Adapting operational research training to the Rwandan context: the Intermediate Operational Research Training programme

Evidence-based Decision Making: Infectious Disease Modeling Training for Policymakers in East Africa

Background

Mathematical modeling of infectious diseases is an important decision-making tool for outbreak control. However, in Africa, limited expertise reduces the use and impact of these tools on policy. Therefore, there is a need to build capacity in Africa for the use of mathematical modeling to inform policy. Here we describe our experience implementing a mathematical modeling training program for public health professionals in East Africa.

Methods

We used a deliverable-driven and learning-by-doing model to introduce trainees to the mathematical modeling of infectious diseases. The training comprised two two-week in-person sessions and a practicum where trainees received intensive mentorship. Trainees evaluated the content and structure of the course at the end of each week, and this feedback informed the strategy for subsequent weeks.

Findings

Out of 875 applications from 38 countries, we selected ten trainees from three countries - Rwanda (6), Kenya (2), and Uganda (2) - with guidance from an advisory committee. Nine trainees were based at government institutions and one at an academic organization. Participants gained skills in developing models to answer questions of interest and critically appraising modeling studies. At the end of the training, trainees prepared policy briefs summarizing their modeling study findings. These were presented at a dissemination event to policymakers, researchers, and program managers. All trainees indicated they would recommend the course to colleagues and rated the quality of the training with a median score of 9/10.

Conclusions

Mathematical modeling training programs for public health professionals in Africa can be an effective tool for research capacity building and policy support to mitigate infectious disease burden and forecast resources. Overall, the course was successful, owing to a combination of factors, including institutional support, trainees' commitment, intensive mentorship, a diverse trainee pool, and regular evaluations.

Designing an operational research TB training program in Zambia

BACKGROUND

The USAID-funded Eradicate TB Project (ETB) partnered with the National Tuberculosis and Leprosy Control Program (NTLP) to establish an operational research (OR) training program in order to generate local evidence to enhance TB care in Zambia.

METHOD

Between 2017 and 2021, healthcare workers (HCWs) from district teams underwent two 10-day intensive training sessions. The program evolved to include a competitive application process and an additional primer workshop on developing feasible research questions.

RESULTS

Of the 36 enrollees in the OR training program, 26 (72.2%) completed it, leading to nine OR studies that informed interventions for TB care improvement. Notable achievements include reduced TB mortality, increased pediatric notifications, and enhanced sputum courier systems, with all studies disseminated at national and international conferences, four submitted to peer-reviewed journals, of which three were published. Two studies were replicated by the NTLP at provincial and national levels.

CONCLUSIONS

Integrating OR training into TB initiatives is feasible and beneficial. The program's phased execution and adaptive strategies provide valuable insights for similar settings, although challenges in sustainability of mentorship and funding persist. This success underscores the importance of continuous OR capacity strengthening among HCWs in Zambia.

Health research mentorship in low-income and middle-income countries: a global qualitative evidence synthesis of data from a crowdsourcing open call and scoping review

INTRODUCTION

Research mentorship is critical for advancing science, but there are few practical strategies for cultivating mentorship in health research resource-limited settings. WHO/TDR Global commissioned a group to develop a practical guide on research mentorship. This global qualitative evidence synthesis included data from a crowdsourcing open call and scoping review to identify and propose strategies to enhance research mentorship in low/middle-income country (LMIC) institutions.

METHODS

The crowdsourcing open call used methods recommended by WHO/TDR and solicited descriptions of strategies to enhance research mentorship in LMICs. The scoping review used the Cochrane Handbook and predefined the approach in a protocol. We extracted studies focused on enhancing health research mentorship in LMICs. Textual data describing research mentorship strategies from the open call and studies from the scoping review were coded into themes. The quality of evidence supporting themes was assessed using the Confidence in the Evidence from Reviews of Qualitative research approach.

RESULTS

The open call solicited 46 practical strategies and the scoping review identified 77 studies. We identified the following strategies to enhance research mentorship: recognising mentorship as an institutional responsibility that should be provided and expected from all team members (8 strategies, 15 studies; moderate confidence); leveraging existing research and training resources to enhance research mentorship (15 strategies, 49 studies; moderate confidence); digital tools to match mentors and mentees and sustain mentorship relations over time (14 strategies, 11 studies; low confidence); nurturing a culture of generosity so that people who receive mentorship then become mentors to others (7 strategies, 7 studies; low confidence); peer mentorship defined as informal and formal support from one researcher to another who is at a similar career stage (16 strategies, 12 studies; low confidence).

