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Lehana Thabane Neil Andersson, Mokgweetsi Masisi, Anne Cockcroft

Building capacities of elected national representatives to interpret and to use evidence for health-related policy decisions: a case study from Botswana. Lehana Thabane Neil Andersson, Mokgweetsi Masisi, Anne Cockcroft. Learning objectives.

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Lehana Thabane Neil Andersson, Mokgweetsi Masisi, Anne Cockcroft

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  1. Building capacities of elected national representatives to interpret and to use evidence for health-related policy decisions: a case study from Botswana Lehana Thabane Neil Andersson, Mokgweetsi Masisi, Anne Cockcroft

  2. Learning objectives • To briefly discuss the goals of the ADAPT 2 (African Development of AIDS Prevention Trial Capacity) programme; • To discuss the training objectives for the Botswana MPs' training; and • To discuss the guiding principles used in the training.

  3. What is ADAPT? ADAPT stands for African Development of AIDS Prevention Trial Capacity Led by CIET (Centro de Investigación de Enfermedades Tropicales): http://www.ciet.org/en/ "Community Information and Epidemiological Technologies” in USA “Community Information, Empowerment and Transparency” in Africa and Europe Under the directorship of Dr Neil Andersson, CIETcanada/University of Ottawa http://www.cihr-irsc.gc.ca/e/41979.html • Funded by an HIV/AIDS Prevention Trials Capacity Building Grant from Canada's Global Health Research Initiative

  4. ADAPT 1 Investigators: PI: Neil Andersson, CIET/University of Ottawa Co-PIs: Shea B, Wilson T Co-I: Fonn S, Sanders D, Mshinda H, Thabane L, Wells G, Coyle D, Caldwell D Aims: to increase the capacity of the individual African researchers to increase the capacity of the African institutions to establish a framework for an African-led, multi-country AIDS prevention trial to facilitate the development of a multi-country AIDS prevention trial

  5. The focal point is 10 countries in Sub-saharan Africa

  6. Why Sub-saharan Africa?

  7. (http://www.unaids.org/documents/20101123_2010_HIV_Prevalence_Map_em.pdf)(http://www.unaids.org/documents/20101123_2010_HIV_Prevalence_Map_em.pdf)

  8. ADAPT 2 investigators • Principal Investigators: • PI: Neil Andersson • Co-PI: Kenneth Matengu • Co-PI: Beverley Shea • Co-Investigators • Lehana Thabane • Anne Cockcroft • Christina Zarowsky • Adrian Puren • John Lengwe Kunda

  9. Aims of ADAPT 2 • Increase the capacities of African researchers in 12 southern African countries to contribute to large high quality RCTs on AIDS prevention; • Increase the institutional capacity in an African NGO and at least two African universities to train people to conduct AIDS prevention RCTs; • Build on the multi-country RCT logistical framework of ADAPT1, that allows for both cluster allocation and intervention cohorts, including the ethical and logistical infrastructure. • Increase the capacities of African policy makers and planners to interpret and to use the findings of research, in particular the findings from RCTs. • Develop further fundable RCT proposals and partnerships that can move AIDS prevention RCTs forward beyond the life of this project

  10. Training the Botswana MPs in evidence-based planning At the invitation of the Minister of Presidential Affairs Mr Mokgweetsi Masisi (former ADAPT 1 fellow)

  11. Map of Botswana and some statistics Districts: - 10 rural and 6 urban Population (2008): - 1,700,000 Literacy rate (2008): - 15-24 years old: 93.9% National funds on HIV: - 2007: 203.8 million USD Total Health Expenditure: - 2009: 10.3% of GDP

  12. Training objectives • To train members of the parliament: • To use evidence in policy making • To understand the language of evidence • How to interpret research evidence • What questions to ask about evidence

  13. Training staff • Dr Neil Andersson, CIET/University of Ottawa • Dr Anne Cockcroft, CIET • Dr Lehana Thabane, McMaster University

  14. The guiding principles used in the training • Keep it simple • An overview of evidence in planning, filling the evidence gaps, questions to ask about evidence, language of evidence • Understanding the landscape of MPs’ thoughts about evidence • Letting the MPs determine the agenda: Striking a balance between what we think and what they think they need to know • Being sensitive to the culture and political climate in the country • Evaluation of the training

  15. The training schedule was over 1.5 days

  16. Overview of evidence in planning • Presented by Dr Neil Andersson • Covered issues such as • Understanding measures of impact • Hierarchy of evidence • Use examples MPs can relate to. Eg. Male Circumcision

  17. Global aim: To provide some insight about MPs’ thoughts • Specifically, • Your feelings about evidence • Where do you as MPs most need to handle evidence? • What or who do you think is the best source of evidence? • Difficulties you face in using evidence • What do you think can help and in what way? • What would you most like to learn about to help you to deal with evidence?

  18. An example of the response

  19. We then asked MPs to write 2-5 words or terms that they usually see in evidence reports and would like to know what their meaning

  20. The language of evidence • MPs provided a list of terms to explain • We supplemented the list with what we thought they need to understand • List included • Randomized controlled trial • Systematic review • NNT • Incidence, prevalenvce • Error • Bias • Accuracy

  21. Filling the evidence gap • Questions that MPs need to ask: Examples • What is the NNT? • What is the unit cost? • Determining areas where the gap exists • Evidence maps: showing geographical variation

  22. Questions to ask about evidence: MPs presented with different scenarios which varied by • The relevance of the evidence to the setting • The quantity of evidence • The quality of evidence • The strength of the evidence • The hierarchy of evidence 26

  23. Some remarks • Botswana MP training is likely the first of its nature in the region • ADAPT philosophy • Combines theory and practical training in RCTs • Builds local capacity in RCTs to develop culturally relevant solutions to inform AIDS prevention policies • Small step in the right direction to • Increase the capacities of African policy makers and planners to interpret and to use the findings of research, in particular the findings from RCTs • The evaluation was generally positive • Provides good feedback to learn from the experience • Areas/groups of focus for future training

  24. The trainees!

  25. That’s me using my hands to teach! And blessing the MPs

  26. SPECIAL Thanks! Many thanks to CIET faculty, Dr AnneCockcroft—for her incredible work in putting together the survey questionnaire within a very short time Thanks to CIET staff—for collecting the information Special thanks to my students Rachel Chu and Jinhui Ma for graphying the data

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