Swaziland Health Research - Research Topics #2

Research Agenda

Research Areas: Communicable Diseases

Communicable diseases contribute the largest share of the burden of disease in Swaziland and are estimated to account for 61% of all causes mortality. The main causes of death are HIV/AIDS and TB. The prevalence of HIV/AIDS in Swaziland stands at 17,291 per 100 000 population and TB prevalence is 907 per 100 000 population [1].

The research on communicable diseases is focused on reduction of morbidity and mortality related to priority infectious diseases; improving effectiveness and cost-effectiveness of interventions; and improving uptake of existing interventions.

1. Research Priorities for HIV/AIDS
Assessment of burden and determinants:
  • Proportion of young women who test positive for HIV in antenatal or delivery care: (i) receive and take drugs for PMTCT; (ii) are assessed to determine if they need lifelong HAART; (iii) are started on lifelong HAART if clinically indicated.
  • Assess burden of HIV/AIDS and determinants among key populations, including young women, men having sex with men (MSM), IDU, inmates, and mobile populations.

Research to Improve Existing Interventions:
  • Develop effective communication strategies on Male Circumcision, social and behavioural change,
  • Improve treatment, care and support through referral linkages from HTC to pre-ART, TB / HIV treatment integration and optimize strategies for managing co-infection and co-morbidities for PLHIV, and preventing mother-to-child transmission (PMTCT) through transmission of HIV post eight weeks.
  • Assess aspects of the delivery of HIV testing and counselling services that are most important from the perspective of adolescents: the speed of the results; confidentiality and anonymity; the social and health services offered; the counselling offered; whether or not they are integrated into the health system.
  • Develop strategies for optimizing demand for HIV Testing and Counselling, condom usage and Family Planning.
  • Identify factors that facilitate uptake, retention and adherence and minimize HIV treatment failure.
  • Quantify effects of user fees on access to, use of and retention in treatment among adolescents living with HIV.
  • Determine factors that influence the disclosure of HIV status to others among adolescents.

Research to Improve Effectiveness and Cost-Effectiveness:
  • Determineeffectiveness and cost-effectiveness of male circumcision, life-skills education strategies, community interventions, service provision for key populations (including young women, men having sex with men (MSM), IDU, inmates, mobile populations), HIV Testing and Counselling.


2. Research Priorities for Tuberculosis
Assessment of burden and determinants:
  • Assess the burden of TB disease and drug-resistance in community.

Research to Improve Existing Interventions:
  • Investigate community contextual factors contributing to social mobilization and demand creation.

Research to Improve Effectiveness and Cost-Effectiveness:
  • Evaluateeffectiveness and cost-effectiveness of the TB diagnostic algorithm, active case finding and systematic contact tracing strategies.

Research to develop new capacities (tools and products):
  • Identify new TB medicines to reduce the duration of treatment.


3. Research Priorities for Acute Respiratory Infections (ARIs)
Assessment of burden and determinants:
  • Assess the burden of ARIs among adults and paediatrics.
  • Identify bacterial and non-bacterial pathogens associated with ARI morbidity and mortality.

Research to Improve Existing Interventions:
  • Identify strategies for using community health workers to increase safe and effective coverage of antibiotic treatment in communities.
  • Identify strategies to improve health care seeking and access for children with pneumonia in communities.

Research to Improve Effectiveness and Cost-Effectiveness:
  • Evaluate the implementation of policy guidelines and diagnostic tools for the management of ARIs.
  • Evaluate community management of pneumonia.


4. Research Priorities for Diarrhoeal diseases
Assessment of burden and determinants:
  • Assess the aetiology and health determinants of diarrhoeal diseases e.g. safe water, sanitation and nutrition coverage in Swaziland.

Research on health policy and systems:
  • Provide evidence on determinants of health for use in development of policy framework to reduce burden of diarrhoeal diseases.

Research to Improve Existing Interventions:
  • Determine optimal models for social mobilization of communities towards diarrhoeal diseases control.

Research to Improve Effectiveness and Cost-Effectiveness:
  • Efficacy, effectiveness and feasibility of new therapeutic interventions against diarrheal and its complications.
  • Effectiveness studies on water treatment interventions, e.g. use of Jikor water guard tablets.


5. Research Priorities for Neglected Tropical Diseases (NTDs)
Assessment of burden and determinants:
  • Assess the burden of common NTDs such as geohelminthsand its social, behavioural, political and economic determinants/drivers of helminth infection and control.

Research to Improve Existing Interventions:
  • Optimize the use of existing methods (drugs, vaccines, anti-vector measures) for control of helminth infection and transmission.
  • Improve the use of existing diagnostic assays for monitoring and evaluation of the impact of control programmes.

Research to Improve Effectiveness and Cost-Effectiveness:
  • Effectiveness and cost effectiveness of community-directed NTDs interventions.


6. Research Priorities for Malaria
Assessment of burden and determinants:
  • Trends in burden and transmission of malaria, parasite biology, including changes in predominant genotypes.

Research to Improve Existing Interventions:
  • Strategies to optimize:
    •      surveillance of asymptomatic malaria infections,
    •      malaria importation detection,
    •      early treatment of malaria within community,
    •      compliance of health workers to national malaria diagnosis and treatment guidelines, and
    •      achievement and maintenance of malaria elimination.

Research to Improve Effectiveness and Cost-Effectiveness:
  • Optimize strategies for:
    •      management of drug resistance,
    •      alternative vector control,
    •      preventive interventions, and
    •      malaria elimination.
  • Validity and feasibility of new and available diagnostic tools.


7. Research Priorities for Other Infectious Diseases
Assessment of burden and determinants:
  • Determine burden and epidemiology of hepatitis.
  • Determine trend of drug resistance among common viruses, bacteria and fungi.

Research to Improve Existing Interventions:
  • Strategies to improve coverage of testing and treatment for hepatitis.
  • Assess health system preparedness and response to emerging and re-emerging and epidemic prone diseases.

Research to Improve Effectiveness and Cost-Effectiveness:
  • Assess cost-effectiveness of using laboratory diagnostic results, including culture and antimicrobial susceptibility testing, in specific patient care circumstances, including managed care settings.

Contacts

Physical Address: Christian University Building, Office #, Mbabane, Swaziland

Postal Address: P.O Box 5 Mbabane, Swaziland

Phone: 2404 4905

Fax: none

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