Promoting operational research through fellowships: a case study from the South-East Asia Union Office.

In 2009, the International Union Against Tuberculosis and Lung Disease (The Union) and Médecins Sans Frontières (MSF) jointly developed a new paradigm for operational research (OR) capacity building and started a new process of appointing and supporting OR fellows in the field. This case study describes 1) the appointment of two OR fellows in The Union South-East Asia Office (USEA), New Delhi, India; 2) how this led to the development of an OR unit in that organisation; 3) achievements over the 5-year period from June 2009 to June 2014; and 4) challenges and lessons learnt. In June 2009, the first OR fellow in India was appointed on a full-time basis and the second was appointed in February 2012-both had limited previous experience in OR. From 2009 to 2014, annual research output and capacity building initiatives rose exponentially, and included 1) facilitation at 61 OR training courses/modules; 2) publication of 96 papers, several of which had a lasting impact on national policy and practice; 3) providing technical assistance in promoting OR; 4) building the capacity of medical college professionals in data management; 5) support to programme staff for disseminating their research findings; 6) reviewing 28 scientific papers for national or international peer-reviewed journals; and 7) developing 45 scientific abstracts for presentation at national and international conferences. The reasons for this success are highlighted along with ongoing challenges. This experience from India provides good evidence for promoting similar models elsewhere.

[1]  A. Ramsay,et al.  The Structured Operational Research and Training Initiative for public health programmes. , 2014, Public health action.

[2]  A. Ramsay,et al.  What happens after participants complete a Union-MSF structured operational research training course? , 2014, Public health action.

[3]  A. Ramsay,et al.  Research to policy and practice change: is capacity building in operational research delivering the goods? , 2014, Tropical medicine & international health : TM & IH.

[4]  A. Reid,et al.  Notified tuberculosis among Singapore residents by ethnicity, 2002-2011. , 2013, Public health action.

[5]  M. Edginton,et al.  Tuberculosis treatment outcomes among hospital workers at a public teaching and national referral hospital in Kenya. , 2013, Public health action.

[6]  J. Kimani,et al.  Prevalence and incidence of cervical intra-epithelial neoplasia among female sex workers in Korogocho, Kenya. , 2013, Public health action.

[7]  P. Venkatesan,et al.  Number of sputum specimens during treatment follow-up of tuberculosis patients: two or one? , 2013, Public health action.

[8]  S. Satyanarayana,et al.  Pretreatment sputum smear grade and smear positivity during follow-up of TB patients in Ahmedabad, India. , 2013, Public health action.

[9]  S. Zodpey,et al.  How effective is the integration of facility and community-based management of severe acute malnutrition in India? , 2013, Public health action.

[10]  A. Reid,et al.  Intensified Tuberculosis Case Finding among Malnourished Children in Nutritional Rehabilitation Centres of Karnataka, India: Missed Opportunities , 2013, PloS one.

[11]  D. Enarson,et al.  Profile and treatment outcomes of elderly patients with tuberculosis in Delhi, India: implications for their management. , 2013, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[12]  S. Nair,et al.  High prevalence of undiagnosed diabetes among tuberculosis patients in peripheral health facilities in Kerala. , 2013, Public health action.

[13]  S. Satyanarayana,et al.  Tuberculosis-diabetes mellitus bidirectional screening at a tertiary care centre, South India. , 2013, Public health action.

[14]  S. Satyanarayana,et al.  Epidemiology and interaction of diabetes mellitus and tuberculosis and challenges for care: a review. , 2013, Public health action.

[15]  A. Harries,et al.  Screening tuberculosis patients for diabetes in a tribal area in South India. , 2013, Public health action.

[16]  A. Harries,et al.  Taking on the diabetes-tuberculosis epidemic in India: paving the way through operational research. , 2013, Public health action.

[17]  A. Harries,et al.  Characteristics of patients with diabetes screened for tuberculosis in a tertiary care hospital in South India. , 2013, Public health action.

[18]  A. Harries,et al.  Is screening for diabetes among tuberculosis patients feasible at the field level? , 2013, Public health action.

[19]  A. Harries,et al.  Does a nutrition education programme change the knowledge and practice of healthy diets among high school adolescents in Chennai, India? , 2013 .

[20]  D. Enarson,et al.  Outcome of Tuberculosis Treatment in Patients with Diabetes Mellitus Treated in the Revised National Tuberculosis Control Programme in Malappuram District, Kerala, India , 2013, PloS one.

