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Institute for Global Health and Development - Staff Profiles

Karina Kielmann, Senior Lecturer, IGHD

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Areas of interest

Public Health : Health systems in low- and middle income settings; human resources for health; access to TB and HIV care; TB/HIV co-infection; integration of health services; lay and informal health care providers; rapid diagnostic technologies.

Anthropology : medical knowledge and truths/uncertainty; illness as biographical disruption; ethics and ethnography

 

Overview

Karina is a medical anthropologist with training in anthropology and public health. She has 15 years of experience in research, teaching, and developing capacity for social science research in international public health settings.

Prior to joining IGHD in 2011, Karina was based at in the Department of Global Health & Development at the London School of Hygiene and Tropical Medicine (2001-2011) as a lecturer and senior social scientist advising on three successive DfID-funded programmes: the TB Knowledge Programme (2001-2006); the TARGETS RPC for Communicable Disease Control (2005- 2010) and the Evidence for Action RPC on HIV Treatment and Care (2006-2011).

 

Research

Karina’s current research is in two main areas, firstly, examining the ‘boundary work’ of community and lay health workers in Southern Africa and in India and secondly, investigating the social and health systems context of rolling out rapid diagnostic testing technologies in Southern Africa.

Active Research Areas Public Health : Health systems in low- and middle income settings; human resources for health; access to TB and HIV care; TB/HIV co-infection; integration of health services; lay and informal health care providers; rapid diagnostic technologies. Anthropology : medical knowledge and truths/uncertainty; illness as biographical disruption; ethics and ethnography

Funded Projects

Optimizing health systems to improve delivery of decentralized care for patients with drug resistant tuberculosis

Joint Health Systems Research Initiative (JHSRI) - The aim of the project is to identify opportunities for feasible, short to medium term interventions to improve decentralization of services for patients with drug-resistant TB (DR-TB) in South Africa. Supporting colleagues from the University of Cape Town's Department of Medical Microbiology, we will assess health systems factors that enhance or undermine the delivery of treatment for DR-TB, and determine what works and why it works, across different settings.

Whole systems of care for stroke patients China

This initiative, funded by the Medical Research Council, the Wellcome Trust, the Economic and Social Research Council and the Department for International Development, seeks to encourage research that addresses key questions on strengthening and improving health systems in developing countries. Co-investigators from QMU include Professor Brendan McCormack (Head of the Division of Nursing) and Guanyang Zou, who is a doctoral candidate in IGHD and is currently based at Sun Yat-Sen University in Guangzhoun, China. The 16-month project has been developed in collaboration with medical anthropology, nursing, and public health researchers at Sun Yat-Sen University to build evidence towards the development of a stroke care system for older adults in Guangdong Province.

Increased TB treatment adherence & improved outcomes in vulnerable groups in EEA (WHCA lead)

As part of a larger programme of work funded by the European Centre for Disease Control (ECDC) and World Health Communication Associates (WHCA) in partnership with the London School of Hygiene and Tropical Medicine (LSHTM), this project will provide preliminary evidence for the impact of a tailored Tuberculosis (TB) adherence support intervention upon interim treatment outcomes, and through process evaluation will report the challenges encountered in delivery of this intervention. This study is being carried out among specific hard-to-reach and vulnerable population groups in Riga, Latvia.

 

Teaching

Karina coordinates and teaches on the modules Health Systems, Global Public Health, and Health Workforce Development for Stronger Health Systems, and further contributes to the modules Researching Global Health & Development, Research Design & Proposal Writing, and Qualitative Research Methods.

Programme Leader for:

MSc Global Health, MSc Sexual and Reproductive Health, MSc Social Development and Health

Teaches on:

PG NM305 Global Public Health, PG NM217 Health Systems, PG NM303 Qualitative Research Methods

 

Supervision

Karina currently supervises or co-supervises 8 PhD candidates, many of whom are working on topics at the interface of medical anthropology and health systems, for example, the professional socialisation of community health workers in Pakistan, and health workers’ receptiveness to new rapid diagnostic tests for tuberculosis in South Africa. Karina welcomes applications from those interested in pursuing a PhD in the following areas:  medical anthropology; health systems research; bioethics; and human resources for health.

 

Selected publications

Books/edited volumes

(2013) Adelson, N., Butt, L., and Kielmann, K. (eds) Troubling Natural Categories: Engaging the Medical Anthropology of Margaret Lock.  Montreal: McGill-Queens University Press.

Journal Articles

1. (2016) Cataldo, F. and Kielmann, K. Qualitative Research to Enhance the Evaluation of Results-Based Financing Programmes: the Promise and the Reality. Health, Nutrition, and Population (HNP) Discussion Papre. Washington, DC: The International Bank for Reconstrucion and Development / The World Bank http://documents.worldbank.org/curated/en/2016/03/26012500/qualitative-research-enhance-evaluation-results-based-financing-programmes-promise-reality

2. (2016) Takemura, T., Kielmann, K. and Blauuw, D. Job preferences among Clinical Officers in public sector facilities in rural Kenya: a discrete choice experiment. Human Resources for Health. 14(1):1. doi: 10.1186/s12960-015-0097-0 http://human-resources-health.biomedcentral.com/articles/10.1186/s12960-015-0097-0

