Research Capacity Strengthening in Sub-Saharan Africa: Recognizing the Importance of Local Partnerships in Designing and Disseminating HIV Implementation Science to Reach the 90-90-90 Goals

Research training needs on HIV and oral health among dentists in resource limited settings: A cross-sectional study

Background: Oral health among people living with Human Immunodeficiency Virus (HIV) in Uganda is under-researched, despite its critical impact on their overall health and quality of life. This gap is partly attributed to limited capacity in human resources and research infrastructure. This study aimed to evaluate the HIV/oral health research training needs among dentists in Uganda. Methods: We conducted a cross-sectional study among 86 dentists licensed to practice in Uganda. A self-administered online questionnaire, adapted from the Hennessey-Hicks training needs analysis tool, was used to collect data. The questionnaire included four rating scales to assess HIV/oral health research training needs by comparing the perceived importance of specific competencies to the current performance ratings provided by participants. Performance improvement was analyzed using two rating scales to determine whether the identified training needs could be better addressed through organizational changes or individual training. Data analysis was performed using STATA version 17.0. Results: Between September and October 2024, 86 dentists participated in the study. The median age of participants was 32 years (interquartile range (IQR): 27-38), with 59.3% being male. Significant HIV/oral health research training needs were identified, with a median difference score between perceived importance and current performance ratings of 1.3 (IQR: 0.5-2.2) and a P-value of <0.001. Both organizational changes and individual training approaches were similarly rated as important in addressing these training needs, with median scores of 5.9 (IQR: 5.1-6.6) and 6.1 (IQR: 5.2-6.7), respectively (P-value = 0.108). Conclusion: The findings highlight significant HIV/oral health research training needs among dentists in Uganda. Addressing these needs requires a combined approach that integrates individual training with organizational support initiatives.

Unravelling the complexity of research capacity strengthening for health professionals in low- and middle-income countries: A concept analysis

AIMS

Research capacity strengthening (RCS) is crucial in enhancing healthcare outcomes, particularly in low- and middle-income countries (LMICs), which face challenges due to limited resources, unequal access to care and the need for evidence-based decision-making. We seek to move beyond a surface-level understanding of RCS, unearthing the core attributes, the factors that precede its implementation and the transformative outcomes it generates within the LMIC healthcare landscape.

DESIGN

This study employs the Walker and Avant approach to concept analysis to comprehensively explore the dimensions and attributes of RCS as it pertains to allied and public health professionals in LMICs, propose empirical referents and suggest an operational definition.

DATA SOURCES

Ovid MEDLINE, Embase, CINAHL and Cochrane CENTRAL were searched from inception to 27 July 2023, to identify studies on RCS in LMICs. The Walker and Avant approach to concept analysis was selected because it provides a framework for systematically examining and clarifying the meaning and implications of RCS. This method involves a structured process of defining RCS, identifying its attributes, antecedents, consequences and cases, and ultimately providing a clear understanding of its meaning and implications. Identifying empirical referents offers measurable indicators that researchers and policymakers can use to assess the effectiveness of RCS initiatives in LMICs.

CONCLUSION

RCS for health professionals in LMICs involves a sustainable process that equips them with essential research skills, fostering the ability to conduct high-quality research and improve healthcare delivery in resource-constrained settings.

IMPLICATIONS

RCS aims to empower health professionals to apply evidence-based practices, reduce disparities and enhance the well-being of populations in LMICs.

IMPACT

Ultimately, a concept analysis of RCS empowers us to harness the full potential of research to enhance healthcare delivery, improve patient outcomes and advance the well-being of populations worldwide.

Lassa Fever: Critical Review and Prospects for Control

Lassa Fever is a deadly viral haemorrhagic disease, causing annually several hundreds of deaths in West Africa. This zoonotic disease is primarily transmitted to humans by rodents of the genus Mastomys, even though other rodents reportedly carry the Lassa virus, while secondary interhuman transmission accounts for approximately 20% of cases. Although this disease has been endemic in rural zones of Nigeria, Sierra Leone, Liberfia, and Guinea for hundreds of years, it is also characterised by epidemic outbreaks in the dry season, responsible for heavy death tolls. No licensed vaccine or satisfying treatment is currently available. Disease management is hindered by the incomplete knowledge of the epidemiology and distribution of the disease, resulting from an inadequate health and surveillance system. Additional scientific constraints such as the genetic diversity of the virus and the lack of understanding of the mechanisms of immune protection complexify the development of a vaccine. The intricate socio-economic context in the affected regions, and the lack of monetary incentive for drug development, allow the disease to persist in some of West Africa's poorest communities. The increase in the number of reported cases and in the fatality rate, the expansion of the endemic area, as well as the threat Lassa Fever represents internationally should urge the global community to work on the disease control and prevention. The disease control requires collaborative research for medical countermeasures and tailored public health policies. Lassa Fever, created by the interconnection between animals, humans, and ecosystems, and embedded in an intricate social context, should be addressed with a 'One Health' approach. This article provides an overview of Lassa Fever, focusing on Nigeria, and discusses the perspectives for the control of disease.

