Capacity Building in Sub-Saharan Africa as Part of the INTENSE-TBM Project During the COVID-19 Pandemic

Tuberculous meningitis (TBM) is the most severe and disabling form of tuberculosis (TB), with at least 100,000 cases per year and a mortality rate of up to 50% in individuals co-infected with human immunodeficiency virus type 1 (HIV-1). To evaluate the efficacy and safety of an intensified anti-tubercular regimen and an anti-inflammatory treatment, the INTENSE-TBM project includes a phase III randomised clinical trial (TBM-RCT) in four countries in sub-Saharan Africa (SSA). Within this framework, we designed a comprehensive capacity-building work package ensuring all centres had, or would acquire, the ability to conduct the TBM-RCT and developing a network of skilled researchers, clinical centres and microbiology laboratories. Here, we describe these activities, identify strengths/challenges and share tools adaptable to other projects, particularly in low- and lower-middle income countries with heterogeneous settings and during the coronavirus disease 2019 (COVID-19) pandemic. Despite major challenges, TBM-RCT initiation was achieved in all sites, promoting enhanced local healthcare systems and encouraging further clinical research in SSA. In terms of certified trainings, the achievement levels were 95% (124/131) for good clinical practice, 91% (39/43) for good clinical laboratory practice and 91% (48/53) for infection prevention and control. Platform-based research, developed as part of capacity-building activities for specific projects, may be a valuable tool in fighting future infectious diseases and in developing high-level research in Africa.

The INTENSE-TBM project aimed to design a comprehensive work-package on capacity building, ensuring all centres would acquire the ability to conduct a phase III randomised clinical trial on TBM in sub-Saharan Africa, to reduce tuberculous meningitis mortality and morbidity in patients with/without HIV-1 co-infection. Therefore, the INTENSE-TBM project is an example of how an international clinical research consortium can provide opportunities to enhance local capacity building and promote centres without previous experience in clinical research. This article provides practical approaches for implementing effective capacity-building programmes. We highlight how to overcome limitations imposed by the COVID-19 pandemic to successfully complete clinics, laboratory set-ups and personnel training, so as to optimise resources and empower African institutions on a local level. At the same time, our experience shows how capacity-building programmes can deliver long-lasting impact that extends beyond the original aims of the project (e.g. HIV and TB), and support local health systems in fighting other infectious disease (e.g. COVID-19). Research projects in low- and lower-middle income countries with heterogeneous settings could stand to benefit the most.

Qualitative and Statistical Impacts of Home Language on Responses to the Items of the Sixteen Personality Factor Questionnaire (16PF) in South Africa

The primary aims of the study were to compare the responses of different population groups to the items of the 16 Personality Factor Questionnaire, and also to explore some of the reasons for the observed differences. One quantitative and two qualitative studies were conducted in the process. For the quantitative study, 983 students of psychology or industrial psychology from four South African universities participated in the study. For the qualitative study, two samples were used, namely 71 second-year students and 10 honours-degree students from the Department of Industrial Psychology of the University of the Western Cape. To test for statistically different response patterns between the groups on each of the items, chi-squared tests were used. The findings showed that serious problems existed as far as the comparability of the items across groups was concerned, that participants whose home language was neither English nor Afrikaans experienced critical difficulties in understanding many of the words that would, as a rule, be regarded as rudimentary by English mother-tongue speakers, and also that the manner in which the items had been constructed impeded the comprehension of respondents who did not speak English as a first language. It would appear that the observed language difficulties may be associated with a number of socio-political and educational factors, but, based on the present results, it was not possible to uncover tenable explanations of some of the differences which are not so clearly bound to language issues. Nonetheless, the nature of the findings should be interpreted to sound a clear warning against the use of the test.

The (un)Fair Usage of the 16PF (SA92) in South Africa: A Response to C.H. Prinsloo and I. Ebersöhn

A study completed in 1996, challenged the continued usage of the 16PF (SA92), and found that this imported test was biased against black mother-tongue speakers in the South African context. Six years later, Prinsloo and Ebersohn questioned the methodological and statistical techniques employed in the study. This article is a response to their claims and reaffirms the results and position that the necessary research must be conducted on imported tests, prior to it's adoption within South Africa.

The comparability of the constructs of the 16PF in the South African context

The primary aims of the study were to determine whether the scores of the 16PF (SA92) are comparable in a crosscultural setting in South Africa, and also to investigate the influence of the gender of the research participants on the scores of the 16PF (SA92). The sample consisted of 983 students who were enrolled at different universities at the time of the field work. The statistical methods involved the application of descriptive statistics as well as methods to determine the comparability of the constructs. The results showed that although race exercised a considerable influence on the findings, this was not necessarily the case as far as gender was concerned. The presence of problems relating to the construct comparability of the test were also identified, as significant differences in means were found between the different race groups. Some of the implications of persisting with the use of the 16PF (SA92) in the South African context are outlined against the background of recently promulgated labour legislation. Opsomming Die primere doelstellings met die onderhawige studie was om die toepaslikheid van die 16PF (SA92) in Suid Afrikaanse konteks met sy diversiteit van kultuurgroepe te evalueer. Die invloed van die geslag van die navorsingsdeelnembers op die resultate is ook nagevors. Die deelnemergroep het bestaan uit 983 studente wat ten tye van die veldwerk aan verskillende universiteite gestudeer het. Benewens normale beskrywende statistiek, is daar ook gebruik gemaak van metodes om konstrukvergelykbaarheid te evalueer. Die bevindings het daarop gedui dat alhoewel ras 'n belangrike invloede op die toetsfaktore uitoefen, dit nie die geval is in soverre dit geslag betref nie. Die teenwoordigheid van probleme het ook ten opsigte van konstrukvergelykbaarheid na vore getree, aangesien betekenis voile verskille tussen gemiddeldes gevind is. Sommige van die implikasies van die volgehoue gebruik van die 16PF (SA92) in Suid Afrika word ook in die lig van die resente arbeidswetgewing bespreek.