3. (2015) Edoka, I., McPake, B., Witter, S., Kielmann, K., et al. Are CHW programmes cost-effective in LMIC? INsights from a multi-country study in Kenya, Indonesia, and Ethiopia. Bulletin for the World Health Organisation 93:631-639. doi: http://dx.doi.org/10.2471/BLT.14.144899

4. (2015) Cataldo, F., Kielmann, K., Kielmann, T., Mburu, G., Musheke, M., ‘Deep down in their heart, they wish they could be given some incentives’: a qualitative study on the changing roles and relations of care among home-based caregivers in Zambia. BMC Health Services Research 2015, 10.1186/s12913-015-0685-7. http://www.biomedcentral.com/1472-6963/15/36

5. (2014) Furin, J., Isaakidis, P., Reid, AJ, Kielmann, K. ‘I’m fed up’: experiences of prior anti-tuberculosis treatment in patients with drug-resistant tuberculosis and HIV.  International Journal of Tuberculosis and Lung Diseases  18 (12): 1479-1484(6). http://www.ingentaconnect.com/content/iuatld/ijtld/2014/00000018/00000012/art00017?crawler=true

6. (2014) Kielmann, K., Datye, V., Pradhan, A., Rangan, S. Balancing authority, deference and trust across the public–private divide in health care: Tuberculosis health visitors in western Maharashtra, India, Global Public Health: An International Journal for Research, Policy and Practice, DOI: 10.1080/17441692.2014.94189 http://www.tandfonline.com/doi/full/10.1080/17441692.2014.941898#.VHyQ4DhyZoA

7. (2014) Kufa, T., Hippner, P., Charalambous, S., Kielmann, K., Vassal, A., Churchyard, GJ, Grant, AG, Fielding, K. A cluster randomised trial to evaluate the effect of optimising TB/HIV integration on patient level outcomes: The MERGE trial protocol. Contemporary Clinical Trials 39 (2): 280–287. http://www.sciencedirect.com/science/article/pii/S1551714414001499

8. (2014) Ferguson, L., Grant, AD, Lewis, J., Kielmann, K., Watson-Jones, D., Vusha, S., Ong'ech, JO, Ross, DA.   Linking women who test HIV-positive in pregnancy-related services to HIV care and treatment services in Kenya: A mixed methods prospective cohort study. PLoS ONE 9(3): e89764. doi:10.1371/journal.pone.0089764

9. (2013)  Isaakidis, P., Rangan, S., Pradhan, A., Reid, T., Ludmirska, J., Kielmann, K"I cry every day": experiences of patients co-infected with HIV and multidrug-resistant tuberculosis in Mumbai, India. A qualitative study. Tropical Medicine and International Health 18(9): 1128-1133.

10. (2012) Lees, S., Kielmann, K., Cataldo, F. & Gitau-Mburu, D.  Understanding linkages between informal and formal caregivers for people living with HIV.  Global Public Health 7(10): 1109-19.

11. (2012) Plagerson, S., Harpham, T., Kielmann, K.  Cash transfers and citizenship: evidence from South AfricaJournal of Development Studies 48(7): 969-982.

12. (2011) Dahab, M., Kielmann, K., Charalambous, S., Karstaedt, AS, Hamilton, R., La Grange, L., Fielding, KL, Churchyard, GJ, Grant, AD. Contrasting reasons for discontinuation of antiretroviral therapy in workplace and public-sector HIV programmes in South Africa. AIDS Patient Care and STDS 25 (1): 53-59.

13. (2010) Mortagy, I., Kielmann, K, Baldeweg, S., Modder, J. and Pierce, M. Integrating preconception care for women with diabetes into primary care: a qualitative study. British Journal of General Practice 60: 815–821.

14. (2010) Kudale, A., Salve, S., Rangan, S., and Kielmann, K. Health systems responses to the rollout of antiretroviral therapy (ART) in India: a comparison of two HIV high-prevalence settings. AIDS Care 22 Suppl 1: 85-92.

15. (2010) Kielmann, K. and Cataldo, F. Tracking the rise of the ‘expert patient’ in evolving paradigms of HIV care. AIDS Care 22 Suppl 1: 21 — 28.

16. (2010) Pradhan, A., Kielmann, K., Gupte, H., Bamne, G., Porter, J. and Rangan, S. What outliers tell us about missed opportunities in TB control: a cross-sectional study from Mumbai, India. BMC Public Health 10:263.

17. (2010) Joseph, S., Kielmann, K., Kudale, A., Sheikh, K., Shinde, S., Porter, JDH, and Rangan, S. Examining Sex Differentials in the Uptake and Process of HIV Testing in Three High Prevalence Districts of India. AIDS Care 22(3):286-295.

18. (2006) Datye, V., K, Kielmann, K. Sheikh, D. Deshmukh, S. Deshpande, J. Porter and S.Rangan. Communication between private practitioners and their patients around HIV testing in Pune, India: gaps in policy and practice. Health Policy and Planning 21(5): 343-352.

19. (2005) Kielmann, K., Deshmukh, D., Deshpande, S., V.Datye, J.Porter and S. Rangan. Managing Uncertainty around HIV/AIDS in an Urban Setting: Private Medical Providers and their Patients in Pune, India. Social Science and Medicine 61(7): 1540-1550.

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