As outlined in the Business Plan for the current (Norming) phase of the CBTBR, our knowledge brokerage strategy proposed participation on three platforms: (a) the operational environment of the CBTBR; (b) interaction with the scientific community – contributing to and sourcing from the global knowledge pool; (c) knowledge translation to stakeholder groups such as policy makers and healthcare service providers, and to a lesser extent the health consumer. During 2007, efforts continued in the following areas:

The operational environment
Both nodes are actively involved in the sharing of knowledge amongst researchers within the CBTBR through lab meetings held at least weekly, where a hands-on approach is taken in assessing results and discussing lab-based problems. Journal Club meetings, held weekly at both sites, also provide the sharing of broader-based scientific issues and ideas within the field of biological sciences.

The IT services of the respective host institutions have provided a high level of service and security with selective authentication to databases on a LAN and knowledge is made more accessible to staff and students by provisions of computers, laptops and network points to the facilities and regular software updates. The development and implementation of an in-house Document Management System (DMS) has been achieved by the Research Manager, Dr. Baker, in 2007. This system will facilitate the sharing of administrative documentation and research findings between the two nodes and also operate at a level where specific research themes within the nodes can be discussed and shared.

Interaction with the scientific community
The CBTBR Website was launched in March 2006 and is regularly updated (www.tuberculosis.org.za). This site is hosted by the MRC and enjoys a presence on the SA HealthInfo knowledge network (www.sahealthinfo.org) module for TB, which is currently being converted into a true Internet portal by the MRC.

Expert consultation on XDR-TB
Direct patient and community benefit
Highly transmissible MDR and XDR strains have important implications for TB control, healthcare workers, patients and communities. The findings of our research have been communicated to the TB control program and to clinicians through presentations at several meetings in the region. Greater vigilance is required to contain the drug-resistant TB epidemic in all settings. This can be achieved by the development and implementation of rapid diagnostics, provision of appropriate therapy, ensuring treatment adherence and intensified screening of contacts. However, in order for diagnosis and treatment to be effective it is essential that communities are educated to improve health seeking behavior.

Since 2000, a CBTBR project, under the leadership of Prof. T. Victor, has involved a consultation with clinicians and the TB control program to study the drug resistant TB epidemic in 72 clinics in the Boland-Overberg-South-Cape–Karoo (BOKS) regions. More recently, we have developed a biometric fingerprint identification system that captures the thumb fingerprint and clinical information from the patient in a database which is directly linked between a clinic and the molecular laboratory at CBTBR. The system (three computers placed at different positions in the clinic and a main computer at CBTBR (Tygerberg) is established in a clinic in George as a pilot project to test the feasibility of using this technology for tracking patient visits, flow of clinical samples and managing patient records. It also provides molecular results of TB and drug resistance tests, entered at the laboratory at Tygerberg, in real-time to clinical staff at Lawaaikamp in a few days. It is therefore not only the patient that benefits directly but also the community as a whole and the TB control program. The newly developed biometric fingerprint identification system is also used to record everyone who passes through the clinic. This provides a dataset which will allow us to investigate various scientific aspects of TB epidemiology such as nosocomial transmission of the bacterium within an overcrowded clinic in a high incidence area. Similar overcrowded clinics are found throughout the region and it will be important to determine the degree of transmission between a patient and healthy individuals within these crowded clinics. In the CBTBR, we are currently using molecular DNA fingerprint typing on isolates collected from all TB patients that visit the clinic. Then, by linking the fingerprints of the isolates with the thumb fingerprints of any other individual that passed through the clinic on a particular day (together with other information in the database), we can determine whether transmission of a specific strain has occurred between patients and healthy individuals on that particular day. For instance we have captured fingerprints from about 900 individuals that passed through the clinic during the last month. The time window to accurately measure transmission in this kind of project must be at least two years without any interruption of data collection and analysis. 

We have successfully provided additional workspace at Lawaaikamp for this project. The activities of this project and that of the clinic and patients are very tightly linked. The additional TB area that is essential for our research activities, however, staff and patients at the clinic also benefit from these alterations. The CBTBR has provided a temporary nursing sister and also provides a car and the sister has successfully followed up MDR and XDR- patients who are reluctant to re-visit the clinic for treatment. The sister and car have made a significant contribution to serve as a link between DOTS-workers in the community and the TB clinic sister.

