Applying learning health systems thinking in codeveloping integrated tuberculosis interventions in the contexts of COVID-19

van Rensburg, André Janse, Petersen, Inge, Awotiwon, Ajibola, Bachmann, Max Oscar ORCID:, Curran, Robyn, Murdoch, Jamie ORCID:, Ras, Christy Joy and Fairall, Lara (2022) Applying learning health systems thinking in codeveloping integrated tuberculosis interventions in the contexts of COVID-19. BMJ Global Health, 7 (10). ISSN 2059-7908

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The COVID-19 pandemic reversed much of global progress made in combatting tuberculosis, with South Africa experiencing one of the largest impacts on tuberculosis detection. The aim of this paper is to share our experiences in applying learning health systems (LHS) thinking to the codevelopment of an intervention improving an integrated response to COVID-19 and tuberculosis in a South African district. A sequential partially mixed-methods study was undertaken between 2018 and 2021 in the district of Amajuba in KwaZulu-Natal. Here, we report on the formulation of a Theory of Change, codesigning and refining proposed interventions, and piloting and evaluating codesigned interventions in primary healthcare facilities, through an LHS lens. Following the establishment and formalisation of a district Learning Community, diagnostic work and a codevelopment of a theory of change, intervention packages tailored according to pandemic lockdowns were developed, piloted and scaled up. This process illustrates how a community of learning can generate more responsive, localised interventions, and suggests that the establishment of a shared space of research governance can provide a degree of resilience to facilitate adaption to external shocks. Four main lessons have been gleaned from our experience in adopting an LHS approach in a South African district, which are (1) the importance of building and sustaining relationships, (2) the utility of colearning, coproduction and adaptive capacity, (3) the centrality of theory-driven systems strengthening and (4) reflections on LHS as a framework.

Item Type: Article
Additional Information: Funding Information: This research was funded by the National Institute for Health and Care Research (NIHR) Global Health Research Unit on Health System Strengthening in sub-Saharan Africa, King’s College London (GHRU 16/136/54) using UK aid from the UK Government to support global health research. This research was also supported by the National Institute of Mental Health (NIMH) (U19MH113191-01) which funds the Southern African Mental Health Integration (SMhINT) U19 hub.
Uncontrolled Keywords: covid-19,health services research,health systems,screening,tuberculosis,public health, environmental and occupational health,health policy,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2739
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 15 Dec 2022 03:55
Last Modified: 15 Dec 2022 03:55
DOI: 10.1136/bmjgh-2022-009567

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