INTERPRETATION

Research mentorship is a collective institutional responsibility, and it can be strengthened in resource-limited institutions by leveraging already existing resources. The evidence from the crowdsourcing open call and scoping review informed a WHO/TDR practical guide. There is a need for more formal research mentorship programmes in LMIC institutions.

Health research mentorship in low- and middle-income countries: a scoping review

OBJECTIVE

The objective of this scoping review was to explore and synthesize the available literature on health research mentorship in low- and middle-income countries (LMICs).

INTRODUCTION

Research mentorship is broadly considered a useful strategy to improve research capacities and research outputs. Existing literature and guidance on research mentorship have focused on high-income countries and assumed resource-rich environments. Despite the successful endeavors to improve health research capacity in LMICs, the strategies that work best under different circumstances are poorly understood. There is a need to map and understand the evidence on health research mentorship in the context of LMICs.

INCLUSION CRITERIA

Sources that reported existing practices, barriers, and mitigation strategies related to health research mentorship in LMICs were included.

METHODS

We searched for published and unpublished studies and reports written in English, Spanish, or Portuguese. The search strategy was not limited by search dates and the last search was conducted on January 28, 2022. The databases searched included MEDLINE (PubMed), Embase, Web of Science Core Collection, CINAHL (EBSCOhost), Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis . We also searched for gray literature in a selection of websites and digital repositories. The JBI scoping review methodology was used.

RESULTS

A total of 77 studies and reports were included in the review. The majority of the papers were from Africa (n=28). Others were from the Americas (n=7), South East Asia (n=4), East Mediterranean (n=2), and Western Pacific (n=2). The remaining studies were from LMICs that included at least 2 regional offices. Most of the mentorship projects (n=55) were initiated and funded by institutions from high-income countries. The first authors of 41 papers were primarily affiliated with LMICs. The findings were categorized under a description of research mentorship practices, barriers related to research mentorship, and suggested mitigation strategies. Deliverable-driven training using intensive hands-on mentorship and ongoing peer mentorship programs were some of the non-regular, non-institutionalized approaches used to improve research capacity for junior researchers in LMICs. None of the included papers focused on institutional components of research mentorship in LMICs. The barriers to research mentorship activities in LMICs included lack of clarity on mentorship, cultural variations, unbalanced power dynamics, socio-political influences, language barriers, lack of experienced mentors, and limited local funding. Institutionalizing research mentorship, adapting mentoring methodologies relying on local resources, and addressing and respecting diversity in mentorship programs were among the main strategies identified to effectively implement research mentorship in LMICs.

CONCLUSIONS

Research mentorship initiatives and practices are limited in LMICs. Few available practices have been introduced by researchers and research institutions from high-income countries and those that have are not yet institutionalized. The identified existing practices, barriers, and facilitators on health research mentorship could help the design, implementation, and evaluation of programs to institutionalize health research mentorship in LMICs.

REVIEW REGISTRATION

Open Science Framework osf.io/jqa9z/.

SUPPLEMENTAL DIGITAL CONTENT

A Spanish-language version of the abstract of this review is available as supplemental digital content: http://links.lww.com/SRX/A32.

Capacity building in operational research on obstetric fistula: Experience in the Democratic Republic of Congo, 2017-2021

OBJECTIVE

To implement a Flexible Operational Research Training (FORT) course within the Fistula Care Plus Project, Democratic Republic of Congo, from 2017 to 2021.

METHODS

A descriptive study using design and implementation (process and outcome) data. Two to four members of medical teams from three supported sites were selected for the training based on their research interests and level of involvement in the program.

RESULTS

Two courses (13-14 months each) involving nine facilitators and 17 participants overall were conducted between 2017 and 2021. Most participants in both courses were medical doctors (67% and 71%, respectively) from the supported hospitals (83% and 77%, respectively). About half were women. In addition to classic face-to-face didactic modules, the courses integrated online platforms to cope with the changing contexts (Ebola virus and COVID-19). Most participants reported having gained new skills in developing research protocols, collecting, managing, and analyzing data, and developing research manuscripts. The two courses resulted in six scientific manuscripts and three presentations at international conferences. Participants subsequently published five papers from their research after the first course. The total direct costs for both courses were representing a cost of $3669 per participant trained.

