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The Wellcome Trust

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Facing ethics: Identifying ethical issues in computational phenotyping research 30 Sep 2017

Computational phenotyping research uses big data methods to refine the diagnosis of rare genetic diseases. Photographs (and other biomedical data) of people with genetic syndromes are used to train machine-learning algorithms to identify the phenotypic features associated with different disorders. The data are obtained from consortia of clinicians and researchers involved in rare disease research, and directly from patients themselves through online direct participation initiatives. This research programme will identify ethical issues arising from the use of photographic images in computational phenotyping research. This grant will enable us to: a) undertake exploratory interviews with data–sharing consortium members and patient group representatives to determine their perceptions of ethical issues arising from the sharing and use of photographic data in phenotyping research b) undertake a scoping literature review concerning the use of photographs in (biomedical) research, and c) hold a meeting of Consortium members to disseminate and discuss findings of the pilot work. The expectation is that this will lead to a collaborative proposal that will develop an ethical position on the sharing of image data and explore research participants’ views of the use of their photographs and other data in phenotyping research.

Amount: £27,408
Funder: The Wellcome Trust
Recipient: University of Oxford

Wellcome Centre for Integrative Neuroimaging 30 Oct 2016

Understanding how interactions between neurons generate human behaviour, why individual brains vary from one another, or whether a patient is likely to develop a particular disease, requires explanations that span vast differences in scale. Yet such explanations are essential if insights from neuroscience are to make a meaningful impact on human health. Precise mechanisms discovered in animal models must be related to clinical phenotypes discovered through population studies; both must be combined to improve diagnosis and treatment in individual patients. Neuroimaging offers a powerful route to connect these different scales, providing measurements that are sensitive to cellular phenomena and that can be acquired in living humans. The WT Centre for Integrative Neuroimaging will enable novel insights into brain function that span levels of description, and therefore bridge the gap between laboratory neuroscience and human health. This will require fundamental discoveries concerning relationships between species and between scales, and major technological developments for mapping big-data discoveries onto neurobiological mechanisms. We will bring together diverse investigators who can tackle different themes within this grand challenge. Within each theme, neuroimaging will be used alongside complementary methodologies, ensuring that it takes inspiration from, and has impact on, areas beyond its typical reach.

Amount: £11,463,085
Funder: The Wellcome Trust
Recipient: University of Oxford

Health and economic benefits of water-sensitive revitalisation in informal urban settlements 06 Oct 2016

Urbanisation is a major demographic trend globally. Informal settlements account for much urban growth, exacerbating the inextricably linked challenges of sanitation, water provision, and public health. The conventional ‘big pipes’ solution to these challenges has changed little in 150 years, comes at major financial, environmental, and social costs, and frequently overlooks informal settlements. We have pioneered an alternative, water-sensitive approach that integrates sustainable design with the management of the water-cycle, benefiting human health and urban ecosystems. This decentralised, climate-change sensitive approach provides financial flexibility for multistage developments and adaptability to future technologies. It promises a solution to the water services challenges of informal settlements, yet has only been demonstrated in developed world settings. We will examine whether the water-sensitive approach can be applied to revitalise developing-world informal settlements to improve environmental and public health outcomes. Our evidence-based assessment of its efficacy across 24 settlements, poorly served by water infrastructure in Makassar and Suva, will deliver the first public health and environmental data on the benefits and risks of water-sensitive approaches. Our scientific, economic and implementation findings will provide the basis for profound changes to infrastructure policies, investments, loan strategies, and their sustainability across the Asia-Pacific and the developing world.

Amount: £8,472,026
Funder: The Wellcome Trust
Recipient: Monash University

‘Pre-embryos’ Revisited: a historical sociology of translational biology 02 May 2017

This project will revisit the debates on human fertilisation and embryology that took place after the release of the Warnock report in 1984 and ended with the enactment of the Human fertilisation and Embryology Act in 1990. Firstly, it will ask how developmental biologist Dame Anne McLaren (1927-2007) used the scientific concept of the ‘pre-embryo’ as a rhetorical device in the debates to make the case for the continuation of research. McLaren’s role as the only research scientist on the Warnock Committee, but also in public debate and in the scientific community offers insight into the translational dimensions of human embryo research. Secondly, the research will explore the legacy of the term ‘pre-embryo’ by asking practicing developmental biologists conducting research that begs for an extended limit on in vitro research on human embryos, to reflect on the term in order to suggest which lessons about biological translation can be taken from the debates in the 1980s, and to assess the usefulness of new scientific terms and concepts when engaging lay-audiences in scientific debates.

