The Implementation Research Division is under the leadership of Dr Dr Salome Charalambous, Managing Director: Implementation Research Division.
About Implementation Research
The main areas of focus include; case finding, diagnostics, care and case management, prevention and evaluation of health programmes. Implementation Research primarily conducts work in primary health facilities, communities, correctional facilities and mines.
Dr Salome Charalambous - Managing Director: Implementation Research Division
Dr Salome Charalambous is currently the Research Director at the Aurum Institute. Her training includes a medical degree from Wits University and a MSc and PhD in Epidemiology at the London School of Hygiene and Tropical Medicine.
What We Do
Policy & Advocacy
Areas Of Focus:
TB & HIV Diagnosis
Care & Treatment
The Implementation Research Team:
Projects in the Division fall under one of the areas of focus above and each project is led by a team of external and internal investigators (Scientists). The team of Scientists based at Aurum is led by Dr Salome Charalambous.
Policy & Advocacy
We have been involved in a project to support data utilisation and modelling to support the TB control policy and practice in South Africa. The primary objective of this project is to create a sustainable system to integrate quantitative analysis into TB control policy and implementation decision-making in South Africa. Collaboration with the London School of Hygiene and Tropical Medicine funded through Bill and Melinda Gates Foundation. The NDOH-owned TB Think Tank has been set up with support from this grant. The Think Tank is a group of TB experts from academia, public benefit organisations and government that advice and assist the National Department of Health in TB decision making. The evidence collation/generation team is functioning well and results have been requested by and presented to, NDOH at least 10 times over the previous 12 months.
The project impact (influence on policy/practice) includes:
- Input into NDOH central government TB budget decision-making
- Set focus of the SAMRC/UKMRC research council funding calls on operational research
- Influence of the South African health minister’s World TB day presentation to include clinic-based screening and setting of evidence-based screening targets
As the Think Tank becomes more established and trusted by/useful to NDOH, we expect its ability to inform evidence-based policy making will strengthen.
Case Finding For HIV & TB
The ultimate goal of identifying individuals at risk of having TB or HIV or both is to improve patient outcomes for and to reduce transmission in the community. Household contact tracing (HHCT) for tuberculosis is a well-established method for detecting cases earlier and preventing further transmission (Ribolola, INHIBIT TB). Provider-initiated testing and counselling (PITC) is a longstanding and important method of identifying individuals living with HIV. Importantly, it reaches individuals who are already seeking clinical care and ready to engage with the medical care system. Together with London School of Hygiene, Johns Hopkins and Africa Centre, funding has been awarded by the MRC South Africa/United Kingdom Newton Fund to define and evaluate an ideal model for HHCT. Similarly in collaboration with Johns Hopkins University and with funding from USAID, approaches to improving PITC will be assessed.
Care & Case Management For HIV & TB
Following a positive diagnosis for either TB or HIV, there is often delays in initiating treatment either for TB or HIV or both. The delay between diagnosis and entry into car must be decreased to maximise the potential impact of treatment regimens that are available for both TB and HIV. Early diagnosis and treatment initiation not only help reduce mortality but also prevent disease transmission. There is a need to reduce delays in linking into both TB and HIV care. We evaluated various strategies to improve linkage to care among individuals being investigated for TB using a case manager strategy and use of mHealth approaches. In the case of HIV, we have evaluated a combination of strategies including minimising time between getting a positive HIV test result and getting CD4 counts done, providing money for transport and care facilitation.
Another project, looking at increased treatment for HIV, is the project looking at Treatment as prevention (TasP) or Universal Test and Treat in correctional facilities in Southern Africa. We need to characterise and assess the performance of the integrated HIV/TB care continuum under TasP and assess system-level and inmate-level barriers to and facilitators of TasP implementation in Southern African correctional settings.
In addition, we will characterise the resources, activities, and other programmatic inputs required for TasP implementation in correctional facilities and examine policymaker attitudes and preferences regarding TasP policy adoption in Southern African correctional facilities.
A number of studies have been completed recently that have evaluated TB/HIV integration: These have ranged from studies to understand how to improve TB case finding among HIV-infected individuals (XPhactor) and also how to improve TB/HIV integration overall (Merge project). In addition, we have just completed TB FAST TRACK, a study to evaluate the effect of a point-of-care TB test-and-treat algorithm on early mortality in people with HIV accessing ART, a trial with randomisation at a clinic level. Further work to address the issues around TB/HIV integration, includes a new trial, the WHIP3TB trial, where a new regimen for prevention of TB, the 3HP regimen (3 months of high-dose Rifapentine and INH) will be evaluated. This is a large multi-country trial that will involve sites in Ethiopia and Mozambique.
Resistance To TB Infection
The HETU-1 study is studying the immunology of highly TB exposed, persistently uninfected South African gold miners. The goal of the study is to identify miners that have been highly exposed but remain persistently uninfected with TB and identify immunological mechanisms that provide protection against TB infection, which may be used to develop TB vaccines and host-directed therapies. The study is a collaboration with the London School of Hygiene and Tropical Medicine. The study is funded by the Bill and Melinda Gates Foundation.
Health Programme Evaluations
We also work with our Public Health Division and our Health System Strengthening Division, to assist with the evaluation of the programmes. These include the following projects:
- Impact evaluation of quality improvement interventions targeting patient empowerment in HIV/AIDS clinical management
- Evaluation of a private practitioner model of care for HIV management in South Africa
- A study to assess the yield of Digital CXR when used as an initial screening tool in Correctional Service Facilities