Knowledge translation to stakeholder groups
CBTBR members were involved in numerous public awareness activities countrywide in 2007:

• Public awareness, public engagement, and publicity
• Video clip to inform public on drug-resistant TB. Tommie Victor and Madeleine Hanekom from the SU node of the CBTBR were involved in making a video clip concerning drug resistant tuberculosis in consultation with the company Video Launch in Cape Town. Karl Bremer Hospital served as the TB hospital and actors played the roles of patients and health-care practitioners. The video describes how an individual can contract TB, the symptoms of drug susceptible and drug resistant TB, how the disease can be prevented and how susceptible and drug-resistant forms of TB can be treated with combinations of first and second line drugs. The focus then shifted to MDR and XDR-TB – what is meant by these terms, symptoms, how these forms of the disease can be treated and how to prevent transmission of strains of M. tuberculosis that are highly resistant to anti-tubercular drugs. The video was made in consultation with the Department of Health and will be used for training purposes.
• Public lecture on MDR and XDR-TB – Darwin Seminar Series. On June 6, Valerie Mizrahi presented a public lecture at the University of Cape Town on “Key Scientific Issues Pertaining to Multi- and Extensively Drug-Resistant Tuberculosis” at the University of Cape Town.  The lecture was part of the Darwin Lecture Seminar series hosted jointly by the Africa Genome Education Institute and the Department of Human Genetics of the University of Cape Town. A shortened version of her talk was published on the Op-Ed page of the Cape Times on Friday, June 8.
• There were a number of newspaper (Die Burger, Cape Times, Sunday Times, Rapport) and radio interviews (some live), involving Profs. van Helden and Victor in particular, e.g. in Die Burger oo 24 July, 2007 and in the Argus on 6 September 2007.
• In May 2007, Dr. Kana was interviewed by SABC Radio for a program on general TB awareness. He also hosted a journalist on her site visit to the Wits node and discussed innovative ways to understand basic scientific concepts.
• Prof. Mizrahi’s Order of the Mapungubwe: Silver Award attracted considerable media attention locally both in terms of TB awareness and the advancement of women in science in South Africa.
• On 4 October, 2007, Prof. Mizrahi was interviewed in Paris for a film that is being made to commemorate the 10th Anniversary of the L’OREAL-UNESCO For Women in Science Awards. As Laureate for Africa and the Middle-East Region for 2000, Prof. Mizrahi was in Paris to serve together with past Laureates and others on the International Jury for the 2008 L’OREAL-UNESCO Awards. This film will be screened at the 2008 Awards Ceremony, to be held in Paris on 6 March, 2008, and will be distributed widely for television broadcast around the world.

Dr. Bhavna Gordhan was profiled on the MRC Website (www.mrc.ac.za) for the period of 28 May – 3 June 2007 for public awareness as part of their Capacity Development Programme.

Team Members are frequently called on to provide information to the public by responding to questions about TB that are submitted via email and telephone calls. The following illustrates a typical example: “I would like to know about the investigations that are done to determine whether a human being is infected with Bovine TB or not. Secondly can you be infected through drinking milk? What is the treatment for humans?”

Outreach activities

TB awareness community outreach
On 30-31st August, Prof. Victor together with 6 members of the CBTBR and Dr. Kristin Kremer from National Institute for Public Health and the Environment in the Netherlands (an international expert), visited the study site in George to raise awareness about this serious disease and to inform the community about our activities at the clinic. The focus was on what cause the disease, symptoms, diagnosis, the fact that the disease can be treated, how drug resistance develops and how everybody in the community have a responsibility to get this disease under control. On one evening during the visit, an informal cocktail party was held at the Lawaaikamp clinic, with fruitful discussions with local community leaders. To convey the message we played the “role of actors” and made use of an interactive tuberculosis exhibition that was developed at the CBTBR for this purpose. On 31 August, about 200 school children and TB patients in the immediate vicinity of the clinic were involved during a sport day organised in associated with the local healthcare workers. We provided prices for the winners and certificates and snacks for all the participants. Spot prizes were also handed out for those who could correctly answer a question about tuberculosis and HIV. Throughout the event the some of CBTBR members manned a TB awareness exhibition. The event was a great success and has made an impact on the community. Continued awareness will be a powerful tool to fight against this disease.

Other outreach activities
The role that Prof. V. Corfield plays in outreach activities has almost become the stuff of legend. She is extensively involved in HIV awareness in schools and communities and each year runs science workshops at the Grahamstown Festival and MTN Science Centre. She recently developed a TB-specific exhibit – “The Trouble with TB…” – which was show-cased for the first time in 2007.

