Research skills to improve TB outcomes in Indonesia and PNG
Program Disease Elimination
Health Themes Tuberculosis (TB)
Working Groups Tuberculosis Elimination and Implementation Science Group
People Professor Steve Graham ; Geoffrey Chan ; Doctor Philipp du Cros ; April Holmes ; Doctor Stefanie Vaccher ; Doctor Tafireyi Marukutira ; Associate Professor Suman Majumdar ; Doctor Dani Lin ; Doctor Khai Lin Huang ; Alexa Murray ; Doctor Jane Greig
Public health programs in low- and middle-income countries have been described as "data rich but information poor" — awash with information but limited in translational use to inform or improve health practices.
The Structured Operational Research and Training IniTiative (SORT-IT) under the Special Programme for Research and Training in Tropical Diseases at the World Health Organization (WHO-TDR) seeks to help change that.
The training aims to improve healthcare delivery and outcomes by searching for knowledge on strategies, interventions or tools that can enhance the performance of local health programs to address a broad range of conditions and diseases, from malaria and tuberculosis (TB) to antimicrobial resistance and HIV/AIDS.
Burnet and local partners are working with the local governments in Indonesia and Papua New Guinea — which bear some of the highest TB burdens in the world — to help mitigate and aid the fight against TB, including by building research capacity through SORT-IT training.
Burnet Senior Principal Fellow Professor Steve Graham said the program taught participants how to conduct quality operational research to strengthen their research capacity and apply new knowledge to their programs. They also learnt practical skills required to write study protocols, including data capture and analysis, and to prepare for submission to a peer-reviewed journal.
"The opportunity to come together and take the time to learn operational research skills for TB, using findings from their own clinical and public health program activities is highly valued by the participants," Professor Graham said.
"Feelings of achievement, ownership and direct relevance, empower [participants] to articulate and address the challenges.
"Participants realise that operational ‘research’ is not done in isolation but as teamwork that is potentially accessible to all healthcare workers to identify priority gaps and improve health outcomes."
A peer-reviewed study on the Spectrum of TB Disease and Treatment Outcomes in a Mobile Community Based Active Case Finding Program in Yogyakarta Province, Indonesia, was published in the Journal of Tropical Medicine and Infectious Disease, with several more under review, as a result of the recently concluded 2023 training session.
There are ten participants in the Indonesian SORT-IT course with facilitators from Universitas Gadjah Mada, Menzies School of Health Research and Burnet Institute providing ongoing support and guidance.
"The facilitators and mentors were very helpful as they always encouraged us to learn, discuss and write," said Dr Nur Rahmi Ananda, a course participant from Yogyakarta.
"Hopefully more operational research will be done to address health problems in Indonesia, especially for TB."
April Holmes coordinated the SORT-IT PNG modules, with Burnet Senior Research Fellow Dr Stefanie Vaccher, TB Specialist Dr Tafi Marukutira, Chief Health Officer - COVID and Health Emergencies Associate Professor Suman Majumdar, Infectious Diseases Specialist Dr Dani Lin, and Acting Co-Head of Tuberculosis Elimination, Implementation Science Dr Khai Huang, and Senior Research Officer & Project Manager Alexa Murray involved as facilitators.
The first two in-person modules of SORT-IT in PNG were held by Burnet in Port Moresby in November 2022.
The first module, led by Professor Graham, facilitated the development of an operational research protocol and ethics submission.
The second module, led by Burnet Senior Operational Epidemiologist Dr Jane Greig, trained participants in effective data collection and analysis methods, with participants forming a plan for the data they capture during their research projects.
The third and final module, completed last month, focused on data analysis and manuscript writing, where participants prepared to submit their projects for publication in a peer-reviewed open-access journal.
Two facilitators of this year’s PNG course, Dr Trevor Kelebi and Dr Al Maha, were participants of the 2017-2018 course that published 12 original peer-reviewed manuscripts.
The training is designed to create an organisational culture of operational research that informs policy and practice, and ultimately, develops adequate and sustainable operational research capacity.
More broadly, SORT-IT has been attended by health workers and health programmers in 93 countries through different facilitators and partnerships.
SORT-IT PNG and Indonesia were implemented by Burnet Institute and funded by the Australian Government through the Indo-Pacific Centre for Health Security and the Medical Research Future Fund.
Burnet would like to acknowledge all those who contributed to the success of the training. In Indonesia: Dr Rina Triasih, Dr Bintari Dwihardiani, Dr Chris Lowbridge, Dr Trisasi Lestari, Professor Ari Probandari, Stephanie Main, Rob Franzone, Christa Dewi, Dr Riris Andono Ahmad, Dr Guardian Yoki Sanjaya, Hastarina Mulia, Mutiara Shinta Noviar Unicha, Zusril Rawna, Nanda Safira and Dr Firdaus Hafidz.
A sample of participants’ SORT-IT projects includes:
Tolerability of linezolid containing regimens for the treatment of patients with multidrug-resistant or rifampicin-resistant tuberculosis in Daru, Western Province
Frequency of TB-culture contamination and characteristics associated with contamination in all sputum samples cultured during a diagnostic clinical trial in Port Moresby
Treatment outcomes of tuberculosis patients attending three basic management units in Madang Province: A three-year retrospective study (2019- 2021)
Comprehensive Tuberculosis Screening and Treatment among Inmates and Staff at Detention Center in Mimika District, Central Papua Province, Indonesia
High tuberculosis preventive therapy coverage using short regimens in a patient-centered approach among household contacts in Yogyakarta
Implementation of the Zero TB Yogyakarta Model in Increasing TB Screening Coverage and Providing TB Prevention Therapy (TPT) to PLHIV in Yogyakarta City