The UBOMI BUHLE project aims to improve the quality of care provided to pregnant women and newborns, by developing a pregnancy exposure registry that assesses the performance of public health therapeutic interventions such as antiretroviral therapy and their impact on maternal and birth outcomes in South Africa. This initiative will prioritize the assessment of the safety of ARV use as treatment and in the Prevention of Mother to Child Transmission (PMTCT) program, while implementing a series of health systems strengthening initiatives that will contribute to the creation of a sustainable surveillance platform. The project will prioritise monitoring the performance of dolutegravir-based antiretroviral therapy and its impact on maternal and birth outcomes. This work is being undertaken as a partnership between the provincial departments of health, academic institutions and supportive non-governmental organizations.
Implementers in 3 provinces in South Africa (click to expand):
Gauteng Province: ESRU
RMMCH, https://www.esru.co.za/Home/AboutUs.html is a regional mother and child hospital which functions as both a primary care and referral institution. There are approximately 15000-16000 babies delivered at RMMCH annually. The site is the only delivery facility in Region B of the City of Johannesburg district . RMMCH is linked to the University of the Witwatersrand (Wits) academic paediatric and obstetrics/gynaecology circuits. The hospital also houses the Wits University affiliated research unit Empilweni Services and Research Unit (ESRU) whose mission it is to “Investigate and implement evidence based best practice in health care by conducting world class and cutting edge research that is relevant to the local conditions to optimise outcomes of women, children and families in South Africa.” RMMCH provides care to patients from its immediate catchment area but also acts as a regional referral centre for high risk or complex neonatal, paediatric and obstetric/gynaecology cases.
Gauteng Province: WitsRHI
Shandukani Research Site, http://www.wrhi.ac.za/expertise/detail/shandukani-research-centre, is situated in Hillbrow, next to the Hillbrow CHC and Esselen Street clinics in the inner city of Johannesburg. The site has conducted work over many years with local clinics in the area, Charlotte Maxeke Johannesburg Academic Hospital, Sizwe Tropical Disease Hospital and various other district level hospitals across the Greater Johannesburg area.
The unit runs well-established research clinics across three floors in an easily accessible urban setting. The core focus of this unit is paediatric and maternal health, covering HIV, TB and vaccine preventable diseases including COVID-19. Both treatment and prophylactic studies are carried out at the site, which employs over 150 staff. The unit works with many international networks and pharmaceutical companies in order to assist solving health challenges particularly affecting African countries.
Gauteng Province: Wits VIDA
Wits VIDA Research Unit https://wits-vida.org/about/ conducts cutting-edge scientific research. Our aim is to continue to save lives across Africa and low and middle-income countries (LMIC) through translational research that informs local and global policy recommendations on infectious diseases and the use of next-generation and novel vaccines. Formerly known as the Respiratory and Meningeal Pathogens Research Unit (RMPRU) and founded in 1995, the Vaccines and Infectious Diseases Analytics (VIDA) Research Unit of the University of the Witwatersrand is an internationally recognised, African-led research unit in the field of epidemiology of vaccine preventable diseases, and clinical development of life-saving vaccines.
Under the guidance of Professor Shabir Madhi, a globally-recognised leader in the field of paediatric infectious diseases and the Dean of the Faculty of Health Sciences at the Wits University, Wits VIDA is conducting translational research on vaccine preventable diseases and training the next generation of clinician scientists.
KwaZulu-Natal Province
Prince Mshiyeni Memorial Hospital (PMMH) is a regional hospital in the South of eThekwini in KwaZulu-Natal. It is a 1075-bedded facility that serves the surrounding area, including part of the Eastern Cape. It is situated in Umlazi Township. The hospital offers health services to the community at regional and district levels and has 17 clinics attached; servicing both urban and rural clients, The hospital is one of the sites for PMTCT and has the largest crisis centre – now called the ‘Place of Comfort’. Prince Mshiyeni’s vision is to provide optimal health care to all patients in the catchment area. This is supported by the hospital mission and core values.
The UBOMI BUHLE (UB) Project is conducted at three PMMH feeder clinics; namely Umlazi D, Umlazi U21 and KwaMakhutha clinics. It has a complement of 9 ground level staff; comprising of the Project Manager, Data Manager, Site Manager/Nurse Mentor, Ultrasound Radiographer and 5 Data Capturers. One Data Capturer is assigned at each recruiting site and two are assigned at PMMH in the ANC High Risk clinic and the postnatal area. The ultrasonographer conducts ultrasound services at each recruiting site one day per week.
Participants are recruited at the 3 recruiting sites and followed up until they deliver. If there are any abnormalities or risk factors noted during the pregnancy, the participants are referred to PMMH ANC High Risk Clinic for management. All UB participants are encouraged to deliver at PMMH. If a baby is born with a congenital disorder, s/he is referred to the Genetics Clinic at Inkosi Albert Luthuli Central Hospital for further management.
UB staff offer comprehensive training modules to the antenatal care and labour ward nurses at UB sites, which assist with strengthening of the health system and capacity building.
Western Province: CIDER
The Cape Town PER was initiated in 2016 at Gugulethu Midwife Obstetric Unit (GMOU), https://www.westerncape.gov.za/facility/guguletu-midwife-obstetrics-unit a primary care obstetric facility with a catchment area including Philippi; Nyanga; Lower Crossroads; Heideveld and Gugulethu. GMOU provides antenatal services 5 days per week, and has a 24-hour, 7 days per week labor ward facility. Patients who require secondary and tertiary obstetric care are referred to Mowbray Maternity Hospital (MMH) and Groote Schuur Hospital (GSH), respectively. On average, there are 400 first antenatal visits (called “booking visits”) at GMOU every month, with approximately 200 women delivering at GMOU monthly, with the remainder being referred either antenatally or during labor to MMH/GSH for higher levels of care. ART is initiated in eligible pregnant women.
Pregnancy Exposure Registry (PER) data staff are embedded at GMOU and MMH and we visit GSH twice a week for data collection. Data are entered using routine provincial data collection platforms and housed by the Provincial Government of the Western Cape, being integrated into provincial data systems.
The Cape Town PER team comprises 4 data clerks, 1 research assistant, 1 part-time medical officer and the site principal investigator with input from the UBOMI BUHLE senior team and the provincial data services. The academic site is the Centre for Infectious Disease Epidemiology & Research (CIDER), a research centre in the School of Public Health at the University of Cape Town.
