Tshwane Insulin Project (TIP)

The Tshwane Insulin Project (TIP) is a partnership between the University of Pretoria and Lilly Global Health Partnership with the support of the South African National Department of Health, Gauteng Province and the City of Tshwane. The project was officially launched on the 19th of September 2018 in Pretoria, South Africa. However, actual implementation of the project started in January 2019.
 
TIP is a translational research program of a duration of 5 years that will focus on diabetes care and management at primary care level in the Tshwane District. The aim of the project is to optimise the control of blood glucose, blood pressure and lipids in people with type 2 diabetes. The goal is to develop evidence-based interventions adapted to the South African health system.
 
The Tshwane District is situated in the northern part of Gauteng Province in South Africa. Tshwane District is divided into seven sub-districts or health regions. It has a population of about 3,500,000. The district has a total of 68 health facilities that are managed by the City of Tshwane (local government) and the Gauteng Department of Health (provincial government). In South Africa, the majority of population who access health care through public health facilities are medium to low-income. They often do not have private medical insurance and rely on public primary care services that are free of charge.
 
The implementation of the project will be done in 5 phases:

  • Phase I: Identification of challenges and opportunities for insulin use in primary care;
  • Phase II: Review of the legal and policy framework for insulin use in primary care;
  • Phase III: Exploratory trial to test a new model of care to facilitate initiation and titration of insulin;
  • Phase IV: Stepped wedge cluster randomised trial;
  • Phase V: Implementation of the model of care into routine care.

 
Each phase has specific objectives that can be summarised as follows:
 
#1: To identify the barriers and opportunities for insulin initiation and titration at primary care level in the Tshwane District from both patients and healthcare providers’ perspective.
#2: To investigate the gaps and missed opportunities in the management of people with type 2 diabetes at primary care level in the Tshwane District.
#3: To conduct a critical review of current policy guidelines, relevant legislation and clinical practice on the initiation and titration of insulin in South Africa.
#4: To design and evaluate a novel model of care that facilitates insulin initiation and titration in primary care clinics in the Tshwane District.
 
Various activities will be conducted to achieve the program objectives including a Knowledge, Attitudes and Practices Survey, an audit of medical records, an interview of role players, a document analysis and a pilot study. During the course of the project, there will be various training workshops with health professionals and various engagement meetings with stakeholders.
 
The success of the project requires a strong collaboration with key partners including the South African National Department of Health as well as the local authorities which are Gauteng Province and City of Tshwane. The support of the partners will allow for the integration within the health system of the interventions developed through the project.

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