Amount: £135,903
Funder: The Wellcome Trust
Recipient: University of Cambridge

Visualizing Citizen Voice in a Moment of 'Big Data' 30 May 2017

Visualizing Citizen Voice in a Moment of 'Big Data'

Amount: £21,350
Funder: The Wellcome Trust
Recipient: University of Cambridge

Deep evolutionary history of bacterial pathogens 05 Jul 2016

How old are bacterial pathogens, and what evolutionary steps have they undergone? Comparative genomics can accurately resolve recent demography and genealogy of bacterial pathogens. Some historical pathogenic lineages have also been reconstructed by taking advantage of ancient genomes (aDNA), including the causes of plague, cholera, tuberculosis and leprosy. Although ground-breaking, these lineages were relatively easy to analyse using conventional tools due to limited genetic diversity and little recombination, and prior studies on existing genomic diversity. Generating a historical framework for most bacterial pathogens that currently threaten human health, and our food supply, is much more challenging because historical records do not provide unambiguous bacterial identification. Furthermore, the long-term population structure and genealogies of most bacteria are not well defined due to high levels of genetic diversity and frequent recombination, including Salmonella enterica. We will reconstruct the long-term evolutionary history of bacterial pathogens using both metagenomic data from ancient samples and population genetic data from present-day bacteria. We will use the latest developments in aDNA sequencing, develop new bioinformatic approaches for metagenomic analyses, and create a big-data overview of modern genetic diversity. This strategy will be implemented for S. enterica, and then applied to other pathogens.

Amount: £1,944,236
Funder: The Wellcome Trust
Recipient: University of Warwick

Using antibiotic resistance as an opportunity to tackle bad bugs 01 Sep 2016

The emergence of bacteria that can resist antibiotics is a major health emergency. Many advances in medicine, including organ transplantation, increased survival of pre-term infants, cancer chemotherapy and surgery are dependent on antibiotics that prevent or treat infection. Antibiotics work by targeting processes that bacteria use but humans cells do not. For example, penicillin stops bacteria making cell walls, which human cells do not have. This means that penicillin can attack bacterial cells but not human cells. Unfortunately, when bacteria become resistant these bacterial processes can no longer be targeted. The aim of this project is to use antibiotic resistance itself as a target for a new type of antibiotic. One of the most important types of resistance involves a bacterial enzyme that cuts up penicillin and similar antibiotics, and stops them from working. Dr Andrew Edwards and colleagues from Imperial College London will design new antibiotics that look similar to penicillin. However, when the enzyme cuts these antibiotics they will become lethal to the bacteria. In addition to killing resistant bacteria, the project team believe that this approach will also reduce damage to the good bacteria in the body, which are often harmed by conventional antibiotics.

Amount: £125,000
Funder: The Wellcome Trust
Recipient: Imperial College London

Dissonance. 20 Jan 2015

Dissonance uses the paradox of a puppet to explore current thinking into the social, emotional and cognitive processes that underlie mental-health and empathy in a direct and comical style. How can something so obviously not alive become so alive? Drawing on ideas such as Cognitive Dissonance (Leon Festinger) Terror Management Theory (Sheldon Solomon) and Fight or Flight (Walter Bradford Cannon) the performance features a punch-bag puppet suffering an existential crisis, embarking on an unfo rgettable odyssey through the doors of the human mind. Building on the scientific expertise of Dr. Nathan Heflick, University of Kent, School of Psychology, and his ongoing research, award-winning Strangeface will create an original piece of theatre to give the audience a greater awareness of their cognitive processes. Aimed at adults and played in a variety of venues the hour-long piece will have a programme of wider engagement online and in person. We will pilot the performance on ca mpus, in flagship arts venues and at a community venue for a Creative People and Places project, the ACE investment programme in areas where people's involvement in the arts is significantly below the national average. Developed concurrently the team will make a viral personality test to pique interest and gather data on the compelling desire to formulate narratives from objects. Written documentation, films and photographs will support the project and capture the process for future develop ment. Both challenging and empowering the work is ultimately a testament to the power of the imagination and the staggering potential of human beings.

