KNOWLEDGE TRANSLATION PLATFORM MALAWI (KTPMALAWI)

Transcription

1 KNOWLEDGE TRANSLATION PLATFORM MALAWI (KTPMALAWI) Cmmunity f Practice Meeting: Integratin f Nn-Cmmunicable Diseases Int HIV Care and Treatment 5-6 Nvember 2013 Cresta Crssrads Htel, Lilngwe, Malawi

2 Table f Cntents Executive Summary... 3 KTPMalawi Backgrund... 4 NCD and HIV CP Opening Remarks... 5 Sessin 1: Overview f KTP Malawi and CP Structure and Purpse... 5 Sessin 2: Current NCD and HIV Integratin Implementatin and Research Initiatives... 5 Sessin 3: NCDs in Nen: Integratin effrts... 5 Sessin 4: Narrwing the Cntent Scpe... 6 Sessin 5: Overview f the Evidence Brief: Terms f reference and internatinal experiences... 6 Sessin 6: Defining the Prblem and Brainstrming Plicy Optins... 6 Annex 1: CP Participants... 7 Annex 2: Evidence Brief Terms f Reference

3 Executive Summary Dignitas Internatinal (DI) in cllabratin with the Ministry f Health (MH) and with funding frm the Evidence-Infrmed Plicy Netwrk (EVIPNet) established the Malawi Knwledge Translatin Platfrm (KTPMalawi) in The aim f KTPMalawi is t prmte evidence-infrmed health plicymaking in Malawi by facilitating a crdinated apprach t the generatin and utilizatin f health-related research. In June 2013, KTPMalawi frmed a natinal-level KTPMalawi Steering Cmmittee wh priritized the develpment f tw Cmmunities f Practice (CP) in: 1) The Integratin f Nn- Cmmunicable Diseases (NCDs) int HIV Care and Treatment and 2) Supply Chain Management. See Steering Cmmittee Reprt linked here. With supprt frm Malawi s Health Research Capacity Strengthening Initiative (HRCSI) and Canada s Internatinal Develpment Research Centre (IDRC), KTPMalawi cnvened the inaugural Integratin f NCDs int HIV Care and Treatment CP meeting n 5-6 Nvember 2013 in Lilngwe at Cresta Crssrads Htel. The meeting was c-facilitated by Dr. Damsn Kathyla f the Ministry f Health, Dr. Jep Van Osterhut f DI and Dr. Lnia Mwape frm the University f Zambia and the Zambia Frum fr Health Research. The bjective f the CP meeting was t cnvene NCD-HIV stakehlders and build the utline f an evidence brief that will be develped ver the cming mnths by selected authrs frm within the CP. CP members fllwed a structured terms f reference (TR), shwn in appendix 2 develped by the SURE cnsrtium, t narrw the cntent scpe f the evidence brief, describe the prblem and brainstrm initial thughts arund ptential plicy ptins. CP members selected hypertensin and HIV as the evidence brief s fcus and described the prblem as a high burden f undiagnsed hypertensin amngst HIV+ patients. Three ptential plicy ptins t address the prblem were: 1. Rutine hypertensin screening in HIV clinics with referral fr hypertensin care t NCD r Chrnic Care Clinics (ART prvider refers fr hypertensin care) 2. Full integratin f hypertensin diagnses and care in HIV clinics (same prvider) 3. Develp/peratinalize rutine hypertensin screening at all health system levels, including but nt limited t HIV patients (n specialized clinics) Over the next several mnths select members f the CP will be trained in the develpment f evidence briefs. These authrs will then be supprted in develping rigrus evidence briefs. Once cmpleted these briefs will serve as a primary input int plicy dialgues, which will cnvene senir level fficials as well as members f KTPMalawi s steering cmmittee and this CP. The develpment f this evidence brief and the cnvening f the plicy dialgue will inject timely evidence int the plicymaking prcess. 3

