Health Systems Research Unit

Current projects

Randomised Control facility and community based intervention to improve the impact of PMTCT programmes
Recruitment for this community based RCT is now complete and data entry underway.

Assessing disinhibition to avoid risk behaviours among HIV-positive individuals receiving highly active antiretroviral therapy in South Africa
It is hypothesized that HIV patients who are receiving highly active antiretroviral therapy (HAART) will experience disinhibition to avoid risk behaviour due to multiple factors, including the perception that their condition is curable and an overall health improvement. The baseline data has been collected and follow up work has been completed with more than 80% of participants.  

Control trial to evaluate implementation of district support interventions to support comprehensive HIV/AIDS programme in the Western Cape and KwaZulu-Natal
Funding has recently been secured in a joint project with the Health Systems Trust and the University of the Western Cape to evaluate a district-based intervention to introduce and support the introduction of integrated clinical guidelines and improve continuity of care. Baseline data has been collected and interventions are being jointly developed.

Assessing the effect of new ART programmes on human resources in the public health system
The objectives for this study will be to review existing practices relating to staffing allocations; skills mix; substitution; and scopes of practice at community, facility and district levels. Special attention will be paid to examine relations between nurses, doctors and community-based lay health workers in the context of HIV/AIDS care and to identify the skills required and training needs for successful HIV/AIDS management at primary level. A paper describing the first phase of this work is in press at the WHO bulletin.

Evaluation of the peer educators programmes in high schools across the Western Cape
The Unit, in collaboration with the Adolescent Health Unit at the University of Cape Town, has been successful in a bid for this evaluation project of the peer educators programme against HIV in high schools across the Western Cape. The project has completed baseline data and is now following a sub-sample of peers.

WHO-sponsored development of integrated assessment tools for PMTCT and Maternal and Child Care
WHO, Geneva has sponsored the Unit to develop and test a management tool to assess the level of integration of the Prevention of mother-to-child-transmission programme into the broader maternal and child health care system

Health systems evaluation of the introduction of provider initiated HIV testing in routine STI care
This is a randomised controlled trial of the introduction of provider initiated HIV testing protocol into routine STI services across Cape Town. The outcome measures include a wide array of health systems factors such as changes in HIV testing uptake; impact on health workers; changes in number of clients initiating HIV treatment.

UNICEF multi-country review of Child Health Day (CHD) outreach activities
We are in the midst of conducting a five country review of CHD outreach programme. This is being conducted in Uganda, Ethiopia, Zambia, Tanzania and Madagascar. Scheduled to be complete in Jan 2008

Lay health workers and care for people living with HIV/AIDS
Lay health workers (LHWs) are increasingly being used to provide care and support, including for antiretroviral treatment, for people living with HIV/AIDS and their families. Research by this Unit has indicated that LHW interventions may be effective for health issues such as TB control and immunisation promotion. However, there is little rigorous evidence regarding the effects of such interventions in improving treatment outcomes and quality of life for those living with HIV/AIDS. Exploratory work is now underway to address these questions.

Long-term evaluation of the impact of child support grants on key childhood outcomes
After two years we are assessing the impact of a randomised intervention that provided assistance to families to access child support grants as early as possible after the birth of a child.

In addition to these projects the Unit has secured long-term (5 year) funding from the CDC for six innovative health systems research projects. The total funding for these projects from CDC is over $1.5 million.