Projects and Research

 

This university-wide,virtual Centre for Research in HIV and AIDS was founded on two large grants based at the School of Public Health They are as follows:

 

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Human Capacity Development to Address HIV and AIDS in South Africa

 

This five-year  CDC/PEPFAR-funded project , Human Capacity Development to address HIV and AIDS in South Africa CDC-RFA-PS07-719) closed in March 2014, having documented and learned from the experience of teams working to strengthen human capacity in different contexts.

 

Rather than “scaling up” one intervention, UWC sought to support a broad-spectrum approach reflecting the range of interventions, contexts, and approaches that must somehow be strengthened if the complex and uneven South African HIV/AIDS pandemic is to be stopped.

 

Teams from seven faculties and one NGO (TB/HIV Care) – and one from another university - addressed issues ranging from viral resistance and databases for managing human resources for health, to integrating PMTCT into nurses’ training and to developing HIV-informed leadership in government.  There was also work with teachers and learners at schools, and parents in nearby neighbourhoods.

 

Although not a research grant, this project provided opportunities to learn about and theorize capacity development for concerted “social change management” across social sub-systems with differing interests, structures, and organizational cultures. While they covered only a small part of the landscape, they began to engage the complexity and disconnections inherent in working in the uneven realities of HIV and AIDS in South Africa — where everything matters, and one size does not fit all.
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Transforming Health and Education Policies and Systems for improved HIV Prevention and Care - part of UWC's Dynamics of Building a Better Society Programme.

 


This was a long-term academic collaboration between UWC and Flemish universities to develop and strengthen capacity and engage in joint research collaboration and supervision of PhD students. Completed uin March 2014, this VLIR Programme was integrated into the wider UWC Dynamics of Building a Better Society: (DBBS) Programme. Within the School of Publich Health (SOPH), VLIR provided core support to the flagship Annual UWC HIV-In-Context Research Symposia convened by the Centre for Research in HIV and AIDS (CRHA) as well as catalytic funding for research and exchange activities in the Centre. It has funded three PhD scholarships and the CRHA's first post-doctoral fellow.

 

The overall academic objective of the project was to develop sustainable HIV-related research capacity in the Centre. The overall development objective was to transform health and education policies and systems with two long-term aims:

1) to decrease the burden of HIV and TB, and

2) to improve the impact of education on HIV/AIDS prevention and to develop better responses for prevention of and response to gender-based violence. 

 

The specific academic objective was to build research capacity and strengthen partnerships in the areas of integrated HIV/AIDS prevention and care, with a specific focus on HIV/TB, education and gender-based violence. The specific development objective was to make policy recommendations based on research in the areas of integrated HIV/AIDS prevention and care, with a specific focus on HIV/TB, education and gender-based violence.

 

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Other Centre projects

 

In addition to these two founding grants, the Centre currently convenes and/or participates in a range of other projects with colleagues both within and beyond the University.

 

Increasing access to TB case finding and treatment in Sisonke district, South Africa

The aim of this WHO/TB REACH-funded project is to increase access to early TB diagnosis and treatment in Sisonke, a poor rural district in South Africa, whilst contributing to strengthened and integrated health systems. This project is a collaboration between TB/HIV Care Association (THCA), the Department of Health (DOH), the National Health Laboratory Services (NHLS) and the University of the Western Cape (UWC). A steering committee with national, provincial and district TB programme representatives helped plan implementation, review progress, and plan for sustainability.

HIV and AIDS Research in Complex Contexts of Inequality (HARICCI)

 

HIV and AIDS Research in Complex Contexts of Inequality - or the HARICCI Collaboration  - will develop and implement an interconnected body of research studies, symposia, fellowships, and participatory interventions that build on existing research programs and partnerships across the university, and address migration, inequality and substance abuse as both entrypoints and cross-cutting themes engaging HIV, health, education, and gender-focused issues and societal responses.

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Health systems resilience: A complex adaptive systems analysis

 

Resilience is emerging as the dominant concept underpinning development assistance and humanitarian support in nations vulnerable – through conflict or natural disaster – to crisis (World Bank, 2011a, 2011b; PPA Resilience Learning Partnership, 2012). It is also increasingly recognised more broadly for development policy. The CRHA is working with Columbia University and the ReBUILD Consortium to develop a model of health systems resilience that informs planning and strengthening of service systems in contexts of adversity.

As a construct resilience is not without critique, however. For example, its weak operationalization and potential blindness to imbalances in power have been noted (Béné et al., 2012). Nonetheless, there is wide recognition that resilience provides a valuable framework for policy and practice on the basis of its focus on developing the capacities of populations and anticipating ‘shocks’ to systems. In particular, the capacity to ‘bounce back’ from adversity is increasingly being conceptualized as the response of complex adaptive systems to experienced shocks.

This project will develop a model of health systems resilience through the following objectives:
1. Develop graphical system dynamic (SD) models of factors influencing health systems performance in the context of environmental ‘shocks’ through intensive, participatory /consultation with stakeholders in three crisis-related settings (Cote D’Ivoire, N Nigeria & Liberia)
2. Refine these models through sensitivity analysis drawing upon HMIS and other service-level data
3. Collate policymaker-friendly case study reports for each setting indicating areas of vulnerability (and areas of adaptation and resilience) and potential points of leverage for systems strengthening work suggested by these analyses.
4. Develop a graphic, accessible model of health systems resilience drawing on insights from these case studies
5. Define policy options for strengthening health systems resilience in situations of adversity by running simulations of alternative scenarios with policy-makers
6. Develop capacity for system dynamic (SD) modelling within health researchers in West Africa and beyond

 

Mainstreaming a health systems approach to delivery of maternal health services: Transdisciplinary research in Rwanda and South Africa

 

 

 

Too many women in low- and middle-income countries (LMICs) still die as a direct result of pregnancy and childbirth. We know from experiences in high-income countries that the vast majority of these deaths are preventable. Most experts believe that strengthening various aspects of the health system (as conceptualized in the six WHO building blocks, which include the health workforce; health information systems; leadership and governance; and actual service delivery) is the solution. It is still unclear however, which building blocks are most important, which interventions within the building blocks are best value for money, and how interventions in different building blocks influence one another.

 

Another aspect that is critical for improving maternal health but is insufficiently emphasised in the building blocks is enabling patients to demand good access to high-quality services. We postulate that the key steps needed to improve services in pregnancy include holding maternal health managers accountable for these services and encouraging community participation to increase patient demand. Moreover, much more is needed to shore-up the skills of public sector managers and how they function in teams that work to improve these services. Finally, we hold that services would be improved through better use of information routinely collected by maternal health services, especially learning from instances of maternal death.

 

To test this hypothesis, we are documenting illustrative cases of successes and failures in maternal health services in Rwanda and South Africa, to identify opportunities to improve the way these services are provided, and to enhance workers' motivation and leadership. We are studying services for treatment of HIV disease in pregnant women and for providing care during emergencies in pregnancy or childbirth. Through working closely with policy leaders and civil society, throughout the project, we are taking joint actions to improve maternal services. Practically, this means that teams of policy makers and researchers in Rwanda and South Africa will apply knowledge learnt in the project and attempt to markedly improve the way maternal services are organised. In both countries, the major reforms underway and the relative inclusiveness of policy processes, mean that presently there are major opportunities to positively influence policy directions and their implementation.

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