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Students engaged in interactive small-group learning, February 2014

Knowledge Translation Unit / PALSA PLUS

The Knowledge Translation Unit (KTU) at the University of Cape Town Lung Institute has leveraged the scale-up of HIV and TB programmes to develop, implement and test interventions combining integrated clinical practice guidelines with educational outreach to primary care nurses, to improve the recognition and management of patients with respiratory diseases and HIV: the PALSA PLUS Programme.

In essence, the programme combines user-friendly clinical practice guidelines with a modified cascade training programme, that sees nurse middle managers equipped as outreach trainers. In turn these nurse managers deliver short focused interactive training sessions to all health facility staff, repeated over several months. The guideline and training materials backed by a ‘train the trainer’ cascade model enables a rapid upscale of nurse training and a consequent increase in appropriate treatment and referral of patients. This approach has been proven to improve quality of care and health outcomes and has been widely implemented throughout South Africa reaching more than 19,000 health workers in two thirds of the country’s clinics. The programme has been enthusiastically received by practitioners and managers as the guideline is easy to use and integrates an approach to common conditions, and the training model causes little disruption to facility services. More recently PALSA PLUS has been expanded to include all common chronic conditions and symptoms among adults attending primary care: a 3-year trial of Primary Care 101 in the Eden and Overberg districts of the Western Cape is drawing to a close, and pilot implementation has been also completed in three further provinces, with a national rollout of the expanded programme planned. Adaptations of the PALSA PLUS and Primary Care 101 programmes have also been implemented in Malawi, Mexico, Brazil, Botswana (as part of the MEPI award to the University of Botswana) and the Gambia.

To meet the SURMEPI long term goal of improving clinic al competencies of undergraduate medical students with regards to TB and HIV, during 2012 and 2013 the KTU adapted and tested its PALSA PLUS programme, widely implemented as an in-service training programme for primary care staff, among medical undergraduates during the IVth year theoretical module on Clinical Immunology and Infectious Diseases.

www.knowledgetranslation.co.za

Dr Lara Fairall
Head of KTU
MBChB, PhD

Lara Fairall is the founding head of the KTU. She is a clinician scientist and expert in the design and conduct of pragmatic cluster randomised controlled trials in less developed country primary care settings, specifically those which investigate how to improve the quality and integration of primary care for priority conditions including HIV/AIDS, tuberculosis, non-communicable diseases, and mental health. She has published over 30 peer-reviewed publications and led the development of educational interventions to improve the quality of primary care in South Africa and other African countries. She is currently the co-Principal Investigator of a NIMH-funded trial to improve the quality of primary care for people on lifelong ART. She is a founding member of the National Heart Lung and Blood Institute (NHLBI) Collaborating Center of Excellence in South Africa – the Chronic Disease Initiative in Africa (CDIA). In 2011, she was recognised as one of South Africa’s Top 200 Young South Africans in the health category by the Mail and Guardian.

Gill Faris
MPhil Education, ACE (Advanced Certificate in Adult Education), Dip Nursing (General, Midwifery, Oncology & Psychiatry)

Gill Faris has a background in psychosocial oncology and life-skills training in the private and public health sectors. She joined the Knowledge Translation Unit in December 2005 as a programme developer and nurse trainer. She has brought her facilitation, training and considerable expertise in adult education to the design and implementation of the programmes offered by the KTU. She recently completed a masters degree. This analytical case study uses Activity Theory to better understand the complexity of the multiple organisational layers, the interactions and relationships within organisations.

Dr Ruth Cornick
MBChB, DCH, MPH
GUIDELINE DEVELOPER

Dr Ruth Cornick has a background in family medicine and joined the Knowledge Translation Unit in 2005 as a guideline developer, trainer and researcher. Her most recent clinical experience involved integrating TB, HIV and ARV care in a primary care setting which formed the foundation for her masters thesis, and contributed towards strengthening the integration of the these diseases in the PALSA PLUS guideline and training programme. She has led the expansion of the PALSA PLUS guideline to address other common symptoms and priority chronic diseases among adults, including cardiovascular disease and mental health problems (Primary Care 101). She represents the Knowledge Translation Unit on the Western Cape Department of Health’s Chronic Diseases Reference Group. Ruth’s role in SURMEPI is to lead guideline revision, co-ordination of guideline correlation with current policies and policy changes, adaptation of training materials, assisting with training of trainers and design and composition of student exam paper.

Lauren Cawood
B.Cur (General, Psychiatric, Community and Midwifery), Dip Primary Health Care (Nursing)

Lauren Cawood joined the Knowledge Translation Unit in May 2014 as a Nurse Trainer. She studied a Bachelor of Nursing Science (B.Cur) at Stellenbosch University and completed a Primary Health Care Diploma through the University of KwaZulu Natal in 2008. She also has a higher certificate in Nursing Management and a certificate in the management of patients on Antiretroviral and Tuberculosis treatment. Lauren has worked as a Community Project Manager for a Non-Profit Organisation in KwaZulu Natal and more recently as a Facility Manager at a Community Health Centre in the Western Cape. Her particular interest is Primary Health Care and she has experience in Management, Strategic planning, System implementation and Training design and implementation.