Amount: £29,814
Funder: The Wellcome Trust
Recipient: Strangeface

We Cannot Unsee. 01 Oct 2014

As the British Film Institute stages a major retrospective of Science Fiction film, We Cannot Unsee asks: can science-fiction get closer to the lived, subjective experience of psychological disorders than written, codified scientific definitions, like those contained in DSM-IV? We Cannot Unsee is initiated and overseen by British Film Institute, in collaboration with no.w.here, University of the Arts, London and researchers based at Kings College London. The project takes its title from the d escription of someone suffering from Palinopsia, a condition whereby after images appear to linger - a prime example of a condition that begs to be explored via film, not words. We Cannot Unsee will result in a number of short, experimental films that explore the potential of science-fiction imagery and narratives to communicate the ways people experience a range of symptoms associated with psychiatric and brain disorders. With the support of no.w.here, a visual research and development labo ratory for artists, emerging artists (studying at or recently graduated from UAL colleges) will create films in collaboration with Vaughan Bell, Lidia Yaguez-Hervas, Zerrin Atakan from the Institute of Psychiatry Kings College and Pat Walsh from the Centre of Medical Law and Ethics. The project will also seek input from those who experience these symptoms first hand. By utilizing film - a visual form which offers alternative non-linear, non-verbal impressionistic ways to convey experience - We C annot Unsee aims to deepen our understanding of symptoms associated with pathopsychologies, and reassign agency to those who experience them.

Amount: £21,652
Funder: The Wellcome Trust
Recipient: British Film Institute

Development of novel small molecules for the treatment of antibiotic resistant bacterial infections 24 Jul 2013

Due to a dearth of new antibiotics in development, resistant bacteria are presenting a growing challenge to patients, physicians, and health organizations, resulting in higher patient morbidity and mortality as well as increased health system costs.For example, the alarming spread of newly emerging “CRE” (Carbapenem-Resistant Enterobacteriaceae) “super-bugs” threatens to become a global crisis. With an investment of $8.9M from the Wellcome Trust Translation Fund, VenatoRx is developing new antibacterial therapeutic products to address multi-drug resistant gram negative bacteria, including resistant E. coli, K. pneumoniae, and P. aeruginosa, important causative agents for complicated urinary tract infections, complicated intra-abdominal infections and many types of serious pneumonia.

Amount: £5,885,167
Funder: The Wellcome Trust
Recipient: VenatoRx Pharmaceuticals Incorporated

Understanding variability in systems pharmacology with application to drug target identification 31 Oct 2012

There is currently a big gap between understanding the molecular mechanisms ofbiological networks, identifying drug targets and predicting clinical outcomes of drug treatments in a heterogeneous population of patients. The goal of this project is to narrow this gap by developing a framework that combines mechanistic systems modelling, drug pharmacokinetics and patient variability in a unified fashion. This framework will enable us to make progress in understanding healthy and diseased network physiology, guide us to select optimal drug interventions andquantitatively predict the success of drug therapies on variable patient subpopulations. Specifically, I will develop a quantitative systems pharmacology (QSP) model of a nerve growth factor (NGF) signalling pathway using clinical and molecular data. I will extend the existing model to capture variability in the biological pathway as well as variability between and within individual patients. The model will be used to identify robust drugtargets and to guide aspects of quantitative drug discovery and development for treating paindisorders.

Amount: £97,576
Funder: The Wellcome Trust
Recipient: Imperial College London

Transforming tissue repair: ‘out-of-the-bag’ elastic meshes that accelerate wound repair 23 Jan 2014

Professor Anthony Weiss, University of Sydney, and collaborator Dr Rob Daniels of Elastagen, are developing a novel product to repair full thickness skin wounds arising from injury, surgery or disease. The product being developed is a mesh produced from elastin, a protein naturally present in the skin as fibres which are responsible for the skin's elastic properties.Elastin also plays an important role in the regeneration of skin tissue following injury; however, as we age our bodies lose the ability to produce sufficient elastin to support this repair process. Through this Wellcome Trust sponsored research and development program the elastin mesh product is being refined to optimise its physical and biological properties and its safety and efficacy will be evaluated in preclinical models.