4 KTPMalawi Backgrund In early 2012 thrugh seed funding frm the WHO-Evidence-Infrmed Plicymaking Netwrk (EVIPNet), KTPMalawi cmpleted an in-depth cntext analysis f current KT stakehlders (plicymakers, health researchers and practitiners) and systems. This analysis led t tw successful capacity building wrkshps that imprved Malawi-based researchers and plicymakers ability t develp and evaluate systematic reviews and evidence-infrmed plicy briefs. Thrugh these wrkshps stakehlders prvided future directins, bjectives and activities f Malawi s KTP setting the stage fr further develpment. Als in 2012, wrking with an emerging cmmunity f natinal KTPs in Africa, KTPMalawi representatives attended tw Internatinal KT Frums: the EVIPNet Internatinal Frum and the EVIPNet Africa Frum. These fra have prvided KTPMalawi with pprtunities t strategically link with ther reginal and internatinal KTPs. Lessns learned have been shared acrss platfrms. On June 17 th, 2013 the inaugural KTPMalawi Steering Cmmittee Meeting was held at Kamuzu Central Hspital, Lilngwe with 17 plicymakers, health research leaders and civil sciety members. The purpse f the KTP Steering Cmmittee is t engage Malawi s plicy and research leaders in prviding verall strategic directin and expertise t KTPMalawi t ensure its success in significantly imprving the use f evidence and research in the develpment and implementatin f health plicy. During this meeting, this high-level grup, led by Dr. Damsn Kathyla, MH Directr f Research reviewed planned KTPMalawi bjectives and activities, cnsidered several distinctive KTPMalawi structural mdels, fed int the KTPMalawi steering cmmittee terms f reference (TR) and priritized the develpment f tw Cmmunities f Practice (CPs): 1. Supply chain management 2. The integratin f nn-cmmunicable diseases with HIV Treatment and Care These CPs will reprt t the steering cmmittee and will bring tgether plicymakers, researchers and prgram implementers wh are fcused n these specific cntent areas. Each CP s purpse will be t prduce plicy-relevant dcuments, such as graded evidence briefs, based n emerging research within these cntent areas in clse cllabratin with the relevant MH stakehlders and technical wrk grup (TWG) partners. 4

5 NCD-HIV CP Meeting Reprt NCD and HIV CP Opening Remarks - Dr. Kathyla (MH Directr f Research) The CP meeting was pened by Dr. Kathyla wh welcmed delegates and their cmmitment t the KTPMalawi initiative. He emphasized that health sectr plicy and practice must based n evidence and that these frums will assist the MH t synthesize research findings and develp recmmendatins fr imprved plicy and practice. Sessin 1: Overview f KTP Malawi and CP Structure and Purpse - Kenneth Phiri (Dignitas Internatinal, Research Manager) The selectin, purpse and respnsibilities f the tw CPs were presented, including the CPs mandate t prduce plicy-relevant dcuments such as evidence briefs. CPs are t wrk clsely with relevant MH stakehlders and crrespnding technical wrking grups (TWGs). Sessin 2: Current NCD and HIV Integratin Implementatin and Research Initiatives - Dr. Beatrice Mwagmba (MH Prgramme Manager, NCDs & Mental Health) Dr. Mwagmba presented an verview f internatinal and Malawian NCD data. Glbally, cancers, cardivascular diseases, chrnic respiratry diseases and diabetes were labeled silent killers. Accrding t the Malawi Natinal STEPS Survey fr Chrnic Nn- Cmmunicable Diseases and their Risk Factrs high bld pressure r Hypertensin (HT) is quite cmmn in Malawi with 33% f participants having high bld pressure r currently n bld pressure medicatin. High chlesterl leading t cardivascular disease and diabetes (DM) were als fund t be prevalent. ( The Natinal Cancer Survey (2010) shwed >8000 new cancer cases annually. Cervical cancer is the mst diagnsed cancer in females (45%) with Kapsi s sarcma the mst diagnsed in men (21%). Delegates were cncerned that while health care wrkers (HCWs) are trained t lk fr cmmn NCDs in every patient many patients with NCDs are being missed. Sessin 3: NCDs in Nen: Integratin effrts - Dr. C. Kachimanga (Partners in Health) Dr. Kachimanga presented PIHs effrts t integrate NCD and HIV care in Nen District. PIH currently integrates HIV care with HT, asthma, DM and epilepsy treatment. Implementatin fcuses n getting NCD patients in their Chrnic Care Clinic t g fr HIV Testing and Cunseling (HTC) aiming t reduce discriminatin. This has been nging since This integratin is seen t have assisted many c-mrbid patients getting tested and treated apprpriately. Patients are referred t clinicians and nurses wh respnsible fr bth ART and chrnic care assessments and treatment. Pints frm discussins: 800 Cmmunity Outreach Wrkers are trained and paid MK 6000 per mnth by PIH as an incentive as they facilitate NCD interventins in Nen. The integratin f NCDs with HIV, asthma and epilepsy can be adapted t the NCD 5

