Research training needs in Peruvian national TB/HIV programs

<p>Abstract</p> <p>Background</p> <p>There are few published reports of <it>research training </it>needs assessments and research training programs. In an effort to expand this nascent field of study and to bridge the gap between research and practice, we sought to systematically assess the research training needs of health care professionals working at Peruvian governmental institutions leading HIV and tuberculosis (TB) control and among senior stakeholders in the field.</p> <p>Methods</p> <p>Six institutional workshops were conducted with the participation of 161 mid-level health professionals from agencies involved in national HIV and TB control. At each workshop informants completed a structured questionnaire and participated in small and large group discussions. Additional data and institutional commitment was obtained through in-depth interviews from 32 senior managers and researchers from the Ministry of Health, academia and NGOs.</p> <p>Results</p> <p>Participants exhibited an overwhelming receptivity for additional research training, observing a gap between current levels of research training and their perceived importance. Specialized skills in obtaining funding, developing research protocols, particularly in operational, behavioral and prevention research were considered in greatest need. Beyond research training, participants identified broader social, economic and political factors as influential in infectious disease control.</p> <p>Conclusions</p> <p>The needs assessment suggests that future training should focus on operational research techniques, rather than on clinical skill building or program implementation only. Strengthening health systems not only requires additional research training, but also adequate financial resources to implement research findings.</p

Institutional influence: The role of international donors in shaping development goals, implementation and effectiveness

Doctoral dissertationPrevious research on development assistance highlights the importance of the recipient country implementing environment in mediating the impact of aid; however, little is known about the donor side of the donor-recipient relationship. This dissertation fills this gap in understanding by characterizing and assessing the role of this powerful yet neglected set of stakeholders and their influence on aid goals, implementation and effectiveness. It investigates: what are the salient dimensions along which donors differ, how these differences influence health coverage and outcomes, and what features of the domestic policy process shape which approaches donors pursue. I examine these questions using mixed methods: analyses of Congressional hearings, a comparative case study of international donors in the health sector in Peru, and quantitative analyses of the cross-national Development Assistance for Health dataset. This body of work offers three key insights for development assistance, related to recipient country ownership, donor type and goal alignment. First, the most prominent difference across donors was the extent to which they formally involved recipient country public, private and civil society sectors in problem identification, resource administration, program design, implementation and governance. The Peruvian context revealed three ownership patterns: ‘doctor knows best’, ‘empowered patient’ and ‘it takes a village’ models, highlighting the dominance of foreign actors and the central government in development activities. The cross-national data support wide variation in donor perception of the capability and roles of recipient country actors, indicating very low levels, infrequent and inconsistent allocation of budget support financing, in which funds are channeled directly through recipient institutions. Second, rather than observing systematic differences between bilateral and multilateral donors, there was greater variation among rather than across donor types. Actors along the aid implementation chain identified multiple entities to whom they were accountable. Third, although there existed considerable goal alignment among stakeholders within donor countries and between donors and recipients, there was little harmonization or coherence across these very wide sets of goals. Taken together, these findings highlight the unrealized potential to substantially expand the formal involvement of recipient country actors, and the need to prioritize among broad sets of foreign assistance and development goals.This research was funded in part by a Thomas Francis, Jr. Global Health Fellowship

Toward greater inclusion: lessons from Peru in confronting challenges of multi-sector collaboration Hacia una mayor inclusión: enseñanzas del Perú para afrontar los retos de la colaboración multisectorial