Amount: £500,000
Funder: The Wellcome Trust
Recipient: Elastagen Pty Ltd

Institutional Strategic Support Fund 2012/13 17 Oct 2012

Neuroscience & Behaviour Leicester has clear strengths in neuroscience and behaviour research and our previous ISSF encouraged new appointments and substantial grant funding Genomes and ‘Big Data’ Genome variation and dynamics is a long-standing cornerstone of research excellence at Leicester. Stratified Medicine. Modern genomic and biomarker studies are revealing heterogeneity in susceptibility, prognosis and treatment responses of patients assigned to established diagnostic groups. Our previous ISSF award allowed us to invest in next generation sequencing and proteomic infrastructure to interrogate this heterogeneity Public Health Our Population Science and Diabetes research themes are central to Leicester’s contribution in bridging the second translational gap, converting preclinical and clinical research into public health outcomes. (ii) Facilitation of collaborative initiativesLeicester’s biomedical research strategy is driven through our College research themes. However, all themes have affiliates from other Colleges, with a specific Life-Sciences Interface Theme crossing our College and the College of Sciences and Engineering (iv) Public engagement strategyOur new ISSF award will allow us to develop and deliver a more focused public engagement (PE) strategy that will build upon the previous general good practice within our College. We will develop a coordinated plan via two complementary mechanisms

Amount: £500,000
Funder: The Wellcome Trust
Recipient: University of Leicester

Institutional Strategic Support Fund 2012/13. 17 Oct 2012

Recruitment and Career Development ISSF has funded start-up packages (equipment, PhD studentships, laboratory consumables and relocation costs) for the recruitment of outstanding biomedical researchers. These new recruits work across cell and molecular biology, bacteriology, immunology, parasitology and drug discovery. The ISSF has also been used to provide bridging support for researchers experiencing short-term funding gaps. This flexible and reactive support has enabled PhD students and investigators to generate data for key publications and successful grant/fellowship applications. Enhancement of Research Infrastructure The ISSF has supported our strategy to have innovative core facilities in key research areas and to develop computational and informatics resources that underpin our WT funded research. Software developers have been appointed to develop computational and informatics resources to support the outstanding mass spectrometry-based proteomics facility [http://www.lifesci.dundee.ac.uk/cast/fingerprints-proteomics-facility] in the School of Life Sciences. Novel ways of managing, visualising and analysing ‘big data’ in the field of quantitative proteomics have been developed, in addition to a customised Laboratory Information Management System (LIMS). Translational Research A flexible Translation Medical Research Fund (TMRF) was used to link the strongest basic and clinical research across the University of Dundee (2011-2014). Funding was awarded on a competitive basis and 25 different projects have been supported including; Pump-priming projects, Strategic projects that benefitted several groups across the University and increase overall institutional competitiveness in translational research; and translational medicine (non-clinical) PhD projects. Public Engagement The ISSF supports community engagement activities targeted at the next generation of scientists to enhance a culture of curiosity, confidence and engagement with science with our communities. A key aim is to increase awareness of Life Sciences Research in schools in areas of social deprivation to promote widening of access to opportunities in science. ISSF funds support the appointment of a School Outreach Organiser (this post greatly increases the quality and scope of our work and supports public engagement activities of our WT funded researchers); school projects; city and rural Science Festivals, the Dundee Women in Science Festival; projects to translate science into public art; an interactive display at the Dundee Science Centre; a Life Sciences career paths booklet and website (through interviews, time-lines and photographs); Open Doors Days; Magnificent Microbes and Marvellous Microbes activities; Café Science; Bright Club science comedy; public talks and debates. The impact of activities is assessed by questionnaires and reflective feedback discussions with stakeholders. We plan a quarterly public survey in Dundee to capture audience knowledge of the Life Science Research and Wellcome Trust activities. This will give us a measure of whether public engagement activities are reaching the community.

