Africa Centre for Systematic Reviews and Knowledge Translation “Africa Centre” Prof. SEWANKAMBO, Nelson (Principal Investigator) Dr. OBUKU, Ekwaro (Coordinator) 29 th May, 2014 Research Forum, Infectious Diseases Institute, College of Health Sciences Makerere University, KAMPALA, UGANDA

OUTLINE OF SESSION 1.Use of evidence for decision making 2.What is Knowledge Translation 3.Systematic Reviews and decision making 4.The Africa Centre for Systematic Reviews and Knowledge Translation

Promising activities that increase research to policy uptake: Interaction between researchers and decision takers/policy makers. Building research to policy partnership networks and trust General climate: timing and timeliness of research evidence Innvaer et al. 2002

Barriers to research R2P include: Lack of perceived relevance of the research by decision takers/policy makers. Negative attitude towards use of research evidence by decision takers/policy makers. Lack of relevant skills by decision find, read, appraise & interpret research evidence. Use of jargon in research evidence brief write ups. Power and budget struggles among decision takers/policy makers. Innvaer et al. 2002

Research NOT ALWAYS USED by decision makers*

Where am I? You’re 30 metres above the ground in a balloon You must be a researcher Yes. How did you know? Because what you told me is absolutely correct but completely useless You must be a policy maker Yes, how did you know? Because you don’t know where you are, you don’t know where you’re going, and now you’re blaming me The Trust Problem Slide courtesy of Martin McKee

What is Knowledge Translation? “KT is a dynamic and iterative process that includes the identification, synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, provide more effective health services and products and strengthen the healthcare system” (Canadian Institute of Health Research, 2004) Synonyms of KT: Implementation Science Operations Research Knowledge Management Diffusion of Innovation CPD/CME

Figure 1: The Knowledge-to-Action Cycle

Figure 2: Models of Linking Research To Action (Lavis et al, 2006) NICE MakCHSMoH NARO & NAADS

Use of EVIDENCE to inform decision-making Figure 3: Knowledge Pyramid (WHO, 2004) NICE -Scoping -Assessment -Appraisal BMRC NAADS NARO

What is a systematic review? Reviews prepared using a documented systematic approach, in order to minimize bias and random errors. (Chalmers and Altman, 1995) -Protocol driven -Well defined question: PICOST -Eligibility criteria: explicit inclusion and exclusion -Outcomes: clear and a priori -Search strategy: comprehensive

Why do we need systematic reviews?

Systematic Reviews& decision making

Issue of CDSR CDSR: Cochrane Database of Systematic Reviews Number and proportions (%) of Cochrane reviews by location of contact author in developing/developed countries, 1997 to % Issue 3/97 Issue 3/98 Issue 3/99 Issue 3/00 Issue 3/01 Issue 3/02 Issue 3/03 Issue 3/04 Issue 3/05 Issue 3/06 Issue 3/07 Nu m b er o f re v ie w s Developed countries Developing countries 12% 9% 8% 7% 8% 12% 10 %10 % 7% 9% CLOC, 2012: 21.9%

The Africa Centre for Systematic Reviews and Knowledge Translation

OBJECTIVES

Objective 1: Building capacity for conducting systematic review and utilization among researchers, health professionals and health decision makers in Uganda. Objective 2: Conducting high quality systematic reviews in the priority areas of Millennium Development Goals 4 (child health) or 5 (maternal health) and or 6 (infectious or non-communicable diseases) relevant to sub- Saharan Africa. Objective 3: Disseminating products of evidence synthesis and facilitating interaction between researchers and policy makers in Uganda to prioritize plan and deliberate on research evidence from systematic reviews.

Objective 4: Assessing the extent to which existing published systematic reviews are informative and helpful in answering urgent policy makers’ needs (questions) handled by Rapid Response Mechanism in the four study countries. Objective 5: Planning for a systematic evaluation of the Rapid Response Mechanism in Uganda, Burkina Faso, Zambia and Cameroon.

Quasi Experimental Intervention –Training –Deliberation workshops –Seminar series TIME: 36 months total O1 O2 O3 T0T0 T5T5T4T4 BEFOREAFTER T1T1 INTERVENTION T3T3

PHASE III 26 reviewers enrolled 20 (77%) Completed phase I 24 (92%) Completed phase II 8 (31%) Women scientists August 2013 – Jan =Kenya 1=Tanzania 1=Cameroun 1=Botswana 19=Uganda

Phase III Review production –“Africa Centre” “Priority setting exercise” Teams –Cochrane Collaboration Dr. Andy Oxman/EPOC –Individual projects Individual projects –PhD students 2 questions: –KT platforms for MV in TZ –Antimicrobial self medication –Non degree training 4 questions –Depression in DM –Breast Cancer in SSA –Integration of NCDs/HIV –Task shifting in surgery Cochrane collaboration –?1 protocol update –Integration of PHC –?1 new protocol –Anti-depressants in HIV Challenge 1

DEMAND: Participants suggestions: How to increase the visibility of the “Africa Centre”? Communication: –Group –Website –Face book –Twitter –Newsletter Circulate Systematic Reviews Course training materials –Drop box Embed Systematic Reviews course in undergraduate & graduate training at university –Consider for Masters projects –PhD sub-projects Seminar series on Systematic Reviews: –Universities e.g. IHSU, MUST –Research institutions e.g. IDI Sense of belonging –Membership to the Africa Centre Challenge 2

"My fellow Americans, ask not what your country can do for you, ask what you can do for your country." John Fitzgerald KENNEDY, 35th President of the USA 1961 Inaugural Speech

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