CONCLUSION

The FORT model proved feasible, efficient, and successful. However, scaling up will require more adaptation efforts from programs and participating sites.

Building a 'Virtual Library': continuing a global collaboration to strengthen research capacity within Nepal and other low- and middle-income countries

To fill the gap in health research capacity-building efforts, we created the ‘Virtual Library’ (VL) – a web-based repository of context-relevant resources for health researchers in low- and middle-income countries (LMICs). This paper describes the participatory process used to systematically develop the VL, and describes how our interprofessional team – representing both an LMIC (Nepal) and a high-income country (HIC) (USA, US) – engaged in shared meaning-making. A team of researchers and clinicians representing a range of subdisciplines from Nepal and the US created a replicable search strategy and standardized Resource Screening Guide (RSG) to systematically assess resources to be included within the VL. Descriptive methods were used to summarize findings from the RSG and lessons learned from the collaborative process. Collectively, 14 team members reviewed 564 potential resources (mean = 40, SD = 22.7). Mean RSG score was 7.02/10 (SD = 2). More than 76% of resources met each of the four quality criteria (relevant; reputable, accessible; understandable). Within the published VL, 298 resources were included, organized by 15 topics and 45 sub-topics. Of these, 223 resources were evaluated by the RSG; 75 were identified by team member expertise. The collaborative process involved regular meetings, iterative document revisions, and peer review. Resource quality was better than expected, perhaps because best practices/principles related to health research are universally relevant, regardless of context. While the RSG was essential to systematize our search and ensure reproducibility, team member expertise was valuable. Pairing team members during peer-review led to bi-directional knowledge sharing and was particularly successful. This work reflects a highly collaborative global partnership and offers a model for future health research capacity-building efforts. We invite engagement with the Virtual Library <https://lmicresearch.org> as one supportive pillar of infrastructure to develop individual and institutional research capacity.

Building Capacity for Cancer Research in the Era of COVID-19: Implementation and Results From an International Virtual Clinical Research Training Program in Zambia

The incidence of cancer in sub-Saharan Africa is increasing rapidly, yet cancer research in the region continues to lag. One contributing factor is limited exposure to clinical research among trainees. We describe implementation and results of a virtual clinical research training program for Zambian clinical oncology fellows developed jointly by the Cancer Diseases Hospital in Zambia and the MD Anderson Cancer Center to address this need.

Strengthening research capacity: a systematic review of manuscript writing and publishing interventions for researchers in low-income and middle-income countries

INTRODUCTION

Health researchers from low-income and middle-income countries (LMICs) are under-represented in the academic literature. Scientific writing and publishing interventions may help researchers publish their findings; however, we lack evidence about the prevalence and effectiveness of such interventions. This review describes interventions for researchers in LMICs aimed at strengthening capacity for writing and publishing academic journal articles.

METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to report literature searches in PubMed, Embase, Global Health, Scopus and ERIC. Our keywords included LMICs, low-income and middle-income countries, health research and writing/publication support interventions, with no restrictions on publication date. Our screening process consisted of title screening, abstract review and full-text review. We collected information about the content, implementation and evaluation of each intervention, if included.

RESULTS

We identified 20 interventions designed to strengthen capacity for scientific writing and publishing. We summarised information from the 14 interventions that reported submitted or published papers as outcomes separately, reasoning that because they provide quantifiable metrics of success, they may offer particular insights into intervention components leading to publication. The writing and publishing components in this 'Publications Reported' group were an average length of 5.4 days compared with 2.5 days in the other group we refer to as 'Other Interventions.' Whereas all 14 Publications Reported interventions incorporated mentors, only two of five in the Other Interventions group incorporated mentors. Across interventions, leaders expressed the importance of a high ratio of mentors to participants, the need to accommodate time demands of busy researchers, and the necessity of a budget for open access fees and high-quality internet connectivity.

CONCLUSION

Writing and publishing interventions in LMICs are an underutilised opportunity for capacity strengthening. To facilitate the implementation of high-quality interventions, future writing and publishing interventions should share their experiences by publishing detailed information about the approach and effectiveness of the interventions.