Amount: £1,000,000
Funder: The Wellcome Trust
Recipient: University of Dundee

The Dharavi Biennale. 28 Nov 2012

Background: More than half of Mumbai's people live in vibrant localities described by the loaded word slum. A previous Wellcome Trust Award supported Dekha Undekha (Seen and Unseen), a project in which mentor artists and local participants worked together to create a multimedia installation. Held in Dharavi, the city's most well-known informal settlement, Ghari/Ghar pe/At homewas an exhibition about health framed within a virtual home. Big idea: A 33-month programme, the Dharavi Biennale builds on this success. We want to give emerging local artists the opportunity to consolidate their conceptual, practical and leadership skills, bring in new participants, engage more deeplywith health issues, and emphasize sustainability. A series of standalone activities (Artboxes) within the whole will involve about 200 participants. The overarching theme will be recycling: artworks will use recycled materials and will address the health effects of recycled behaviours. Plan: In Year 1, we will build skills and consensus and conduct specific art workshops. In Year2, we will plan and then mount the Dharavi Biennale, an event that brings together multimedia work in an exhibition, performances, screenings and site-specific installations. We estimate a direct audience of 3000. In Year 3, we will emphasize participant autonomy and sustainability. Subgrants over the project cycle will support emerging artists in developing their own activities.

Amount: £137,699
Funder: The Wellcome Trust
Recipient: University College London

The Archaeology of Medicine Roadshow. 10 Oct 2012

The Archaeology of Medicine Road-show examines the historical impact of biomedical science by providing an interactive educational experience to fifteen schools across Cheshire & Merseyside to inform and educate approximately 1800 Key Stage 3 pupils and 11,000 members of the public about the history & archaeology of Roman and Anglo-Saxon medicine and medical practices in Britain from AD 43-1066. The project aims to foster interdisciplinary collaboration, being developed in partnership with educ ational experts, archaeologists, osteoarchaeologists and Museum practitioners and teachers. It will explore the historical impact of biomedical science, considering ideas and attitudes towards health, medicine and the human body in both Roman and Anglo-Saxon society. The project will create a range on multi-sensory, hands-on activities to allow young people to learn how medicine was practiced in Britain, what cures the practitioners of the day used, what factors affected how long people lived and the state of their health compared to life in the 21st century. This unique approach will reach new audiences not normally engaged with biomedical science. Upon completion of the school visits, the project will tour for five weekends in public sites, including the Museum of Liverpool, Birkenhead Priory & Museum and Epiacum Roman Fort. This unique approach will allow us to reach new audiences not normally engaged with biomedical science whilst testing new methods of engagement, participa tion and education. The Archaeology of Medicine Roadshow will provide a lasting legacy through the creation of a schools loan box and website offering educational resources.

Amount: £28,650
Funder: The Wellcome Trust
Recipient: Big Heritage CIC

The Archaeology of Medicine Roadshow - Extension. 30 Aug 2013

The Archaeology of Medicine Road-show examines the historical impact of biomedical science by providing an interactive educational experience to fifteen schools across Cheshire & Merseyside to inform and educate approximately 1800 Key Stage 3 pupils and 11,000 members of the public about the history & archaeology of Roman and Anglo-Saxon medicine and medical practices in Britain from AD 43-1066. The project aims to foster interdisciplinary collaboration, being developed in partnership with educ ational experts, archaeologists, osteoarchaeologists and Museum practitioners and teachers. It will explore the historical impact of biomedical science, considering ideas and attitudes towards health, medicine and the human body in both Roman and Anglo-Saxon society. The project will create a range on multi-sensory, hands-on activities to allow young people to learn how medicine was practiced in Britain, what cures the practitioners of the day used, what factors affected how long people lived and the state of their health compared to life in the 21st century. This unique approach will reach new audiences not normally engaged with biomedical science. Upon completion of the school visits, the project will tour for five weekends in public sites, including the Museum of Liverpool, Birkenhead Priory & Museum and Epiacum Roman Fort. This unique approach will allow us to reach new audiences not normally engaged with biomedical science whilst testing new methods of engagement, participa tion and education. The Archaeology of Medicine Roadshow will provide a lasting legacy through the creation of a schools loan box and website offering educational resources.

