Abstract
Real-time operational research can be defined as research on strategies or interventions to assess if they are feasible, working as planned, scalable and effective. The research involves primary data collection, periodic analysis during the conduct of the study and dissemination of the findings to policy makers for timely action. This paper aims to illustrate the use of real-time operational research and discuss how to make it happen. Four case studies are presented from the field of tuberculosis. These include (i) mis-registration of recurrent tuberculosis in Malawi; (ii) HIV testing and adjunctive cotrimoxazole to reduce mortality in TB patients in Malawi; (iii) screening TB patients for diabetes mellitus in India; and (iv) mitigating the impact of COVID-19 on TB case detection in capital cities in Kenya, Malawi and Zimbabwe. The important ingredients of real-time operational research are sound ethics; relevant research; adherence to international standards of conducting and reporting on research; consideration of comparison groups; timely data collection; dissemination to key stakeholders; capacity building; and funding. Operational research can improve the delivery of established health interventions and ensure the deployment of new interventions as they become available, irrespective of diseases. This is particularly important when public health emergencies, including pandemics, threaten health services.
Highlights
Over the years, the terms “operational research”, “operations research”, “implementation research”, “health systems research” and “health services research” have been used interchangeably to describe research conducted in health programmes using routinely collected data to try and effect change in policy and/or practice
As a group working both independently and together over 30 years in health programmes in low- and middle-income countries, we have proposed a pragmatic definition of operational research: “the search for knowledge on interventions, strategies or tools that can enhance the quality, effectiveness, or coverage of programmes in which the research is being conducted” [1]
Further innovative approaches that would benefit from real-time implementation research during the COVID-19 pandemic might include: (i) the strengthening of sputum specimen transportation to and from laboratories; (ii) the use of saliva as an alternative to sputum for diagnosing TB and COVID-19; (iii) the use of adequately equipped mobile vans with on-site Xpert MTB/RIF assays and ultraportable chest x-rays to provide diagnostic outreach; (iv) the application of digital platforms and connectivity solutions to maintain contact with patients during the lockdown periods and to ensure rapid delivery of test results for those being investigated; and iv) mobilization of TB survivors to facilitate contact tracing and active screening for TB in high-risk groups [27,28]
Summary
The terms “operational research”, “operations research”, “implementation research”, “health systems research” and “health services research” have been used interchangeably to describe research conducted in health programmes using routinely collected data to try and effect change in policy and/or practice. The study showed that it was feasible and safe for the NTP at the district level to implement the package of interventions, and it was effective at reducing mortality Another real-time implementation research study with a slightly different methodology, conducted in the North of Malawi, produced almost identical results [14]. Once the studies had been completed, a Ministry of Health meeting was arranged with many stakeholders to discuss the results and the implications, which resulted in a policy of HIV testing and adjunctive cotrimoxazole being recommended for all TB patients in the country [15] This policy was implemented and scaled up over several years and provided the framework for treating HIV-positive TB patients with ART once this treatment became available from 2004. Death during anti-TB treatment in patients with smear-positive PTB decreased from 19% in 2002 to 7.5% in 2008, and this was associated with a striking increase in treatment success, which rose from 72% to 86% [15]
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