Developing sustainable capacity-building in mental health research: implementation outcomes of training of trainers in systematic reviewing

Less than 1% of biomedical research papers originate in Africa. Locally relevant mental health research, including synthesis of existing evidence, is essential for developing interventions and strengthening health systems, but institutions may lack the capacity to deliver training on systematic reviewing for publication in international journals. This paper describes the development and implementation of a training-of-trainers (ToT) course on systematic reviewing. The ToT prepared junior faculty (‘trainers’) from universities in Ethiopia, Malawi, and Zimbabwe to lead a five-day systematic reviewing workshop. Using an evaluation framework based on implementation science outcomes, the feasibility of the ToT was assessed by tracking the number of workshops the trainers subsequently conducted and the number of trainers and trainees who participated; acceptability was assessed through post-workshop surveys on trainee perspectives; impact was evaluated through trainee scores on a 15-item multiple choice test on systematic reviewing concepts; and sustainability was assessed based on whether the workshop was integrated into university curricula. Twelve trainers (86% of those trained) facilitated a total of seven workshops in their home countries (total 103 trainees). The first workshop run in each country was evaluated, and there was a significant improvement in mean knowledge scores between pre- and post-tests among trainees (MD= 3.07, t= 5.90, 95% CI 2.02–4.11). In two of the three countries, there are efforts to integrate the systematic review workshop into university curricula. The cost of the workshop led by the international trainer was $1480 per participant, whereas the trainer-led workshops cost approximately $240 per participant. Overall, ToT is relatively new to research capacity building, although it has been used widely in clinical settings. Our findings suggest ToT is a promising, low-cost way to develop both technical skills of individuals and the pedagogical capacity of universities, and to promote sustainability of research capacity building programs that often have time-limited grant funding.

What is operational research and how can national tuberculosis programmes in low- and middle-income countries use it to end TB?

Despite considerable progress over the years, tuberculosis (TB) still remains the top cause of death among the infectious diseases and has devastating socio-economic consequences for people in low- and middle-income countries. To add to this, the emergence of the COVID-19 pandemic has worsened delivery of TB care across the globe. As a global community, we have committed to end the TB epidemic by 2030. The World Health Organization has framed a strategy to achieve this goal which consists of three pillars namely i) integrated patient-centred care and prevention, ii) bold policies and systems and iii) intensified research and innovation. An analysis of the performance of national tuberculosis programmes (NTPs) across the globe against the ten priority indicators recommended for monitoring the end TB strategy show that there are huge gaps at every step in the cascade of care of TB patients. In our view, these gaps reflect suboptimal implementation of existing strategies known to be efficacious and operational research (OR) is one of the best available tools to plug the gaps. In this paper, we define what operational research is and how it differs from other kinds of research. We also share our views and experiences about how operational research can be used by NTPs to identify implementation gaps and their reasons, and develop and test possible solutions - which are then integrated to make changes to policy and practice and eventually improve programme outcomes. OR can be defined as research into interventions, strategies and tools which produces practical useable knowledge that can be used to enhance the quality, coverage, effectiveness and efficiency of disease control programmes, health services or health systems in which the research is conducted. The key steps in integrating operational research in the NTPs include: i) securing political commitment reflected by inclusion of OR in the national strategic plans of NTPs and earmarked funding, ii) having a critical mass of dedicated and trained human resources in OR within the NTP, iii) setting research priorities and steering the direction of research in the country, iv) using output-oriented models of capacity building such as the Structured Operational Research Training Initiative (SORT IT) model and building communities of practice, v) harnessing existing capacity in the country by forging partnerships with academia, vi) NTP-led nationwide, multicentre OR studies, vii) providing access to anonymized patient and programme surveillance data, vii) creating a forum for evidence dissemination and fostering policy change and ix) monitoring and accountability. In conclusion, ending the TB epidemic will not be possible without new tools (diagnostics, drugs, vaccines) and a multi-sectoral response involving stakeholders beyond the health ministry, including private providers, patients and communities. However, timely conduct of operational research to fine-tune programme implementation and ensuring proper deployment of new tools will be equally crucial to maximize the effectiveness and efficiency of interventions and ultimately contribute towards ending TB.

Implementation, Outputs, and Cost of a National Operational Research Training in Rwanda

Background

Training and mentorship in research skills are essential to developing a critical mass of researchers in low- and middle-income countries (LMICs). However, reporting on the details of such training programs, especially regarding the cost of the training, is limited.