6 care in ther facilities. Integratin f NCDs with HIV, asthma and epilepsy is faced with the challenge f drug supply management (i.e. Insulin, Phenbarbital), s there is a need t invlve the MH, especially with NCD care in rural areas. There are 1 r 2 gvernment hspitals in the cuntry with similar services. Sessin 4: Narrwing the Cntent Scpe - Dalits Segula Research Assciate MLW and Dr. Jep van Osterhut Medical and Research Directr Dignitas Dalits reviewed the current prevalence f hypertensin, diabetes and cervical cancer glbally and within Malawi as an verview fr all CP members. Jep then facilitated a discussin with CP members n narrwing the scpe f the prpsed evidence brief. CP members ultimately chse t narrw the scpe t the integratin f hypertensin and HIV. Sessin 5: Overview f the Evidence Brief: Terms f reference and internatinal experiences - Dr. Lnia Mwape (Assistant Dean, Zambia University) Lnia gave an verview f the evidence brief terms f reference that utline the majr sectins f the evidence brief t be develped (attached as annex 2). This tl was develped by the SURE cnsrtium and is used by several ther KTPs glbally. Examples f cmpleted evidence briefs can be fund here. Sessin 6: Defining the Prblem and Brainstrming Plicy Optins - Shiraz Khan Fllwing imprtant discussin the prblem statement was develped and initially agreed t by CP members as a high burden f undiagnsed hypertensin amngst HIV+ patients. CP members then split up int smaller grups t discuss ptential plicy ptins t address the earlier defined prblem. Three pssible plicy ptins were brught furth: 1. Rutine hypertensin screening in HIV clinics with referral fr hypertensin care t NCD r Chrnic Care Clinics (ART prvider refers fr hypertensin care) 2. Full integratin f hypertensin diagnses and care in HIV clinics (same prvider) 3. Develp/peratinalize rutine hypertensin screening at all health system levels, including but nt limited t HIV patients (n specialized clinics) Over the next several mnths select members f the CP will be trained in the develpment f evidence briefs. These authrs will then be supprted in develping rigrus evidence briefs. Once cmpleted these briefs will serve as a primary input int plicy dialgues, which will cnvene senir level fficials as well as members f KTPMalawi s steering cmmittee and this CP. The develpment f this evidence brief and the cnvening f the plicy dialgue will inject timely evidence int the plicymaking prcess. 6

7 Annex 1: CP Participants Name Title Dr Mathews Kagli MH Deputy Directr DPHS (Epidemilgy) Dr. Mffat Nyirenda Prfessr f Medicine (Glbal Nn-Cmmunicable m.nyirenda@ed.ac.uk Diseases) at LSHTM and Prfessr f Research at the Malawi Cllege f Medicine Dr Beatrice Mwagmba MH Prgram Manager NCDs and Mental Health mwagmbabeatrice@yah.cm Dr Alemayehu Amberbir Medical Epidemilgist / Research Fellw in Epidemilgy, Karnga Preventin Study amberbir@ishtm.ac.uk Dr. Angela Chimwaza Assciate Prfessr, Kamuzu Cllege f Nursing afchimwaza@kcn.unima.mw Dr. Teferi Beyene Medical Prgramme Manager t.beyene@dignitasinternatinal.rg Dr. Jep van Osterhut Medical and Research Directr, Dignitas Internatinal j.vansterhut@dignitasinternatinal.rg Dr. Bagrey Ngwira Senir Lecturer, Faculty f Allied Sciences, bagreyngwira@gmail.cm Department f Envirnmental Health The Plytechnic, University f Malawi Dr. Austin Mnthambala Deputy Directr, HIV atmthambala@gmail.cm Dr. Shiraz Khan Research Crdinatr, UNC skhani@unclilngwe.rg Dr. Chembe Kachimanga DHO, Nen District chembekachimanga@yah.c.uk Jnathan Kalua Clinical Officer NENO DHO jnathankalua@yah.cm Innncent Chitsi Steering Cmmittee Member / Jurnalist i_chitsi@rcketmail.cm 7

8 Dr. Dalits Segula Research Assciate MLW Dr. Lnia Mwape Assistant Dean, Zambia University, schl f medicine lniamagl@yah.cm Bniface Banda Senir Lecturer/Research Crdinatr, CM Malawi bnbanda@htmail.cm Dr. Clin Speight Clinical Advisr, Light Huse cspeight@lighthuse.rg.mw Vanessa van Schr Cuntry Directr, Dignitas Internatinal v.vanschr@dignitasinternatinal.rg Dr. Kelias Msyambza Infectius Disease Officer, WHO msyambzak@mw.afr.wh.int Dr. Damsn. Kathyla MH Directr f Research dkathyla@gmail.cm Dr. Mavut Mukaka Bistatician MLW mmukaka@mlw.medc.mw Dr. Malthida Chithila Prgramme Crdinatr, HRCSI mathildah.chithila@gmail.cm Getrude Chindebvu Knwledge Translatin Crdinatr, Dignitas g.chindebvu@dignitasinternatinal.rg Internatinal Kenneth Phiri Research Manager, Dignitas Internatinal k.phiri@dignitasinternatinal.rg Nellie Wadnda Kabnd Epidemilgist, CDC vzn7@cdc.gv Dr. Mia Crampin Deputy Directr, Kalnga Preventin Study s-clapham@dfid.gv.uk 8

