Queen Margaret University, Edinburgh

Institute for Global Health and Development (IGHD)

Research at IGHD embodies critical thinking, practice engagement and principles of social justice to address the health and development of vulnerable and marginalised populations globally. IGHD’s health systems research on tuberculosis draws on a multi-disciplinary team including health financing and economics (Prof Sophie Witter), medical anthropology (Dr Karina Kielmann), epidemiology (Dr Predrag Duric), systems modelling (Dr Karin Diaconu) and social anthropology (Dr Nicole Vidal).

Recent and on-going health systems work on TB

Adherence support for vulnerable groups
In a recently completed project funded by the European Centre for Disease Prevention & Control (ECDC), and in collaboration with LSHTM and the Centre for Tuberculosis and Lung Diseases (CTLD), Riga, Kielmann, Vidal, and Duric developed and evaluated a pilot intervention to support vulnerable individuals on TB treatment in Latvia. This work contributes an understanding of the systems-related issues including organisation of services and care practices on individuals’ ability to start and stay on treatment.

Together with partners at UCL, University of Southampton and University of Edinburgh, Kielmann is Co-I on an NIHR project (2018 – 2021) focusing on developing and piloting a manualised intervention for vulnerable groups on TB treatment in the UK.

Decentralised TB care in South Africa
In a 4-year project (2016-2020) funded by the Joint Health Systems Research Initiative (JHSRI), Kielmann and colleagues from the University of Cape Town, the South African Medical Research Council, the University of Kwazulu-Natal and LSHTM are examining emerging models of decentralised care for drug-resistant TB in three provinces of South Africa, using realist evaluation to understand the mechanisms at work that facilitate or hinder optimal patient pathways and outcomes.

In another South African project, funded through the ESRC under the AMR Cross Council Initiative (2018-2021), Kielmann (Co-PI) and colleagues from LSHTM, UCT, UKZN, IDS Sussex and UCL takes a ‘whole systems’ approach to policies and practices for infection control and prevention (IPC) in clinics within two provinces of South Africa. The project aims to inform the design of a health systems intervention package to reduce nosocomial transmission in the context of decentralised DR-TB care in South Africa.

Financial incentives for the TB workforce
Witter, Duric, and Diaconu are Co-I on a review of a Results-Based Financing (RBF) project in Georgia, funded through the JHSRI (2017-2021). Together with collaborators from Curatio International Foundation, LSHTM, and ITM Antwerp, the project evaluates the roll-out of an integrated care intervention coupled with an incentive payment scheme for TB providers. The evaluation includes a cluster randomized clinical trial, health economic and realist evaluation.

Doctoral research on TB

Guangyang Zou is using systems-thinking to understand TB prescription practices within the context of integrated service delivery in designated hospitals in China. Annie Willets is comparing uptake and use of POCT including GenXpert at primary care in Kenya. Evans Danso is reviewing the impact of the Global Fund tuberculosis grant and its withdrawal in 2015 for TB treatment outcomes in Ghana.