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DR AJIBOLA AWOTIWON

IS RESEARCH EVIDENCE ACTUALLY USED FOR POLICY?

GLOBAL EVIDENCE SUMMIT SESSION ON KNOWLEDGE MANAGEMENT

15 SEPTEMBER, 2017

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• The Knowledge Translation Unit is a Clinical Research Unit of the University of Cape Town Lung Institute.

• Founded by Associate professor Lara Fairall

• Formally established in 2005 to continue work begun in 2000 to provide primary care guidelines and training on respiratory disease.

• Since expanded its scope to address priority conditions in primary care in line with the Lung Institute’s mandate to “address priority health issues in Southern Africa through education, research and service.”

MY BACKGROUND

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• Developed, rigorously tested and implemented at provincial and national scale several programmes that have helped to standardise and integrate healthcare delivered at primary level.

• Clinical practice guidelines that are evidenced-based, aligned with policy and regularly updated, and that use an evidence-based implementation strategy of educational outreach.

MY BACKGROUND

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National implementation ongoing

Historical pilots

Current pilots underway

Countries actively engaged in discussions to localise content

Countries where Ministries, NGO’s or other partners have expressed interest in PACK

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• Support in-country localisation of the PACK Adult programme – Nigeria and Ethiopia

• Search, process and implement evidence updates

• Cochrane systematic review that assessed the effectiveness of zinc supplementation for children with measles

• Cochrane systematic review on preventing cryptococcal infection in people living with HIV

• MBBS graduate of the University of Lagos

• MSc in Clinical Epidemiology programme at Stellenbosch University in December 2014

• Development of the PACK (Practical Approach to Care Kit) Global Adult guide and a clinical evidence database.

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• Expansion of content to leverage off the footprint left by communicable diseases to tackle non-communicable diseases.

NURSE PRESCRIBING

• Role of nurse-initiated treatment in expanding access to ART in South Africa.

• The STRETCH trial in the Free State province showed that nurses can provide care equivalent or superior to that provided by doctors, supporting the Ministry’s decision to scale-up ART services through expansion to nurses.

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• Questions policymakers ask change over time.

• A lot of evidence focusses on what we should be doing and not on what we should stop doing. It is important to remind people what to stop doing.

• Not always easy to reconcile what the evidence says with what is available.

CHALLENGES

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World Health Organization guidelines

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• We need to anticipate the changes to be able to provide the research evidence to fit the policy window.

LESSONS LEARNT

• We need to contextualise guideline recommendations to fit the reality.