9 Annex 2: Evidence Brief Terms f Reference Ntes abut this dcument: Terms f Reference fr the Evidence Brief The Integratin f Nn-Cmmunicable Diseases int HIV Care and Treatment The purpse f this dcument is t utline the prblem, plicy ptins and implementatin cnsideratins that will be addressed in an evidence brief abut The Integratin f Nn-Cmmunicable Diseases int HIV Care and Treatment. The evidence brief will be used t infrm a stakehlder dialgue being planned n the same tpic. This dcument is develped iteratively and infrmed by research evidence and data, as well the views and experiences f Cmmunity f Practice cmmittee members and key infrmants. The Prvisinal / Draft Respnses reflect the input received t date. This dcument is divided int six parts: 1. Cntext: The evidence brief will mbilize bth glbal and lcal research evidence abut a health systems prblem, three ptins fr addressing the prblem, and key implementatin cnsideratins. Hwever, the dynamic nature f health systems is such that the plicy and plitical cntext fr the issue shuld be brne in mind. 2. Scpe: The scpe f the evidence brief shuld be defined in ways that spark insights abut the issue, while establishing sme parameters that bring fcus t the purpse f the brief. 3. Equity cnsideratins: Health disparities and different challenges are faced by many grups. Such disparities and challenges are ften determined by factrs including: place f residence (e.g., rural and remte ppulatins); race/ethnicity/culture (e.g., Abriginal ppulatins, immigrant ppulatins, linguistic minrity ppulatins); ccupatin r labr-market experiences mre generally (e.g., thse in precarius wrk arrangements); gender; religin; educatinal level (e.g., health literacy); sciecnmic status (e.g., ecnmically disadvantaged ppulatins); scial capital / scial exclusin. One r tw grups that are affected by health inequities such as these will be chsen as examples t bring attentin t equity issues that shuld be cnsidered in terms f the prblem, plicy ptins and implementatin cnsideratins. 4. The prblem: Prblems related t health systems are cmplex and multi-facetted. As such, it is useful t break dwn health systems prblems int cmpnents that help t identify the issues underlying them. 5. Plicy r prgrammatic ptins t address the prblem: Althugh the prblem (r the factrs that cntribute t it) culd be addressed thrugh numerus plicy r prgrammatic ptins, three will be identified and characterized in the evidence brief as examples. The ptins shuld be sufficiently bradly based yet apprpriate t the cntext. Each ptin shuld address hw it invlves the prgram, service r drug currently being used t address a risk factr, disease r cnditin r the current health system arrangements within which prgrams, services and drugs are prvided.

10 6. Implementatin cnsideratins: The successful implementatin f these ptins can be influenced by the capacity t take advantage f ptential windws f pprtunity, but als the capacity t identify strategies t vercme ptential barriers. The evidence brief will describe windws f pprtunities and barriers that can be fund at fur levels: patient/individual, prvider, rganizatin and system. Questins are identified in each sectin t guide develpment f the cntent fr the evidence brief and the input received by key infrmants. Citatins shuld be included where apprpriate in rder t keep track f all relevant data and evidence. 10

11 1. Cntext Questin(s) What imprtant plitical r plicy issues shuld be cnsidered within the cntext f this evidence brief? Prvisinal / Draft Respnses 2. Scpe Questin(s) What cncepts shuld be defined and what definitins shuld be used? What shuld the evidence brief address? What shuld the evidence brief nt address? Prvisinal / Draft Respnses 11

12 3. Equity cnsideratins Questin(s) What grup(s) shuld be given particular attentin in the evidence brief because the prblem, plicy ptins r implementatin cnsideratins disprprtinately affects them? Prvisinal / Draft Respnses 4. The prblem Questin(s) Hw des the prblem relate t a risk factr, disease r cnditin? Hw des the prblem relate t a prgram, service r drug currently being used? Hw des the prblem relate t the current health system arrangements within which prgrams, services and drugs are prvided? Hw des the prblem relate t current degree f implementatin f an agreed upn curse f actin (e.g., a plicy)? Prvisinal / Draft Respnses Delivery arrangements Financial arrangements Gvernance arrangements 12

13 5. Plicy r prgrammatic ptins t address the prblem Questin(s) What are three viable plicies r prgrammatic ptins t address the prblem? Prvisinal / Draft Respnses Optin 1: Elements f this ptin might include: Optin 2: Elements f this ptin might include: Optin 3: Elements f this ptin might include: 13

14 6. Implementatin cnsideratins Questin(s) Prvisinal / Draft Respnses Optin 1 Optin 2 Optin 3 What are the ptential barriers that culd influence the successful implementatin f these plicies r prgrammatic ptins? Patient/individual Prvider Organizatin System Patient/individual Prvider Organizatin System Patient/individual Prvider Organizatin System Ptential windws f pprtunity fr implementing the ptins Type Optin 1 - Optin 2 - Optin 3 - General Optin- 14