Jani Brett Driskell
Cert Shorthand, Cert Personal Assistant, Legal Office Practice and Business, Communication/Administration

ADMINISTRATOR

Jani Brett Driskell is an experienced office administrator and executive personal assistant who joined the Knowledge Translation Unit in 2006. She co-ordinates all training workshops and is responsible for the training database, and distribution of guidelines and training materials to trainers. She provides academic support, sourcing publications and co-ordinating documentation compilation for manuscript submission.

Farieda Carter

Farieda Carter is an experienced receptionist, telephonist and administrative assistant. She joined the Knowledge Translation Unit in April 2011 to assist with data management, data collection, data capturing and issuing of certificates. Farieda supports the fieldworkers and trainers in the field with any IT or data related queries. She is also assisting with the Unit’s electronic guideline (ePACK).

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	Dr Lara Fairall Head of KTU MBChB, PhD Lara Fairall is the founding head of the KTU. She is a clinician scientist and expert in the design and conduct of pragmatic cluster randomised controlled trials in less developed country primary care settings, specifically those which investigate how to improve the quality and integration of primary care for priority conditions including HIV/AIDS, tuberculosis, non-communicable diseases, and mental health. She has published over 30 peer-reviewed publications and led the development of educational interventions to improve the quality of primary care in South Africa and other African countries. She is currently the co-Principal Investigator of a NIMH-funded trial to improve the quality of primary care for people on lifelong ART. She is a founding member of the National Heart Lung and Blood Institute (NHLBI) Collaborating Center of Excellence in South Africa – the Chronic Disease Initiative in Africa (CDIA). In 2011, she was recognised as one of South Africa’s Top 200 Young South Africans in the health category by the Mail and Guardian.
	Gill Faris MPhil Education, ACE (Advanced Certificate in Adult Education), Dip Nursing (General, Midwifery, Oncology & Psychiatry) Gill Faris has a background in psychosocial oncology and life-skills training in the private and public health sectors. She joined the Knowledge Translation Unit in December 2005 as a programme developer and nurse trainer. She has brought her facilitation, training and considerable expertise in adult education to the design and implementation of the programmes offered by the KTU. She recently completed a masters degree. This analytical case study uses Activity Theory to better understand the complexity of the multiple organisational layers, the interactions and relationships within organisations.
	Dr Ruth Cornick MBChB, DCH, MPH GUIDELINE DEVELOPER Dr Ruth Cornick has a background in family medicine and joined the Knowledge Translation Unit in 2005 as a guideline developer, trainer and researcher. Her most recent clinical experience involved integrating TB, HIV and ARV care in a primary care setting which formed the foundation for her masters thesis, and contributed towards strengthening the integration of the these diseases in the PALSA PLUS guideline and training programme. She has led the expansion of the PALSA PLUS guideline to address other common symptoms and priority chronic diseases among adults, including cardiovascular disease and mental health problems (Primary Care 101). She represents the Knowledge Translation Unit on the Western Cape Department of Health’s Chronic Diseases Reference Group. Ruth’s role in SURMEPI is to lead guideline revision, co-ordination of guideline correlation with current policies and policy changes, adaptation of training materials, assisting with training of trainers and design and composition of student exam paper.
	Lauren Cawood B.Cur (General, Psychiatric, Community and Midwifery), Dip Primary Health Care (Nursing) Lauren Cawood joined the Knowledge Translation Unit in May 2014 as a Nurse Trainer. She studied a Bachelor of Nursing Science (B.Cur) at Stellenbosch University and completed a Primary Health Care Diploma through the University of KwaZulu Natal in 2008. She also has a higher certificate in Nursing Management and a certificate in the management of patients on Antiretroviral and Tuberculosis treatment. Lauren has worked as a Community Project Manager for a Non-Profit Organisation in KwaZulu Natal and more recently as a Facility Manager at a Community Health Centre in the Western Cape. Her particular interest is Primary Health Care and she has experience in Management, Strategic planning, System implementation and Training design and implementation.
	Jani Brett Driskell Cert Shorthand, Cert Personal Assistant, Legal Office Practice and Business, Communication/Administration ADMINISTRATOR Jani Brett Driskell is an experienced office administrator and executive personal assistant who joined the Knowledge Translation Unit in 2006. She co-ordinates all training workshops and is responsible for the training database, and distribution of guidelines and training materials to trainers. She provides academic support, sourcing publications and co-ordinating documentation compilation for manuscript submission.
	Farieda Carter Farieda Carter is an experienced receptionist, telephonist and administrative assistant. She joined the Knowledge Translation Unit in April 2011 to assist with data management, data collection, data capturing and issuing of certificates. Farieda supports the fieldworkers and trainers in the field with any IT or data related queries. She is also assisting with the Unit’s electronic guideline (ePACK).