Objectives

This paper describes a year-long operational research training and mentorship course in Rwanda, implemented between 2013 and 2017.

Approach

We describe motivations for the design of the Intermediate Operational Research Training Course (IORT) across four iterations. We also report outputs, evaluate trainee experiences, and estimate training and mentorship costs.

Findings

Of the 132 applicants to the course, 55 (41.7%) were selected, and 53 (96.4%) completed the training. The ratio of female-to-male trainees in the course increased from 1:8 in 2013 to 1:3 in 2017. Trainees developed and co-first-authored 28 research manuscripts, 96.4% (n = 27) of which are published in peer-reviewed journals. For the 15 trainees who completed the post-course evaluation, 93.3% and 86.7% reported improvement in their research and analytical skills, respectively. The median cost per trainee to complete the course was US$908 (Range: US$739-US$1,253) and per research project was US$2,708 (US$1,748-US$6,741). The median annual training delivery and mentorship cost was US$47,170 (US$30,563-US$63,849) for a course with a Rwanda-based senior mentor, junior mentor, and training coordinator. The total essential cost for a year-long IORT course with 16 trainees co-leading eight research projects and mentored by two senior and four junior mentors was US$101,254 (US$73,486-US$157,569).

Conclusion

We attribute the high course completion rates, publication rates, and skills acquisition to the learning-by-doing approach and intensive hands-on mentorship provided in the course. IORT was costly and funded through institutional resources and international partnerships. We encourage funders to prioritize comprehensive research capacity-building initiatives that provide intensive mentorship as these are likely to improve the pool of skilled researchers in LMICs.

Building sustainable operational research capacity in Pakistan: starting with tuberculosis and expanding to other public health problems

Background: For many years, operational research capacity has been a challenge and has remained a low priority for the health sector in Pakistan. Building research capacity for developing a critical mass of researchers in Pakistan was done through Structured Operational Research and Training Initiative (SORT IT) courses in Paris and Asia between 2010 and 2016.

Objective: The aim of this paper is to describe the journey of SORT-IT in Pakistan from its inception to progressive expansion and discuss the challenges and ways forward.

Methods: The journey began with the training of the Pakistan NTP research team lead in 2010 in an international SORT IT course at Paris. This was followed by training of two team members in Asia SORT IT courses in 2014 and 2015. These three then worked together to conceive and implement the first national Pakistan SORT IT course supported by WHO/TDR and the Global Fund in 2016. This was facilitated by international facilitators and local trained SORT-IT participants from Paris and Asia. This was followed by two further national SORT IT courses in 2017 and 2018.

Results: Between 2010 and 2017, a total of 34 participants from Pakistan had been enrolled in national and international SORT IT courses. Of the 23 participants from completed courses, 18(78%) successfully completed the course. In total 18 papers were submitted and up until June 2018, 15(83%) have been published and 21 institutions in Pakistan involved with operational research as a result of the SORT IT initiative.

Conclusions: The SORT IT course has been an effective way to build operational research capacity at national level and this has resulted in a large number of published papers providing local evidence for decision making on TB and other disease control programmes. The experience from Pakistan should stimulate other countries to adopt the SORT-IT model.

A narrative review of health research capacity strengthening in low and middle-income countries: lessons for conflict-affected areas

Conducting health research in conflict-affected areas and other complex environments is difficult, yet vital. However, the capacity to undertake such research is often limited and with little translation into practice, particularly in poorer countries. There is therefore a need to strengthen health research capacity in conflict-affected countries and regions.In this narrative review, we draw together evidence from low and middle-income countries to highlight challenges to research capacity strengthening in conflict, as well as examples of good practice. We find that authorship trends in health research indicate global imbalances in research capacity, with implications for the type and priorities of research produced, equity within epistemic communities and the development of sustainable research capacity in low and middle-income countries. Yet, there is little evidence on what constitutes effective health research capacity strengthening in conflict-affected areas. There is more evidence on health research capacity strengthening in general, from which several key enablers emerge: adequate and sustained financing; effective stewardship and equitable research partnerships; mentorship of researchers of all levels; and effective linkages of research to policy and practice.Strengthening health research capacity in conflict-affected areas needs to occur at multiple levels to ensure sustainability and equity. Capacity strengthening interventions need to take into consideration the dynamics of conflict, power dynamics within research collaborations, the potential impact of technology, and the wider political environment in which they take place.

