Research

My first book, Tuberculosis in India: A case of innovation and control (OrientBlackswan, 2015) investigates innovation dynamics in organizational, strategic, technological and service delivery aspects of Tuberculosis control in India from a Science and Technology Studies perspective. The extensive qualitative fieldwork in India is based on in-depth interviews with key stakeholders, documentary research and visits to various sites. It examines how attempts to innovate these different innovations in TB control need to be balanced with ongoing control work (aimed at controlling bacteria, drugs, patients, healthcare workers and data).

The second book, Making global health care innovation work: Standardization and localization (Palgrave Macmillan, 2014; with co-editors: Ine van Hoyweghen & Anja Krumeich) is an edition with chapters based on the best master theses co-authored with their supervisors of the first years of the Global Health Master programme at Maastricht University. It represents an initial exploration into the relationship between standardization and localization across different case studies in global health.

Research projects:

2020–2021 Qualitative research of novel urine LAM assay in Malawi and Zambia to inform WHO policy, funded by DZIF; with Claudia Denkinger (University of Heidelberg)

The aim of this project is to analyse aspects of values and preferences, acceptability and feasibility alongside a prospective accuracy study of a novel TB diagnostic which requires urine as sample (Fujifilm SILVAMP TB (FujiLAM)), and Omega’s Visitect CD4 point of care testing. The project uses qualitative research alongside the trial in Malawi and Zambia.

Project members include:

  • Nora Engel (Maastricht University)
  • Claudia Denkinger, Yannis Hermann, Federica Lainati, María del Mar Castro Noriega (University of Heidelberg)
  • Chanda Mwamba (Centre for Infectious Disease Research in Zambia (CIDRZ))
  • Moses Kumwenda (Malawi-Liverpool-Wellcome Trust Clinical Research Programme)

2020       User perspectives on nucleic acid amplification tests (NAATs) to detect tuberculosis and drug resistant tuberculosis, funded by WHO

This study involves a systematic review of qualitative evidence on ‘User perspectives on automated nucleic acid amplification tests of low-complexity for tuberculosis and tuberculosis drug resistance’ and a qualitative interview study on user perspectives on NAATS to diagnose TB and drug-resistant TB in India, Moldova and South Africa. Results were presented at the WHO guideline group meeting on “Nucleic acid amplification tests to detect tuberculosis and drug-resistant tuberculosis” on 7-18 December, 2020.

Project members include:

  • Nora Engel (Principal Investigator, Maastricht University)
  • Ricky Janssen (Maastricht University)
  • Muthoni Mwaura (Maastricht University)
  • Eleanor Ochodo (Stellenbosch University & Kenya Medical Research Institute)
  • Perpetua Wanjiku Karanja (Department of Health, Kenya)
  • Bey-Marrié Schmidt (South African Medical Research Council)
  • Karen Steingart (Liverpool School of Tropical Medicine)
  • Sandy Oliver (University College London, University of Johannesburg)

2019       User perspectives on Molecular assays intended as initial tests for the diagnosis of pulmonary and extrapulmonary TB in adults and children (PI, funded by WHO)

This study commissioned by WHO as evidence for the guideline making meeting evaluated user perspectives and experiences with regard to feasibility, preferences and values on molecular assays as initial tests for diagnosing TB. Together with Muthoni Mwaura, we conducted a qualitative study with participants in Ukraine, Uganda, Pakistan and South Africa. We interviewed clinicians, laboratory staff, programme officers, TB survivors, and patient advocates with the aim to understand their experiences of using Xpert and diagnosing TB using molecular diagnostics more generally and to contextualize users’ preferences. The results were presented at the WHO guideline group meeting on “Molecular assays intended as initial tests for the diagnosis of pulmonary and extrapulmonary TB in adults and children. Policy Update”, 3-6 December 2019.

 

2019–2020           Ease of use and acceptability of the STANDARDTM G6PD Analyser in point-of-care settings in Bangladesh, funded by Foundation for Innovative New Diagnostics (FIND Geneva)

with Foundation for Innovative New Diagnostics (FIND Geneva), Shafiul Alam (icddr,b Bangladesh), and Benedikt Ley (Menzies School of Health Research, Charles Darwin University)