[21]  Ajay M. V. Kumar,et al.  The Impact of Isoniazid Resistance on the Treatment Outcomes of Smear Positive Re-Treatment Tuberculosis Patients in the State of Andhra Pradesh, India , 2013, PloS one.

[22]  D. Enarson,et al.  LED-Fluorescence Microscopy for Diagnosis of Pulmonary Tuberculosis under Programmatic Conditions in India , 2013, PloS one.

[23]  D. Enarson,et al.  Comparing Same Day Sputum Microscopy with Conventional Sputum Microscopy for the Diagnosis of Tuberculosis – Chhattisgarh, India , 2013, PloS one.

[24]  A. Reid,et al.  High quit rate among smokers with tuberculosis in a modified smoking cessation programme in Dhaka, Bangladesh. , 2013, Public health action.

[25]  S. Srinath,et al.  Is physical access an impediment to tuberculosis diagnosis and treatment? A study from a rural district in North India. , 2013, Public health action.

[26]  A D Harries,et al.  References for scientific papers: why not standardise to one global style? , 2013, Public health action.

[27]  C. Palanivel,et al.  Uptake of HIV testing and HIV positivity among presumptive tuberculosis patients at Puducherry, South India. , 2013, Public health action.

[28]  A. Harries,et al.  Tuberculosis Management Practices by Private Practitioners in Andhra Pradesh, India , 2013, PloS one.

[29]  Ajay M. V. Kumar,et al.  Scaling Up Antiretroviral Treatment Services in Karnataka, India: Impact on CD4 Counts of HIV-Infected People , 2013, PloS one.

[30]  Ross Upshur,et al.  Applying the ICMJE authorship criteria to operational research in low‐income countries: the need to engage programme managers and policy makers , 2013, Tropical medicine & international health : TM & IH.

[31]  M. Ganesh,et al.  The Profile and Treatment Outcomes of the Older (Aged 60 Years and Above) Tuberculosis Patients in Tamilnadu, South India , 2013, PloS one.

[32]  A D Harries,et al.  Operational research capacity building in Asia: innovations, successes and challenges of a training course. , 2013, Public health action.

[33]  S. Egwaga,et al.  Are sputum samples of retreatment tuberculosis reaching the reference laboratories? A 9-year audit in Tanzania. , 2013, Public health action.

[34]  A. Harries,et al.  Does the type of treatment supporter influence tuberculosis treatment outcomes in Zimbabwe? , 2013, Public health action.

[35]  Screening of patients with diabetes mellitus for tuberculosis in India , 2013, Tropical medicine & international health : TM & IH.

[36]  Screening of patients with tuberculosis for diabetes mellitus in India , 2013, Tropical medicine & international health : TM & IH.

[37]  S. Satyanarayana,et al.  Linkage of Presumptive Multidrug Resistant Tuberculosis (MDR-TB) Patients to Diagnostic and Treatment Services in Cambodia , 2013, PloS one.

[38]  A. Kumar,et al.  Xpert(®) MTB/RIF under routine conditions in diagnosing pulmonary tuberculosis: a study in two hospitals in Pakistan. , 2013, Public health action.

[39]  S. Satyanarayana,et al.  Is bleach-sedimented smear microscopy an alternative to direct microscopy under programme conditions in India? , 2013, Public health action.

[40]  A M V Kumar,et al.  Efficient, quality-assured data capture in operational research through innovative use of open-access technology. , 2013, Public health action.

[41]  R. Zachariah,et al.  Universal health coverage in a regional Nepali hospital: who is exempted from payment? , 2013, Public health action.

[42]  D. Wangchuk,et al.  Childhood tuberculosis in Bhutan: profile and treatment outcomes. , 2013, Public health action.

[43]  S. Lawn,et al.  HIV testing in people with presumptive tuberculosis: time for implementation. , 2013, The Lancet. Respiratory medicine.

[44]  V. Chadha,et al.  What Are the Reasons for Poor Uptake of HIV Testing among Patients with TB in an Eastern India District? , 2013, PloS one.

[45]  D. Behera,et al.  Contribution of medical colleges to tuberculosis control in India under the Revised National Tuberculosis Control Programme (RNTCP): Lessons learnt & challenges ahead , 2013, The Indian journal of medical research.

[46]  A. Harries,et al.  The journey to antiretroviral therapy in Karnataka, India: who was lost on the road? , 2013, Journal of the International AIDS Society.