Growing research in global surgery with an eye towards equity

Background

Global surgery research is often generated through collaborative partnerships between researchers from both low- and middle-income countries (LMICs) and high-income countries (HICs). Inequitable engagement of LMIC collaborators can limit the impact of the research.

Methods

This article describes evidence of inequities in the conduct of global surgery research and outlines reasons why the inequities in this research field may be more acute than in other global health research disciplines. The paper goes on to describe activities for building a collaborative research portfolio in rural Rwanda.

Results

Inequities in global surgery research collaborations can be attributed to: a limited number and experience of researchers working in this field; time constraints on both HIC and LMIC global surgery researchers; and surgical journal policies. Approaches to build a robust, collaborative research portfolio in Rwanda include leading research trainings focused on global surgery projects, embedding surgical fellows in Rwanda to provide bidirectional research training and outlining all research products, ensuring that all who are engaged have opportunities to grow in capacities, including leading research, and that collaborators share opportunities equitably. Of the 22 published or planned papers, half are led by Rwandan researchers, and the research now has independent research funding.

Conclusion

It is unacceptable to gather data from an LMIC without meaningful engagement in all aspects of the research and sharing opportunities with local collaborators. The strategies outlined here can help research teams build global surgery research portfolios that optimize the potential for equitable engagement.

Global Health in the 21st Century: Equity in Surgical Training Partnerships

INTRODUCTION

Safe and affordable surgical care has been recognized as an important component of global health. One of the challenges in providing safe and affordable surgical care is the shortage of trained surgical workforce. Partnerships have developed between institutions in high-income countries (HICs) and low- and middle-income countries (LMICs) to strengthen and expand surgical education in LMICs. As these relationships evolve, emphasis needs to focus on development of equitable, bilateral partnerships.

METHODS

We reviewed different global surgery education partnerships to describe key components and features of successful partnerships. We then provide a framework for equitable global surgical training partnerships.

RESULTS

Key features of equitable global surgical education partnerships included an alignment with local priorities, long term collaborations, and locally integrated, competency-based training. To develop a partnership, both parties must meet and perform a needs assessment of the LMIC institution and jointly agree how the partnership can best address these needs. Both the HIC and LMIC institutions must clearly define their goals and expectations. Ideally, a set of output measures will be defined to assess the success of the partnership.

CONCLUSIONS

Improving surgical education in LMIC countries is an integral part of health equity in global surgery. Key components of equitable education partnerships focus on local ownership and long-term relationships. Each party needs to clearly define goals and expectations for the partnership. Equity is essential and unequal relationships must be avoided.

Operational research within a Global Fund supported tuberculosis project in India: why, how and its contribution towards change in policy and practice

BACKGROUND

The Global Fund encourages operational research (OR) in all its grants; however very few reports describe this aspect. In India, Project Axshya was supported by a Global Fund grant to improve the reach and visibility of the government Tuberculosis (TB) services among marginalised and vulnerable communities. OR was incorporated to build research capacity of professionals working with the national TB programme and to generate evidence to inform policies and practices.

OBJECTIVES

To describe how Project Axshya facilitated building OR capacity within the country, helped in addressing several TB control priority research questions, documented project activities and their outcomes, and influenced policy and practice.

METHODS

From September 2010 to September 2016, three key OR-related activities were implemented. First, practical output-oriented modular training courses were conducted (n = 3) to build research capacity of personnel involved in the TB programme, co-facilitated by The Union, in collaboration with the national TB programme, WHO country office and CDC, Atlanta. Second, two large-scale Knowledge, Attitude and Practice (KAP) surveys were conducted at baseline and mid-project to assess the changes pertaining to TB knowledge, attitudes and practices among the general population, TB patients and health care providers over the project period. Third, studies were conducted to describe the project's core activities and outcomes.

RESULTS

In the training courses, 44 participant teams were supported to develop research protocols on topics of national priority, resulting in 28 peer-reviewed scientific publications. The KAP surveys and description of project activities resulted in 14 peer-reviewed publications. Of the published papers at least 12 have influenced change in policy or practice.

CONCLUSIONS

OR within a Global Fund supported TB project has resulted in building OR capacity, facilitating research in areas of national priority and influencing policy and practice. We believe this experience will provide guidance for undertaking OR in Global Fund projects.