Accelerating knowledge translation with a multilevel TB consortium: Strategies from South Africa

Abstract

This dissertation examines the Developing Innovative Solutions for Rapid Undoing of Pulmonary Tuberculosis (TB) Consortium (DISRUPT TB Consortium) in South Africa as a case study to understand how a multilevel research consortium can contribute to accelerating knowledge translation in global public health. Inefficient knowledge translation hinders the uptake of effective interventions into policy and practice, a critical challenge in South Africa given its high burden of TB. This research holistically examines the Consortium's design, function, and contributions to knowledge translation through three studies.The first aim entailed developing an explicit theory of change (TOC) model based on steering committee members' perspectives and analyzed its operationalization. The results indicated that the Consortium emphasized bringing together stakeholders and conducting strong demonstration studies in the first phase of work, with less focus on the scale and sustainability of the interventions. The study highlighted the importance of upfront planning for impact, including a detailed and regularly revisited TOC. The second aim employed an embedded comparative case study design to understand how the three provincial working groups (subunits within the multilevel consortium) functioned and managed challenges in the absence of explicit guidance. The findings revealed strong alignment in the PWGs' focus on supporting demonstration studies but a lack of alignment on other aspects of their mandates. The study results underscored the importance of clear definition of strategic objectives and structural decisions for the subunits to support those objectives. Recommendations from the study include clear conceptualization and documentation of subunits' mandate and structure, and regular performance evaluation of their function. The third aim again used an embedded comparative case study approach to examine the Consortium's contributions to the knowledge translation of the Targeted Universal Testing for TB (TUTT) and LINKEDin interventions. The results showed that the Consortium facilitated timely, relevant, and strong research; expedited the conduct of demonstration studies; and supported broad and targeted dissemination of results. The Consortium also experienced qualified success in ensuring the feasibility and consistent implementation of interventions across diverse settings, and missed opportunities to support the full knowledge translation lifecycle and leverage synergies between interventions. The case study methodology employed qualitative content analysis of semi-structured interviews with Consortium members and stakeholders as well as review of the Consortium's founding documents. The findings provide insights into the strengths, challenges, and opportunities for research consortia in facilitating the translation of research into practice. The dissertation highlights that collaborative partnership structures require strategic planning and maintenance at all levels (using a TOC or similar tool can be helpful). The research also underscores the complexities of managing multilevel structures and the importance of clearly defining the mandate and structure of subunits to ensure alignment with overall consortium objectives. Strategic objectives should inform structural decisions in a research consortium, and it is critical to document both, including assumptions, trade-offs and risk mitigation plans to the extent possible. Ultimately, this dissertation contributes to the knowledge base on how research consortia can contribute to facilitating knowledge translation, offering valuable insights for the design and evaluation of current and future research consortia aiming to improve health outcomes.