Networking in eHealth research: results of the IDRC SEARCH program evaluation.

Background: The IDRC 'Strengthening Equity through Applied Research Capacity building in eHealth' (SEARCH) funded seven research projects in Bangladesh, Burkina Faso, Ethiopia, Kenya, Lebanon, Peru and Vietnam that sought to answer questions or test solutions related to the use of Internet or mobile phone technology in strengthening health systems. The evaluation accompanied these projects over two years to answer, among others, the question how cross-grant learning interactions influenced project outcomes. Methods: The evaluation team conducted repeated interviews and on-line questionnaire surveys with the research teams and analysed the information exchanges among researchers on a SharePoint site established by IDRC. Results: The expectations of the SEARCH program in terms of cross-project learning were only partially realized. The diversity of themes, language barriers and differences in context were cited as main reasons. Non-facilitated active cross-grant networking was only observed between two teams working in English on thematically similar issues. However, networking among all projects was active during two program workshops organized by IDRC. Conclusions: Networking among research teams can increase the quality and the applicability of health systems research and potentially promote knowledge translation. Spontaneous networking across language barriers is, however, difficult. Effective global research networks require dedicated human and financial resources to keep them vibrant and alive. Keywords: e-health, refugees.

Implementation and Operational Research: Programmatic Feasibility of Dried Blood Spots for the Virological Follow-up of Patients on Antiretroviral Treatment in Nord Kivu, Democratic Republic of the Congo.

BACKGROUND: As part of its policy to shift monitoring of antiretroviral therapy (ART) to primary health care (PHC) workers, the Ministry of Health of the Democratic Republic of Congo (DRC) tested the feasibility of using dried blood spots (DBS) for viral load (VL) quantification and genotypic drug resistance testing in off-site high-throughput laboratories. METHODS: DBS samples from adults on ART were collected in 13 decentralized PHC facilities in the Nord-Kivu province and shipped during program quarterly supervision to a reference laboratory 2000 km away, where VL was quantified with a commercial assay (m2000rt, Abbott). A second DBS was sent to a World Health Organization (WHO)-accredited laboratory for repeat VL quantification on a subset of samples with a generic assay (Biocentric) and genotypic drug resistance testing when VL >1000 copies per milliliter. FINDINGS: Constraints arose because of an interruption in national laboratory funding rather than to technical or logistic problems. All samples were assessed by both VL assays to allow ART adjustment. Median DBS turnaround time was 37 days (interquartile range: 9-59). Assays performed unequally with DBS, impacting clinical decisions, quality assurance, and overall cost-effectiveness. Based on m2000rt or generic assay, 31.3% of patients were on virological failure (VF) and 14.8% presented resistance mutations versus 50.3% and 15.4%, respectively. CONCLUSION: This study confirms that current technologies involving DBS make virological monitoring of ART possible at PHC level, including in challenging environments, provided organizational issues are addressed. Adequate core funding of HIV laboratories and adapted choice of VL assays require urgent attention to control resistance to ART as coverage expands.

Chronicle of an outbreak foretold: meningococcal meningitis W135 in Burkina Faso.

Burkina Faso lies within the African meningitis belt. Until recently, serogroup A of Neisseria meningitidis was the most common cause of epidemic meningitis in Burkina Faso. However, during the epidemic that started in January 2002, W135 was the predominant serogroup of meningococcus. Vaccine against the W135 serogroup is expensive and in short supply. Strategies to react to a future African epidemic of W135 meningococcal meningitis with a sufficient and affordable supply of vaccine must be put into place now.