E Ochodo, Stellenbosch University, Evidence synthesis for building a translation pipeline to eliminate infectious diseases

Infectious diseases such as HIV, tuberculosis (TB) and malaria still cause considerable illness and death in Africa. This is despite malaria and TB being treatable, the availability of tests to detect these diseases and the presence of treatment to normalize the health of people living with HIV. One possible explanation for this could be the ineffective ways used to implement or translate findings of research to inform policy. Research translation involves getting the right information to the right people at the right format they can easily understand to inform decision-making. A policy that is implemented too rapidly or too slowly can minimize effective control of disease. Getting this right is important and needs rigorous methods and science to help assure this.

Summarizing available research findings and presenting it in a way that can be easily interpreted and understood (otherwise known as evidence synthesis) can help in decision making. Multiple influencing factors exist between the decision to use an intervention and its use in practice. A portfolio of integrated research findings from different fields including technical aspects, costs, acceptability and practicality is needed but methods of integration are still unclear. Our vision is a broader base of research findings for implementation being supported by summarising research findings from different fields to inform policy, implementation and revisions of policies.

In Africa, there has been limited research and development on methods to improve how research findings are summarised and how to improve translation of research findings to policy. Research methods tailored to the African context are needed to facilitate better uptake and sustainability in the region.

This project aims to formally develop an approach to translating research findings into policy through summarizing and integrating research findings from different fields. We also aim to recommend methods of improving translation of evidence into policy. Ultimately, through this, we aim to establish a research group and in future a sub-regional centre for the science of evidence synthesis and research translation in Kenya. To our knowledge such a directive or coordinating centre does not yet exist in Kenya.

The objectives of this project are:
1. To summarize the effect and delivery of new and existing interventions on HIV, TB and malaria per national priorities of Kenya.
2. To develop and implement methods of summarizing and integrating research findings and knowledge from different fields.
3. To develop summaries of reviews generated by summarizing and integrating research and knowledge.
4. To communicate and circulate know-how and products of this integrative approach to policy makers.

In the process of achieving this, we will establish a research group in evidence synthesis and research translation in HIV, TB and malaria in Kenya.

This project is timely and has potential for great impact. Under new leadership, there is an explicit shift in the World Health Organization (WHO) to devolve policy making to regional level. The future requires the position of control for evidence synthesis to be firmly implanted in the research infrastructure in Africa. The findings of this project will be useful to policy makers in Kenya who require capacity to integrate research findings from different areas when making decisions.

While much scientific progress has been made towards development of interventions to aid elimination of the major infectious diseases in Africa-HIV, tuberculosis (TB) and malaria-the incidence and prevalence of these diseases remains high. One barrier to effective control of these diseases is the suboptimal translation of promising interventions and diagnostic tests into policy and practice.
Multiple influencing factors exist between the decision to introduce an intervention and its use in practice. However, currently, synthesis and translation of these different forms of evidence are done as haphazardly if at all, and we need innovative methods to synthesize and integrate these different forms of evidence. We see the broader base of evidence of scale-up being supported by a pipeline of evidence synthesis from different fields to inform technical policy, programmatic guidance and to inform optimum implementation and revisions to existing policies. This is a methodological research project that aims to formally develop a pipeline approach to translating evidence into policy and practice through evidence synthesis and recommend methods for improving translation of evidence into policy and practice. We will develop syntheses of technical evidence on effectiveness or accuracy with application of absolute effects at country level; and develop methods to summarise relevant programmatic (service delivery) information on feasibility, acceptability, economic evaluation and qualitative research at global, regional and national levels. Ultimately, through this project, we aim to establish a research group and a sub-regional directive or coordinating hub for evidence synthesis and research translation in Kenya. To our knowledge no such hub exists in Kenya. This project is timely and has potential for great impact. Under new leadership, there is an explicit shift in the World Health Organization (WHO) to devolve policy making to regional levels.

Details of the impact of this study can be found in the pathways to impact statement. In summary, this project has immense potential for impact to stakeholders.

Policy makers will benefit from being engaged in the conduct and dissemination of the project. From the outset of this project we will consult with policy makers at the national level regional and international level to identify priority topics that require evidence on effects and service delivery. In this way, their skills and understanding of the process of evidence synthesis and translation will be enhanced. They will also be better equipped on making effective holistic decisions by incorporating technical and service delivery evidence.

The public will greatly benefit from interventions that are effectively implemented into routine care. Well implemented interventions have a high likelihood of improving program and health outcomes. This project will equip decision makers with new skills in making decisions from an integrated pipeline of evidence incorporating technical and program delivery aspects. In this way improving the implementation and scale-up of interventions effectively.

By engaging with key academic institutions in Kenya through our dissemination activities(local meetings or seminars) we envisage improved capacity in the conduct and use of evidence synthesis. We also foresee future research collaborations and introducing training modules of evidence synthesis where there is none.

There is great interest at the Kenya Medical Research Institute (our partner institution) to build capacity in evidence synthesis which is a critical element in the pipeline of policy relevant research that is currently lacking. Staff and students (PhD students) working in KEMRI can be supported locally by the African Research Leader (ARL) and benefit from the regional (South Africa) and international (UK) collaborations that the ARL has with other evidence synthesis centres. We anticipate that studies conducted by the Centre for Global Health Research (KEMRI-CGHR) that have the potential to influence policy will benefit from better strategies in translation of their findings to inform policy.

This project will not only sharpen the leadership skills of the ARL but develop other leaders in evidence synthesis as well by training one PhD student in methods of evidence synthesis and research translation. We ultimately aim to set up a research group and sub-regional hub in the science of evidence synthesis and research translation in Kenya, building other leaders in evidence synthesis is one way of achieving this goal.