Table 1

Case studies from the buddying programme (each representing one researcher–policymaker engagement)

TopicPolicy stagePolicy issueResponseImpactEvidence use20 Illustrative comments or quote from interviews
Depot medroxyprogesterone acetate (DMPA) and risk of HIV acquisitionProblem identificationDMPA most common hormonal contraceptive method in the province; policymakers requested a policy statement on the link between HIV acquisition and DMPA.With the help of a postdoctoral researcher, the researcher buddy produced a summary of four systematic reviews and shared it with the policymakers.Findings of the systematic reviews included in policy statement.Instrumental[Buddy] is somebody neutral who is an evidence specialist, [buddy] can verify what academics tell us.’ (Policymaker 7)
Wellness nutrition guidelinesFormulationNational government policy to improve healthy eating and increase exercise. Province designing implementation plan, had already decided on content, but wanted evidence on effective implementation.Researcher buddy advised on programme content initially, and then subsequently on implementation. The researcher buddy identified existing reviews on content and implementation and provided oral briefings.Some adaptations of the healthy eating guidelines.Symbolic‘…there was not much scope to provide evidence-informed inputs on types of interventions to include and so there was an element of using the evidence to try and enhance the included interventions. In some ways this was also about “endorsing” the included interventions.’ (Buddy 5)
Medication adherence for chronic diseasesFormulationNational government policy to increase medication adherence among people with chronic diseases, including both HIV and non-communicable diseases.Researcher buddy used the Cochrane medication adherence interventions review as basis for discussion, and they jointly prepared a summary document presented at a high-level meeting in the Provincial Department of Health.Research evidence identified potential adherence strategies.Instrumental We [policy-makers] would look for evidence here and there but it’s not formal academic work, so being linked to Centre for Evidence Based Healthcare for this purpose, I feel more comfortable because they’re experts in their field. If I said “I searched for evidence” I’d feel comfortable but if I say I worked with the Centre I feel more confident. So you know the difference between comfort and confidence in a setting like this is big.
(Policymaker 3)
Prevention of mother to child transmission of HIVFormulationThe 2014 updated national guidelines for prevention of mother to child transmission of HIV were released in June 2014. Province adapting it.Researcher buddy provided feedback on various circulars, most prominently on the draft guidelines using the AGREE II tool to score the guideline.The revised guidelines were based on the WHO guidelines, and adapted from South Africa National guidelines.SymbolicSuggestions included wording change in scope and purpose, more stakeholder participation (in particular patients), greater transparency for which stakeholders contributed to the development of the guidelines, rigour of development, inclusion of additional job aids and increased editorial independence.
Integrated care for chronic diseasesFormulationThe existing guidelines were due to be updated. Although not initially part of the Policy BUDDIES workshop, the policymaker reached out to the Policy BUDDIES team requesting the best available evidence on the issue.Researcher buddy provided an overview of a systematic review of continuity of care, as well as more recent systematic reviews.Policymaker found input useful.ConceptualThe policymaker reported reading the inputs from the buddy and finding them helpful, but felt they were still unable to interpret many of the findings without help.
Task shifting for delivering antiretroviral therapy (ART) to adults and childrenImplementationNational government policy gave nurses authority to manage ART in adults since 2012, but the policy had not been implemented.After discussion around the question, the researcher buddy presented an evidence summary of the Cochrane task shifting review, and another review on paediatric task shifting, at a provincial HIV and TB Policy Advisory Committee meeting.Policymakers reported this reassured them, helping them support the changes that the province had made and were implementing.SymbolicThe evidence showed that we were on track…. The scenarios in the systematic reviews were aligned with what the Western Cape was doing. The evidence gave us more confidence.’ (Policymaker 1)
  • AGREE II, Appraisal of Guidelines for Research & Evaluation Instrument; BUDDIES, BUilding Demand for evidence in Decision making through Interaction and Enhancing Skills; TB, tuberculosis.