Despite widespread enthusiasm for broader participation in health policy and programming, little is known about the ways in which multi-sector groups address the challenges that arise in pursuing this goal. Based on the experience of Peru's National Multi-sector Health Coordinating Body (CONAMUSA), this article characterizes these challenges and identifies organizational strategies the group has adopted to overcome them. Comprising nine government ministries, nongovernmental organizations, academia, religious institutions, and international cooperation agencies, CONAMUSA has faced three principal challenges: 1) selecting representatives, 2) balancing membership and leadership across sectors, and 3) negotiating role transition and conflict. In response, the group has instituted a rotation system for formal leadership responsibiliti es, and professionalized management functions; created electoral systems for civil society; and developed conflict of interest guidelines. This case study offers lessons for other countries trying to configure multi-sector groups, and for donors who mandate their creation, tempering unbridled idealism toward inclusive participation with a dose of healthy realism and practical adaptation.<br>A pesar del entusiasmo generalizado por la mayor participación en las políticas y programas sanitarios, poco se sabe sobre las formas de afrontar los retos que se plantean en la consecución de este objetivo por parte de los grupos multisectoriales. Este artículo parte de la experiencia de la Coordinadora Nacional Multisectorial en Salud del Perú (CONAMUSA) para caracterizar dichos retos e identificar las estrategias de organización que ha adoptado el grupo a fin de superarlos. CONAMUSA, formada por nueve ministerios del gobierno, organizaciones no gubernamentales, instituciones académicas, organizaciones religiosas y agencias de cooperación internacional, se ha enfrentado con tres retos fundamentales: 1) elegir a los representantes, 2) encontrar el equilibrio entre la representación de los miembros y el liderazgo en los distintos sectores y 3) negociar el cambio de roles y los conflictos. Para responder a estos retos el grupo ha establecido un sistema rotatorio para las responsabilidades formales de liderazgo y ha profesionalizado las funciones de gestión, se han creado sistemas electorales para la sociedad civil y se han elaborado pautas para los conflictos de intereses. Este estudio de casos aporta lecciones para otros países que estén tratando de configurar grupos multisectoriales, así como para los organismos de ayuda que dirigen su creación, suavizando los idealismos extremos con una dosis de realismo saludable y de adaptación práctica para lograr una participación inclusiva

HTLV-1 and -2 Infections among 10 Indigenous Groups in the Peruvian Amazon

Infections with HTLV-1 and -2 were detected in 12 (1.9%) and 6 (0.9%) indigenous individuals living in 27 Amazonian villages in Peru. All infections occurred in Shipibo-Konibo people. HTLV was more common among participants living in villages distant from larger port cities and women with non-monogamous sexual partners

Reaching the Unreachable: Providing STI Control Services to Female Sex Workers via Mobile Team Outreach

<div><p>Background</p><p>As part of a community-randomized trial of a multicomponent intervention to prevent sexually transmitted infections, we created Mobile Teams (MTs) in ten intervention cities across Peru to improve outreach to female sex workers (FSW) for strengthened STI prevention services. </p> <p>Methods</p><p>Throughout 20 two-month cycles, MTs provided counseling; condoms; screening and specific treatment for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), and vaginal <i>Trichomonas vaginalis</i> (TV) infections; and periodic presumptive metronidazole treatment for vaginal infections. </p> <p>Results</p><p>MTs had 48,207 separate encounters with 24,814 FSW; numbers of sex work venues and of FSW reached increased steadily over several cycles. Approximately 50% of FSW reached per cycle were new. Reported condom use with last client increased from 73% to 93%. Presumptive metronidazole treatment was accepted 83% of times offered. Over 38 months, CT prevalence declined from 15·4% to 8·2%, and TV prevalence from 7·3% to 2·6%. Among participants in ≥9 cycles, CT prevalence decreased from 12·9% to 6·0% (p <0·001); TV from 4·6% to 1·5% (p <0·001); and NG from 0·8% to 0·4% (p =0·07). </p> <p>Conclusions</p><p>Mobile outreach to FSW reached many FSW not utilizing government clinics. Self-reported condom use substantially increased; CT and TV prevalences declined significantly. The community-randomized trial, reported separately, demonstrated significantly greater reductions in composite prevalence of CT, NG, TV, or high-titer syphilis serology in FSW in these ten intervention cities than in ten matched control cities.</p> </div

Prevalences of <i>C. trachomatis</i> and <i>T. vaginalis</i> infections among female sex workers.

<p>The 95% confidence intervals are shown for Cycle 1 (when the number of encounters was smallest). Reductions in prevalences are significant for <i>C. trachomatis</i> (p <0·001) and for <i>T. vaginalis</i> (p <0·001).</p

Proportion of female sex workers new to Mobile Teams at each intervention cycle.

<p>For each cycle, the number of encounters decreases from top to bottom of the figure; participants with greatest number of Mobile Team encounters are depicted at the top, those with lowest (i.e., new participants) at the bottom.</p