Outside the biomedical box of integrated care research. Meet some of our new RESPOND-AFRICA staff
The RESPOND-AFRICA consortium is made up of a range of diverse professionals from Europe and Africa. They are working on several different projects all aimed at improving health outcomes for people living with chronic diseases such as diabetes, hypertension, and HIV in Africa. They are experts in unique activities that range from infectious disease care, non-communicable diseases care, project management, implementation, social science, or health economics. Have you ever wondered what it takes to be involved in a large global health program including multi-country randomised control trials? We have interviewed some of our new RESPOND-AFRICA members who are both on the ground and behind the scenes to give you an idea. Follow along in our series documenting some of our RESPOND-AFRICA consortium members!
Interviewee name: Francis Xavier Kasujja
Role in RESPOND-AFRICA: Project Leader, Uganda
Projects involved within RESPOND-AFRICA: INTE-COMM study
Where they are based: Chronic Diseases and Cancer Theme, MRC/UVRI & LSHTM Uganda Research Unit, Uganda
Past role/job: Medical Team Leader with Study Coordinator with Médecins Sans Frontières (MSF)/Doctors Without Borders; Study Coordinator of the Self-Management and Reciprocal Approach to the Management of Type 2 Diabetes (SMART2D) project at the School of Public Health of Makerere University
Who are you?
My background is in humanitarian medicine and global health. I have previously managed the treatment and training department of a sleeping sickness screening program in Uganda, worked as a Medical Officer for an HIV and multi-drug resistance project in Zimbabwe, and led the medical team for a leishmaniasis treatment program at a refugee camp in South Sudan. More recently, I was the Uganda coordinator for the Self-Management and Reciprocal Approach to Type 2 Diabetes (SMART2D) project. This was a multi-country research collaboration between Makerere University in Uganda, University of Western Cape in South Africa and Karolinska University in Sweden.
My exposure to health inequities across different African contexts has shaped my outlook on the role of integration of care in meeting health system gaps across the region
How has your journey helped you lead to this point in your career?
I have been working closely with international multi-disciplinary teams for several years which makes it easier for me to work across disciplines and cultures. My exposure to health inequities across different African contexts has shaped my outlook on the role of integration of care in meeting health system gaps across the region. And indeed, the lessons I learned from my previous experience developing a community model of care for diabetes have informed my contributions to the development of the INTE-COMM community model of integrated care.
How did you initially get involved in research?
My initial foray into research occurred about a decade ago. As the new MSF doctor on the Human Afrian Trypanosomiasis project, I was tasked with supporting a TDR-sponsored clinical trial to evaluate the efficacy of short-course Eflornithine therapy for late stage disease. Although our stay in the area was short-lived due to a shift on the MSF operational strategy at the time, my experience on the Eflornithine trial had a lasting impression on me. So when I was presented with another opportunity to lead a malnutrition trial among under-fives in the drought-ridden Karamoja region of north-eastern Uganda, I took it with both hands. I learned many lessons on research implementation and people management during the two studies.
HIV patients are at an increased risk of the two non-communicable diseases as a direct complication of the disease and an adverse effect of ART
How has the field of integrated care, especially in sub-Saharan Africa, been changing?
Unlike the case for acute care, sub-Saharan Africa has limited experience of chronic care delivery. Most of what we know about integrated chronic care in this setting is derived from the scale up of the HIV antiretroviral therapy (ART). Integrated care policies, in this context, followed a pragmatic approach whereby large programmes aimed at managing tuberculosis and other co-morbid, opportunistic infections were embedded within the ART program. Today, we are seeing a move by several local and international global health actors towards integrating metabolic diseases, specifically diabetes and hypertension, in the ART program. HIV patients are at an increased risk of the two non-communicable diseases as a direct complication of the disease and an adverse effect of ART. Our work as the RESPOND-AFRICA group looks to extend this further to all individuals with HIV, diabetes and hypertension. We believe that this is the ideal strategic approach to bringing scarce health system resources to bear on the vast chronic care challenges across sub-Saharan Africa.
What areas of HIV and NCD research and/or project management do you think are being neglected?
Despite the availability of some case studies on its implementation, the body of evidence on the delivery and effectiveness of integrated HIV and NCD care is limited. This lack of evidence hampers resource mobilization and the scale up of integrated care. There is also a general lack of contextualized recommendations or contextualized socio-behavioural and lifestyle guidelines for the control of non-communicable diseases making their operationalization difficult for clinicians and policy makers. Besides, outside the realm of the HIV programme, very few healthcare resources are dedicated to the management of non-communicable diseases. Health workers are undertrained and drug and testing reagents are often out of stock. Improving integrated care will require a concerted effort focused both on research and policy.
Improving integrated care will require a concerted effort focused both on research and policy
What do you hope to do in your role and as a member of the RESPOND-AFRICA consortium?
As the Project Leader for INTE-COMM in Uganda, I am responsible for the day-to-day implementation of the study. My goal is to ensure that the study is conducted to the highest level of quality possible and in a timely manner. I hope to also contribute to other projects within the RESPOND-AFRICA consortium, lending my expertise and experience to the design, implementation, and writing up of the projects.
Besides research and randomised control trials, what do you enjoy doing?
I am an avid reader and an aspiring writer.