Dr. Stephanie Topp conducts health systems research as part of a range of health system strengthening initiatives around the world, including most recently in Zambia. As a chief investigator on the Zambia Prisons Health Systems Strengthening Project, she looks to use health systems research to inform policy and program initiatives that tackle systemic weaknesses in prison health care and which make it impossible to contain infectious diseases including tuberculosis and HIV.
Health systems research is multi-disciplinary. For example, as part of her prison work, Dr. Topp participated in several rapid epidemiological assessments to better understand the prevalence of TB and HIV in Zambian prisons. The results of these assessments (published here) demonstrated that rates of HIV in one of the largest prisons in Zambia was 27.4% while rates of TB were more than double that of the local population.
To ensure high quality and accessible healthcare that can effectively and sustainably address this high burden of disease, Dr. Topp led a team to identify major policy and administrative barriers to establishing screening, diagnostic and treatment services in prison – and was able to identify four major constraints (published here) that have become the focus of policy reform work with members of national parliament.
Health systems research also encompasses exploratory and explanatory work utilizing participatory action and ethnographic techniques. In the case of the Zambian prisons project, Dr. Topp again partnered with ZPS and prisoner groups to examine what combination of environmental, relational and institutional factors were influencing facility-level access to services in male and female prisons. Research published here and here has provided critical evidence of the need for organizational and culture change among prison authorities, as well as much needed material investment, if high risk behaviours and health service access for prisoners are to be improved.
As part of a recent Lancet review team, Dr. Topp was able to highlight many of these important points in work published as part of a special edition focusing on TB and HIV among prisoners globally.
Dr. Topp (second fr. Left) with the Zambia Prisons Project Team and Member of Parliament Hon. Michael Kaingu (Centre)
The ZaPHSS Project Team with Lusaka Central Prison Health Committee participating in the 2015 Labor Day March.
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