Outreach activities conducted primarily by Prof. V. Corfield

• DNA, HIV, ENZYME WORKSHOPS
  During the course of 2007, the three workshops “HIV comes to the party”, “The DNA Detective, what’s in your genes?” and “Enzyme Antics” developed by Prof Corfield were presented at a number of venues across the country, not only by her, but also by others who have been trained in the past. The workshops in which she and members of CMCB were involved are detailed below.
  • 5-7 February Prof. Corfield accompanied Mrs. K. Ramahlape (MRC Community Liaison Officer) on a road show to the Eastern Cape. “DNA Detective: what’s in your genes” Workshop was given to learners in Zwelitsha (King Williams Town) and to FET educators in Bizana (wrap-up of SAASTA Public Understanding of Biotechnology grant).
  • 20 February “DNA Detective: what’s in your genes” workshop given to educators at the Primary Science Programme, Philippi.
  • 20-27 March SASOL SCIFEST Grahamstown. Aided by Mrs. Ramahlape, Dr. Craig Kinnear and Mr. Hilton Donson (all MRC) each of the three workshops “HIV comes to the party”, “The DNA Detective, what’s in your genes?” and “Enzyme Antics” was presented daily. The workshops received an award in the category of “Outreach”.
  • May 11 “HIV comes to the party” presented three times in presence of American students studying Global Health. 1. Learners at Beth-al School for Epileptics. 2. Kalkfontein Primary. 3. Labourers at Shadowlands plant nursery (all in Kuilsriver).
  • May 12-19 National Science Week. HIV comes to the party”, “The DNA Detective, what’s in your genes?” and “Enzyme Antics” presented to learners thoughout the week.
  • July 9 and 11 “DNA detective: what’s in your genes?” and “Enzyme antics” given to primary school children from Kalkfontein attending winter holiday programme.
  • 22 July “HIV comes to the party” given to educators attending Cape Teachers’ Institute enrichment programme in Kuils River.
• LINK initiative and “HIV comes to the party”
  LINK is an initiative established by Dr. E. Stellenberg (Dept of Nursing, US) which aims to establish Kuils River as a socially and economically empowered community- a model town in a transformed South Africa. In 2007, Dr. Stellenberg and Prof. Corfield were awarded a Community Interaction Research grant by the University of Stellenbosch to implement and assess an HIV education intervention in Kuils River. Three young facilitators from the community were trained to give “HIV comes to the party” workshops. With the full co-operation of the education department, these are presently being given to children in every grade (R-Matric) in every school in the area. It is anticipated that more than 16 000 learners will be reached. Research to assess the impact of the workshop and retention of knowledge is being undertaken by Stellenberg and Corifield.
• Origins Centre, University of the Witwatersrand
  Prof. Corfield has been asked to give a series of workshops about DNA and its use in tracing human ancestral roots and the origins of man to educators and facilitators at the Origins Centre. Workshops were given on 13 March and 28 June. In addition, she has been asked to write an educators’ book about DNA in the Centre’s “Threads of Knowledge” series.
• “The skin you’re in” exhibition
  In 2007, Prof. Corfield developed an exhibition entitled “The skin you’re in”. This highly interactive exhibition for the general public looks at the skin as an organ in health and disease, and examines the history of the development of skin pigmentation, and how skin colour has been used in discrimination.
  
  It was first shown at National Science Week (NSW) in the Western Cape and a duplicate version was produced for simultaneous display in rural KZN NSW by Mrs. Ramahlape. It was officially launched at SASOL SCIFEST in March 2007, where it received an award in the “Best 6” category. It was also displayed at the Faculty of Health Sciences Research Day in August.
  
  Currently, an application is under review with an American Trust to secure funding for an upgraded display.
• “The Trouble with TB…..” exhibition
  With the assistance of post-graduate students in CMCB and funding from the CBTBR, an exhibit which aims to engage the general public was designed to explore the science of the pathogen and how TB becomes multidrug and then extremely drug resistant. The importance of adhering to the treatment regime is emphasised. This exhibition has travelled to George with Prof. T. Victor for the “TBAwareness community Outreach Day” and was displayed at the SU Faculty of Health Sciences Research Day in August, where it received the Wasserman floating trophy for best scientific exhibit.