Public Health Medicine PhD Graduate Ready to Make Good Use of All She has Learned

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The effectiveness of Quality Improvement (QI) methods in enhancing the integration of HIV and TB services as well as which organisational contextual factors heighten the success of QI initiatives were investigated in a doctoral thesis.

The study was done by research psychologist and public health specialist, Dr Santhanalakshmi Gengiah who graduated with a PhD in Public Health Medicine.

‘With my PhD in hand, my aspirations are to implement in a real-world setting with all that I have learned,’ said Gengiah.

‘I am very proud of this achievement and truly grateful for all the support that I received from CAPRISA, UKZN, UKZN DRILL, my supervisors - Dr Marian Loveday and Professor Myra Taylor - family and friends,’ she said.

Her thesis was titled: The Association of Organisational Contextual Factors and TB-HIV Service Integration Following Exposure to Quality Improvement (QI) Interventions in Primary Health Care (PHC) Clinics in Rural KwaZulu-Natal (KZN).

‘QI methods offer a simple and cost-effective solution to improving the quality of services to patients and streamlining the work of healthcare workers,’ said Gengiah.

Her project involved a cluster randomised controlled trial that provided QI intervention to 20 clinics to improve HIV/TB services and also observed another 20 clinics which received standard of care supervision and support for integrating HIV/TB services.

Said Gengiah: ‘The QI intervention was successful in improving HIV testing rates, TB screening rates, viral load coverage and the initiation of Isoniazid Preventive Therapy. The study was beneficial to the clinics and healthcare workers that participated, in that it provided them with QI skills and tools which can be used to improve all aspects of service delivery.

‘Healthcare workers (HCWs) are a valuable resource and in most primary healthcare facilities, nurses are driving the HIV care and treatment programme,’ she said. ‘Given the large numbers of HIV and TB patients and the many demands placed on HCWs to deliver high quality care, it is inevitable that there is burnout and lack of motivation among our HCWs. I saw potential in this project to address an important gap in how HCWs can be empowered to cope with increasing demands and deliver good quality care.’

Gengiah’s study required close collaboration with Department of Health clinics and the careful building of trust with healthcare workers. ‘It was challenging to work with very busy Department of Health clinics and to keep HCWs motivated to participate in the study while they had to do their jobs at the same time,’ she said.

‘Fortunately, we had a very dedicated research team and motivated KZN district managers who consistently and dedicatedly worked on this study and saw its potential value.’

Gengiah, currently a Public Health Specialist for the US Centers for Disease Control (CDC) based in South Africa, began her research career at CAPRISA in 2007, going on to coordinate several clinical trials and studies, all of which, were aimed at reducing mortality in HIV and TB patients.

‘I grew my research skills and knowledge primarily during this time and am fortunate to have had the experience of working with an organisation that always aims to be at the cutting-edge of research,’ she said.

‘In the last few years, there has been a steady emergence of implementation science research as an important field in bridging the gap between research and implementation.’

She said her study, part of a major project at CAPRISA, provided her with an opportunity to progress from study coordinator to a researcher.

Gengiah enjoys reading, travelling to new places and finding unusual and interesting food experiences.

Words: Nombuso Dlamini

Photograph: Abhi Indrarajan