Despite the disruptions caused by the COVID-19 pandemic and cessation of the UK’s Department for International Development (DFID) funding, the Centre for Operational Research (COR) continued with its impressive work through the year collaborating with other partners, such as the Special Programme on Research and Training in Tropical Diseases (TDR) and World Health Organization (WHO). We worked with TDR on SORT IT courses themed around antimicrobial resistance and worked with other WHO offices on tuberculosis.
Adapting and delivering online
COR was innovative and developed online courses on topics such as scientific paper writing, research protocol development and PubMed Search in order to adapt to the disruptions caused by COVID-19 pandemic. COR developed and delivered many short courses in India, Pakistan and Zimbabwe. Even the SORT IT courses were delivered online in collaboration with partners. A total of 195 papers were published during the year which included 111 original research studies. The links to some of the papers are provided below:
- SORT IT course on Tuberculosis run by WHO country office in Uzbekistan: https://www.mdpi.com/journal/ijerph/special_issues/tuberculosis_project_uzbekistan [11 papers from Uzbekistan published in a special issue of the International Journal of Environmental Research and Public Health]
- SORT IT course on Tuberculosis run by WHO-EURO: https://www.monaldi-archives.org/index.php/macd/issue/view/103 [12 papers from Eastern Europe and Central Asia published in Monaldi Archives of Chest Disease; check under thematic articles in the above link]
- SORT IT courses on antimicrobial resistance run by TDR: https://www.mdpi.com/journal/tropicalmed/special_issues/AMR [21 papers from Asia and Africa published in a special issue of the Tropical Medicine and Infectious Diseases Journal]
COVID and its impact on TB and HIV services
COR led an operational research project on COVID and its impact on TB and HIV services in three African cities (Lilongwe in Malawi, Harare in Zimbabwe, Nairobi in Kenya). In April 2020, The Union worked with the national TB and national HIV/AIDS programmes in Kenya, Malawi and Zimbabwe, with the WHO Special Programme for Research and Training in Tropical Diseases (WHO-TDR) in Geneva and Vital Strategies in USA to develop the protocol for this work. The protocol was posted on The Union website in August so that other researchers and national programmes could use and adapt it for their needs in order to enable similar work to be carried out in other countries.
The Mid-Term Report showed two key analyses. First, a direct comparison of six-month aggregate TB and HIV numbers between March and August 2019 (the pre-COVID-19 period) and between March and August 2020 (the COVID-19 period). Second, the trends in key TB and HIV numbers in the COVID-19 period related to interventions designed to mitigate the impact of SARS-CoV-2 on TB and HIV services. In summary, all three African cities saw a marked decline in TB case finding and HIV testing during the first six-months of the COVID-19 outbreak compared with a similar period of time the year before. TB treatment success decreased and this was largely due to an increase in patients “not being evaluated”. Referrals for antiretroviral therapy were not affected. The three cities had mixed success in mitigating the negative impact of the COVID-19 pandemic. The study was completed in 2021 and here are links to the four published studies from that work:
- Operational Research to Assess the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Health Facilities in Harare, Zimbabwe: https://pubmed.ncbi.nlm.nih.gov/34072803/
- Assessing the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Selected Health Facilities in Nairobi, Kenya: https://pubmed.ncbi.nlm.nih.gov/34068615/
- Assessing the Impact of COVID-19 on TB and HIV Programme Services in Selected Health Facilities in Lilongwe, Malawi: Operational Research in Real Time: https://pubmed.ncbi.nlm.nih.gov/34069332/
- Real-Time Operational Research: Case Studies from the Field of Tuberculosis and Lessons Learnt: https://www.mdpi.com/2414-6366/6/2/97
SORT IT skills support COVID response
Given the COVID-19 pandemic, we conducted a quick survey to 1) capture whether SORT IT alumni are contributing to the pandemic response, and if so, 2) map where and how they are applying their SORT IT skills. The analysis revealed that 302 (62%) of 488 SORT IT alumni who responded to the survey in 72 hours are currently involved with the COVID-19 response, and 219 (73%) are using the skills gained to tackle the pandemic. This finding shows that the SORT IT programme has equipped front-line health workers in 62 countries with the vital skills needed to respond to the unprecedented global public health emergency of COVID-19. More details can be accessed from this published paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558759/
Global public health consultancy
COR also undertook multiple consultancies and contributed to public health around the globe. One of our team members, Dr Srinath, worked as a consultant for WHO’s South-East Asia Regional Office and did a situational analysis on the status of TB Preventive Treatment (TPT) implementation in 2018 and 2019. As per the commitment made by the Heads of the countries of the South-East Asia (SEA) Region during the 2018 United Nations High-Level Meeting (UNHLM) on TB, the regional target is to provide TPT to at least 10.8 million high-risk individuals (household contacts and people living with HIV) between 2018 and 2022. This situational analysis showed that overall in the SEA Region 1.2 million high-risk individuals were initiated on TPT during 2018 and 2019. At the current pace of implementation, the UNHLM TPT target for household contacts is unlikely to be achieved by 2022. In 2020, almost all 11 countries of the SEA Region had revised their policies in accordance with the latest WHO TPT guidelines. The major challenges for TPT scale-up in the SEA Region were resource shortages, knowledge and service delivery/uptake gaps among providers and service recipients, and the lack of adequate quantities of rifapentine for use in shorter TPT regimens. The situational analysis also highlighted that there were several regional opportunities to address these gaps and countries must make use of these opportunities to scale up TPT services rapidly to meet the UNHLM TPT targets and reduce the TB burden in the SEA Region. More details at: https://www.who.int/publications/i/item/9789290228059
Another such consultancy with the WHO country office in Uzbekistan focussed on conducting a situational analysis of the health information systems (including a review all the health indicators for measuring sustainable development goals), identifying gaps and providing recommendations.
COR won a competitive bid to undertake an operational research study in Sri Lanka. This project was funded by the World Bank and aimed at assessing the implementation status of a primary health care system strengthening project with a focus on non-communicable disease services. The project was started in September 2020 and will be completed in October 2021.