Plasmodium vivax, in addition to blood-stage parasites, also generates dormant liver-stage parasites (hypnozoites) that can reactivate within weeks or months following a mosquito-born malaria infection and induce relapses. The currently available hypnozoitocidal drug, primaquine, can potentially cause severe drug-induced haemolysis in glucose-6-dehydronesae deficient (G6PDd) patients; a relatively common genetic disorder in many malaria endemic areas. Reliable and accessible testing for G6PD deficiency is an important part of the continuum of care for P. falciparum and P. vivax. 
Menzies School of Health Research, Darwin, Australia (Menzies) is leading a multicentre randomized, open label trial (PRIMA study) to compare the safety and efficacy of a high dose primaquine treatment in G6PD normal patients with P. falciparum to reduce the risk of subsequent P. vivax episodes compared with current standard practice of providing only schizontocidal treatment.
To screen patients for G6PDd and identify those with G6PD ‘normal’ status who can receive primaquine treatment the biosensor test was introduced. The PRIMA study allowed FIND to evaluate the proficiency of health workers in using this new test immediately after training, and how this proficiency is maintained over the entire study. In collaboration with FIND, we gathered user perspectives on ease of use, feasibility, acceptability and preferences with regard to the test using qualitative methods at one of the clinical trial study sites, in Bangladesh.

Team members included:

  • Nora Engel, Cristian Ghergu (Maastricht University)
  • Mohammad Shafiul Alam,  Mohammad Abdul Matin, Mohammad Golam Kibria ((icddr,b), Dhaka, Bangladesh)
  • Sandra Incardona, Xavier C. Ding, Rosalind E. Howes (Foundation for Innovative New Diagnostics (FIND), Geneva)
  • Kamala Thriemer, Benedikt Ley, Ric N. Price (Menzies School of Health Research, Charles Darwin University)

2019       User perspectives on urine LAM assay for the diagnosis of active tuberculosis in people living with HIV, PI funded by WHO

This study commissioned by WHO as evidence for the guideline making meeting evaluated user perspectives and experiences particularly with regard to feasibility, preferences and values on urine LAM assays for diagnosing TB in people living with HIV. Together with Muthoni Mwaura, we conducted a qualitative study with participants in Kenya, Uganda, and South Africa. We interviewed clinicians, nurses, programme officers, laboratory staff, and patient advocates with the aim to understand their experiences of using TB LAM and diagnosing TB among people living with HIV (PLHIV) more generally and to contextualize users’ preferences about a new diagnostic. The results were presented at the WHO guideline development group meeting on Lateral flow urine lipoarabinomannan assay (LF-LAM) for the diagnosis of active tuberculosis in people living with HIV: policy update (May 2019).

 

2015–2019          HIVSmart! HIV self-testing app transition to scale project

Co-PI with Prof. Nitika Pant Pai, McGill University, Montreal & Prof. Keertan Dheda, University of Cape Town, South Africa, funded by Grand Challenges Canada

Since 2015, I collaborate with Nitika Pant Pai (McGill University) and Keertan Dheda (University of Cape Town) (PIs) in the HIVSmart! HIV self-testing transition to scale project, funded by Grand Challenges Canada. I am responsible for the qualitative evaluation of the app-based self-testing strategy and Ricky Janssen, the PhD student on this project, conducts the ethnography of this diagnostic innovation.

 

2014-2018        ‘Fighting global infectious diseases locally’ VENI grant (personal innovational research incentives scheme) funded by Dutch Science Foundation (NWO)

As part of this personal career grant I have been investigating innovation processes of point-of-care diagnostics (mainly for TB and HIV) and the role that social science insights play therein. The aim of this project is to examine how innovators of point-of-care diagnostics and delivery programs incorporate local settings and how social science notions of ‘attuning-to-local-contexts’ mediate global health innovations.

 

2012-2014      Barriers to point-of-care testing in India and South Africa, funded by the Bill and Melinda Gates Foundation, with Madhukar Pai (McGill University)

Between 2012-2014, I conducted a collaborative research project with Madhukar Pai and Nitika Pant Pai (McGill University), Keertan Dheda and Malika Davids (University of Cape Town), and N. Devadasan and Vijayashree Yellappa (Institute of Public Health Bangalore) on Barriers to point-of-care testing in India and South Africa. I led the qualitative research part wherein we examined diagnostic practices across different points of care and by a variety of actors in the health systems of South Africa and India.

 

Ongoing PhD supervision

I am currently part of the PhD supervision teams of several PhD projects on: Quality of care for non-communicable diseases in rural India (Dorothy Lall); Evaluation of mHealth for HIV selftesting in South Africa (Ricky Janssen); Involvement of private practitioners in tuberculosis control in India (Vijayashree Yellappa); Implementation of patient rights in South India (Meena Putturaj); Evaluation of radical cure strategies for malaria vivax in Ethopia (Muthoni Mwaura) and Cambodia (Sarah Cassidy-Seyoum).