Development of a Complex Intervention for Effective Management of Type 2 Diabetes in a Developing Country

There has been little focus on designing tailored diabetes management strategies in developing countries. The aim of this study is to develop a theory-driven, tailored and context-specific complex intervention for the effective management of type 2 diabetes at a tertiary care setting of a developing country. We conducted interviews and focus groups with patients, health professionals, and policymakers and undertook thematic analysis to identify gaps in diabetes management. The results of our previously completed systematic review informed data collection. We used the United Kingdom Medical Research Council framework to guide the development of the intervention. Results comprised 48 interviews, two focus groups with 11 participants and three co-design panels with 24 participants. We identified a lack of structured type 2 diabetes education, counselling, and collaborative care of type 2 diabetes. Through triangulation of the evidence obtained from data collection, we developed an intervention called VICKY (patient-centred collaborative care and structured diabetes education and counselling) for effective management of type 2 diabetes. VICKY comprised five components: (1) patient-centred collaborative care; (2) referral system for patients across transitions of care between different health professionals of the diabetes care team; (3) tools for the provision of collaborative care and documentation of care; (4) diabetes education and counselling by trained diabetes educators; and (5) contextualised diabetes education curriculum, educational materials, and documentation tools for diabetes education and counselling. Implementation of the intervention may help to promote evidence-based, patient-centred, and contextualised diabetes care for improved patient outcomes in a developing country.

Documenting HIV research-utilization activities, outputs and outcomes: examples and lessons learned from Project SOAR

The importance of using research findings to inform policy and program decisions is well recognized, but the literature on measuring research utilization activities is scarce. As funding to support some areas of research wanes or remains stagnant, the need to document the value of investing in research by its’ effect on improved programs and policies becomes increasingly necessary. We present the experience of Project SOAR, a six-year USAID-funded project focusing on HIV/AIDS-related implementation research, to demonstrate measurement of research utilization. We follow the project’s research-utilization logic model, including inputs, activities, outputs, and outcomes. We present tools the project developed and examples from project studies and discuss what works, remaining challenges and how to overcome them, and lessons learned. We then make recommendations for incorporating research-utilization activities and measurement in implementation-research studies.

Implementing enhanced patient care to promote patient engagement in HIV care in a rural setting in Kenya

BACKGROUND

Patient engagement is effective in promoting adherence to HIV care. In an effort to promote patient-centered care, we implemented an enhanced patient care (EPC) intervention that addresses a combination of system-level barriers including provider training, continuity of clinician-patient relationship, enhanced treatment dialogue and better clinic scheduling. We describe the initial implementation of the EPC intervention in a rural HIV clinic in Kenya, and the factors that facilitated its implementation.

METHODS

The intervention occurred in one of the rural Academic Model Providing Healthcare (AMPATHplus) health facilities in Busia County in the western region of Kenya. Both qualitative and quantitative data were collected through training and meeting proceedings/minutes, a patient tracking tool, treatment dialogue and a peer confirmation tool. Qualitative data were coded and emerging themes on the implementation and adaptation of the intervention were developed. Descriptive analysis including percentages and means were performed on the quantitative data.

RESULTS

Our analysis identified four key factors that facilitated the implementation of this intervention. (1) The smooth integration of the intervention as part of care that was facilitated by provider training, biweekly meetings between the research and clinical team and having an intervention that promotes the health facility agenda. (2) Commitment of stakeholders including providers and patients to the intervention. (3) The adaptability of the intervention to the existing context while still maintaining fidelity to the intervention. (4) Embedding the intervention in a facility with adequate infrastructure to support its implementation.

CONCLUSIONS

This analysis demonstrates the value of using mixed methods approaches to study the implementation of an intervention. Our findings emphasize how critical local support, local infrastructure, and effective communication are to adapting a new intervention in a clinical care program.

Engaging Stakeholders, from Inception and Throughout the Study, is Good Research Practice to Promote use of Findings

The need for research-informed programming and policy making is well established. However, there is limited evidence that, when researchers actively promote utilization of research findings, stakeholders use such findings for decision making in low- and middle-income countries (LMIC). A common barrier for research uptake in LMIC is that researchers focus on passive dissemination of final findings as the primary vehicle to affect research uptake. A more active approach to facilitating research utilization (RU) is necessary. Project SOAR, a six-year USAID-funded operations research project, recognized this gap and developed an approach to include the end data users in the research process from inception to final results dissemination. In this commentary, we make recommendations for active facilitation of research uptake using emerging lessons from SOAR's RU process that focuses on ongoing engagement of stakeholders throughout the life of the study.