Epidemiology Training

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Strengthening National Capacity To Meet Growing Demands

“Field Epidemiology Training Programs (FETP) – in the tradition of CDC’s Epidemic Intelligence Service – may be the single most important thing CDC does in global health. These programs support public health surveillance, field epidemiology, and response activity within ministries of health. FETPs build the pool of public health professionals able to use science and data to effectively prevent, detect, and respond to infectious diseases of human and animal origin, environmental threats, and non-communicable diseases such as diabetes, heart disease, and cancer. FETP advisors, residents, and graduates are essential to creating human and institutional capacity and improving global health security.”
— Dr. Tom Frieden, MD, MPH, Director, Centers for Disease Control and Prevention

South Africa has one of the highest HIV prevalence rates in the world at 18.1%. To combat the epidemic effectively, strategic information must not only be accurate and timely but it must also be utilized by trained epidemiologists to guide program planning and implementation, sustain commitment, and ensure accountability. South Africa needs a highly skilled public health workforce at all levels of the government to monitor the epidemic by developing appropriate surveillance, surveys and health information systems and to evaluate the impact of prevention initiatives.

In addition, with the rapid scale up of HIV treatment in South Africa coupled with the growing need for HIV diagnosis and care, laboratory capacity must be strengthened to meet the demand.

The U.S. Centers for Disease Control and Prevention in South Africa (CDC South Africa), through its Global AIDS Program (GAP), works hand-in-hand with the National Institute for Communicable Diseases (NICD) and National Health Laboratory System (NHLS) to strengthen the epidemiologic and laboratory capacity within South Africa.

South Africa Field Epidemiology Training Program

The purpose of the South Africa Field Epidemiology Training Program (SAFETP) is to build global health security by enhancing South Africa’s capacity to prevent, detect and respond to public health threats through a 2-year training program in applied epidemiology, focused on supervised work experience and training to develop practical public health skills and knowledge.

Program Background

  • The SAFETP, launched in May 2006, is a collaboration between the South African National Department of Health (NDoH), the National Institute for Communicable Diseases (NICD) of the National Health Laboratory Services (NHLS), the University of Pretoria, and Centers for Disease Control and Prevention (CDC).
  • The program is jointly funded by the Presidents Emergency Plan for AIDS Relief (PEPFAR) through CDC’s Division of Global HIV/AIDS, with new and increasing funding and staffing support since 2010 from the Division of Global Health Protection.
  • The SAFETP is one of the four core programs that make up the South Africa Global Disease Detection Centre (SAGDDC), along with the International Emerging Infections Program (IEIP), Influenza, Program and One Health Program.

Program Focus

  • Residents participate in several core modules for their didactic training, and then work with a field supervisor for the remainder of the two years at a national, provincial, district or academic field placement site.
  • Residents develop competency in outbreak investigations, public health surveillance evaluation, statistical analysis, scientific communication, and hypothesis-driven epidemiology research.
  • Of the 65 residents enrolled from the start of the program, a total of 47 have completed the program requirements. 83% (39/47) of the residents achieved a Master of Public Health or Diploma of Public Health degree from the University of Pretoria.
  • A total of 44 SAFETP alumni have remained in South Africa and most are employed with the national, provincial or district Departments of Health.
  • In addition to the 2-year residency program, two field epidemiology short courses are presented annually by program staff, aimed at public health professionals from the different levels of the Departments of Health, who are involved in disease control, disease surveillance, outbreak investigations and data management. Planning is underway to convert the short courses to basic and intermediate courses in applied epidemiology for public health staff currently working for the government.

Recent Achievements

Outbreaks
  • July 2014: Active, laboratory-based surveillance identified an outbreak of candidaemia in a neonatal intensive care unit in Johannesburg. Candida krusei resistant to fluconazole was isolated from 48 neonates. Overcrowding and sub-optimal infection prevention and control practices were identified as risks for infection. Decreasing overcrowding and amphotericin B treatment were recommended.
  • January 2014: Investigation of diarrhea outbreak among patrons at a lodge in Limpopo Province identified Salmonella Enteritidis as the causative agent and drinking diluted fruit juice prepared in the lodge kitchen as the main exposure associated with illness. Specific feedback on food safety and hygiene practices to prevent cross-contamination during food preparation were provided to kitchen staff.
  • March 2013: Rapid response to investigate a case of Cholera in Limpopo Province confirmed that South Africa has improved its capacity to rapidly respond to outbreaks with staff and resources to diagnose and enhance cholera surveillance.
Conference presentations
  • Public Health Association of South Africa National Meeting, September 2014 (3 oral presentations).
  • African Field Epidemiology Network (AFENET) Conference, November 2013 (6 oral presentations, 2 oral/poster presentations).
  • University of Pretoria Faculty Research Day, August 2013 (2 poster presentations).
  • CDC Epidemic Intelligence Service (EIS) Conference, April 2015 (2 poster presentations).
  • Teaching Epidemiology in Public Health Network (TEPHNET), November 2012 (2 oral presentations, 4 poster presentations).

Key Challenges

  • Recruitment: Expand applicant pool of doctors and those with higher degrees and qualified staff from all levels of the National Department of Health of South Africa.
  • Supervision: Increase the level of experience of resident supervisors: currently less than 25% are SAFETP graduates or have similar applied/field epidemiology experience.
  • Outbreak investigations: Increase the quantity and quality of disease investigations.
  • Sustainability: Meet the need for field epidemiology training for public health staff and increase the proportion of program funding support from the South African government.

Opportunities for Integration and Advocacy

  • Increase access to surveillance data for analysis, progressive responsibility for outbreak investigations and provincial assignments with supervisory staff, so residents can focus on and develop expertise in national priority health issues, including gastrointestinal illness, pneumonia and influenza, TB, HIV, maternal and child health and non-communicable diseases.
  • Support epidemiology career path within the government for SAFETP graduates.
  • Highlight benefits of SAFETP for increased country ownership and request training support of higher degreed staff.
  • Ensure support for field epidemiology training at all levels of the public health system as part of the development of the National Public Health Institute of South Africa.