination of synchronous and asynchronous approaches to build capacity in OR  Six participants selected globally (Brazil, India (2), Kenya, Pakistan and Swaziland  Six facilitators providing mentorship and live facilitation of six sessions over 16 month programme

TREAT TB Virtual Learning Programme for Operational Research  Support provided in between live sessions from one-on-one mentorship  Data collection and ethical approval process supported as needed  Small amount of funds available if needed for local research costs

TREAT TB Virtual Learning Programme for Operational Research  Topics currently being researched: "Which combination of the six tuberculosis screening questions predicts sputum smear which highest accuracy?” “Early Anti-retroviral therapy initiation of MDR-TB and HIV co- infected patients in Swaziland.” “Factors associated with unsuccessful treatment outcomes of MDR-TB patients in Tamil Nadu state, India.” “Pulmonary TB contact tracing in a priority municipality for disease control in Brazil.

E-tools for Operational Research Training

Conclusions  Optimal package of OR training approaches and materials will be country specific and likely require a variety of tools and methods  Starting point must be programme priorities to improve programme performance  End point must be meaningful changes in guidelines and policies to improve programmes

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