[47]  S. Satyanarayana,et al.  Assessing compliance to smoke-free legislation: results of a sub-national survey in Himachal Pradesh, India , 2013, WHO South-East Asia journal of public health.

[48]  B. Draguez,et al.  Severe malnutrition in children presenting to health facilities in an urban slum in Bangladesh. , 2012, Public health action.

[49]  R. Zachariah,et al.  Does the 65 cm height cut-off as age proxy exclude children eligible for nutritional assessment in Bangladesh? , 2012, Public health action.

[50]  A. Harries,et al.  Health-care seeking among people with cough of 2 weeks or more in India. Is passive TB case finding sufficient? , 2012, Public health action.

[51]  S. Satyanarayana,et al.  Fast-track writing of a scientific paper with 30 authors: how to do it. , 2012, Public health action.

[52]  A. Harries,et al.  Pre-treatment loss to follow-up among smear-positive pulmonary tuberculosis cases: a 10-year audit of national data from Fiji. , 2012, Public health action.

[53]  P. Dewan,et al.  Can Follow-Up Examination of Tuberculosis Patients Be Simplified? A Study in Chhattisgarh, India , 2012, PloS one.

[54]  S. Zodpey,et al.  Should Sputum Smear Examination Be Carried Out at the End of the Intensive Phase and End of Treatment in Sputum Smear Negative Pulmonary TB Patients? , 2012, PloS one.

[55]  A. Harries,et al.  High Diabetes Prevalence among Tuberculosis Cases in Kerala, India , 2012, PloS one.

[56]  P. Dewan,et al.  Is One Sputum Specimen as Good as Two during Follow-Up Cultures for Monitoring Multi Drug Resistant Tuberculosis Patients in India? , 2012, PloS one.

[57]  A. Harries,et al.  Operational research training: the course and beyond. , 2012, Public health action.

[58]  S. Satyanarayana,et al.  How Did the TB Patients Reach DOTS Services in Delhi? A Study of Patient Treatment Seeking Behavior , 2012, PloS one.

[59]  A. Kabir,et al.  Are all patients diagnosed with tuberculosis in Indian medical colleges referred to the RNTCP? , 2012, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[60]  R. Zachariah,et al.  In reply to 'Language in tuberculosis services' [Correspondence]. , 2012, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[61]  P. Dewan,et al.  Feasibility and Effectiveness of Provider Initiated HIV Testing and Counseling of TB Suspects in Vizianagaram District, South India , 2012, PloS one.

[62]  A. Harries,et al.  Factors Associated with Delays in Treatment Initiation after Tuberculosis Diagnosis in Two Districts of India , 2012, PloS one.

[63]  P. Dewan,et al.  Sputum Smear Microscopy at Two Months into Continuation-Phase: Should It Be Done in All Patients with Sputum Smear-Positive Tuberculosis? , 2012, PloS one.

[64]  A. Harries,et al.  Language in tuberculosis services: can we change to patient-centred terminology and stop the paradigm of blaming the patients? [Perspectives]. , 2012, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[65]  N. Ford,et al.  Is operational research delivering the goods? The journey to success in low-income countries. , 2012, The Lancet. Infectious diseases.

[66]  P. Dewan,et al.  New Vision for Revised National Tuberculosis Control Programme (RNTCP): Universal access - “Reaching the un-reached” , 2012, The Indian journal of medical research.

[67]  P. Dewan,et al.  HIV Prevalence Among Persons Suspected of Tuberculosis: Policy Implications for India , 2012, Journal of acquired immune deficiency syndromes.

[68]  S. Satyanarayana,et al.  Important research, but did the participants consent? , 2012, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[69]  M. Taub The need for building design professionals in operational research in low-income countries. , 2012, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[70]  S. Satyanarayana,et al.  Addressing poverty through disease control programmes: examples from Tuberculosis control in India , 2012, International Journal for Equity in Health.

[71]  S Satyanarayana,et al.  Why ethics is indispensable for good-quality operational research. , 2012, Public health action.

[72]  A. Harries,et al.  Treatment outcomes of adult patients with recurrent tuberculosis in relation to HIV status in Zimbabwe: a retrospective record review , 2012, BMC Public Health.

[73]  A. Harries,et al.  Are Tuberculosis Patients in a Tertiary Care Hospital in Hyderabad, India Being Managed According to National Guidelines? , 2012, PloS one.

[74]  A. Harries,et al.  Treatment outcomes of new adult tuberculosis patients in relation to HIV status in Zimbabwe. , 2011, Public health action.

[75]  A. Harries,et al.  Did successfully treated pulmonary tuberculosis patients undergo all follow-up sputum smear examinations? , 2011, Public health action.

[76]  A. Harries,et al.  The timing of death in patients with tuberculosis who die during anti-tuberculosis treatment in Andhra Pradesh, South India , 2011, BMC public health.

[77]  A. Harries,et al.  Operational Challenges in Diagnosing Multi-Drug Resistant TB and Initiating Treatment in Andhra Pradesh, India , 2011, PloS one.

[78]  A. Harries,et al.  The looming epidemic of diabetes-associated tuberculosis: learning lessons from HIV-associated tuberculosis. , 2011, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[79]  A. Harries,et al.  Building leadership capacity and future leaders in operational research in low-income countries: why and how? , 2011, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[80]  A. Harries,et al.  How Do Patients Who Fail First-Line TB Treatment but Who Are Not Placed on an MDR-TB Regimen Fare in South India? , 2011, PloS one.

[81]  A. Harries,et al.  Will Adoption of the 2010 WHO ART Guidelines for HIV-Infected TB Patients Increase the Demand for ART Services in India? , 2011, PloS one.

[82]  A. Harries,et al.  From Where Are Tuberculosis Patients Accessing Treatment in India? Results from a Cross-Sectional Community Based Survey of 30 Districts , 2011, PloS one.

[83]  P. Dewan,et al.  Tuberculosis Contact Screening and Isoniazid Preventive Therapy in a South Indian District: Operational Issues for Programmatic Consideration , 2011, PloS one.

[84]  D. Kundu,et al.  Source of Previous Treatment for Re-Treatment TB Cases Registered under the National TB Control Programme, India, 2010 , 2011, PloS one.

[85]  S. Satyanarayana,et al.  A rapid assessment and response approach to review and enhance Advocacy, Communication and Social Mobilisation for Tuberculosis control in Odisha state, India , 2011, BMC public health.

[86]  A. Harries,et al.  The Union and Médecins Sans Frontières approach to operational research. , 2011, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[87]  A. Harries,et al.  The published research paper: is it an important indicator of successful operational research at programme level? , 2010, Tropical medicine & international health : TM & IH.

[88]  Varinder Singh,et al.  Characteristics and Programme-Defined Treatment Outcomes among Childhood Tuberculosis (TB) Patients under the National TB Programme in Delhi , 2010, PloS one.

[89]  P. Burney,et al.  Surveillance for MDR-TB: is there an obligation to ensure treatment for individuals identified with MDR-TB? , 2010, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[90]  P. Dewan,et al.  Risk Factors for Treatment Default among Re-Treatment Tuberculosis Patients in India, 2006 , 2010, PloS one.

[91]  K. Laserson,et al.  Operational research in low-income countries: what, why, and how? , 2009, The Lancet. Infectious diseases.

[92]  P. Dewan,et al.  Initial default among diagnosed sputum smear-positive pulmonary tuberculosis patients in Andhra Pradesh, India. , 2008, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[93]  S. Pocock,et al.  Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies , 2007, BMJ : British Medical Journal.

[94]  A. Acharya,et al.  Awareness about dengue syndrome and related preventive practices amongst residents of an urban resettlement colony of south Delhi. , 2005, Journal of vector borne diseases.

[95]  D. Enarson,et al.  Research methods for promotion of lung health. , 2004, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[96]  T. Frieden,et al.  Impact of national consultants on successful expansion of effective tuberculosis control in India. , 2003, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[97]  H. Rieder,et al.  Dosages of anti-tuberculosis medications in the national tuberculosis programs of Kenya, Nepal, and Senegal. , 2002, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[98]  D. Enarson,et al.  Evaluation of a standardized recording tool for sputum smear microscopy for acid-fast bacilli under routine conditions in low income countries. , 1997, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[99]  P. Dewan,et al.  Global guidelines for treatment of tuberculosis among persons living with HIV: unresolved issues. , 2012, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[100]  M. Taub The need for building design professionals in operational research in low-income countries [Correspondence]. , 2012, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[101]  A. Harries,et al.  Tuberculosis 'retreatment others': profile and treatment outcomes in the state of Andhra Pradesh, India. , 2011, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[102]  M. Kumar Confidence intervals and test of significance , 2006 .

[103]  C Rayner,et al.  Informed consent. , 2000, British journal of plastic surgery.