Amount: £18,880
Funder: The Wellcome Trust
Recipient: Big Heritage CIC

MetaboFlow - the development of standardised workflows for processing metabolomics data to aid reproducible data sharing and big data initiatives 16 Jun 2016

The processing and analysis of mass spectrometry and nuclear magnetic resonance spectroscopy data in metabolomics is largely performed on an individual basis following local laboratory methodologies. Metabolomics lacks reproducible computational workflows based on internationally accepted standard operating procedures and this is impacting on the field in terms of reproducibility of studies and subsequent sharing of data. Furthermore, with improvements in reproducibility in analytical equipment, individual laboratories are acquiring larger, more complex datasets, which are a significant challenge to process. We propose to build, test and deliver the cloud-based Galaxy workflow, MetaboFlow, which will have computational capacity to process datasets with 1000s of samples and simultaneously capture all metadata associated with the users’ data processing workflow to allow rigorous reproducibility. We will formulate the workflow using several popular processing, feature extraction and compound identification tools and provide functionality to readily use on-line databases including our international repository, MetaboLights. The tools will be selected based on our current survey of the international metabolomics community. This proposal is a re-submission following consultation with the Trust. Specifically we have developed and implemented a plan to capture the communities’ needs, and have made significant cost savings by integrating our work with other initiatives using Galaxy.

Amount: £141,515
Funder: The Wellcome Trust
Recipient: University of Manchester

The Roman Medicine Roadshow. 22 May 2014

The Roman Medicine Roadshow is designed to engage new audiences with the social and cultural history of medicine and health, engendering debate and discussion on health, social care, medical ethics, pseudo-science and faith healing in the ancient world and the 21st century. It also provides hands-on opportunities for young people to explore trauma, disease and healing through examining osteoarchaeological evidence and participating in 'live' surgery demonstrations based upon procedures documented in Roman medical texts and using reproductions of Roman surgical equipment. In addition, participants will examine the role of plants and herbal treatments in the ancient world, comparing ancient theories (such as humorism and miasma theory) to our modern understanding of the chemical properties of plants and their effects upon the body. The Roman Medicine Roadshow will significantly impact upon the teaching of 'Medicine Through Time' in schools across the UK and will capitalise on the recent changes to the National Curriculum for history at Key Stage 3, which from September 2013 allows schools to develop their own curriculum for historythat best meet the needs of pupils. This project will offer the highest quality of educational workshop to over 14,000 secondary school pupils from areas of socio-economic deprivation. Content will be developed with some of the UK's leading institutions with multi-disciplinary collaboration between archaeologists, osteologists pedagogic experts and delivered by a team of award-winning educational communicators. The project shares the vision of Big Heritage - We are passionate about education, the environment and our shared human past. As an award-winning non-profit organisation, we utilise the history and archaeology of Britain to educate, inspire and improve the lives of the people we work with.

Amount: £199,719
Funder: The Wellcome Trust
Recipient: Big Heritage CIC

Taking treatment of chronic lifelong conditions to scale: applying the positive deviance approach to health programme management. 25 Mar 2014

In sub-Saharan Africa, and in South Africa in particular, there are significant numbers of people living with HIV/AIDS. Increasingly, there are growing numbers of people who are also living with non-communicable disease such as diabetes and heart disease. Although HIV is infectious and diseases like diabetes are not, they share similarities in that they require lifelong management to ensure health. HIV treatment requires a consistent regimen of antiretroviral therapy (ART), while diabetes may require a change in diet as well as regular medication. For policy makers planning health care in South Africa, it is a big challenge to make sure that the state health system has a cost-effective plan to keep these people on treatment and accessing care throughout their lifetime. Although the South African government has made ART available free of charge, recent studies have indicated that many with HIV stop taking the drugs over time. This problem has worsened as the programme has expanded. This is dangerous for their health and is also worrying from a public health standpoint as it could lead to strains of the disease that are resistant to ART as well as increasing the chance of them passing the virus on. Significantly, some clinics dispensing ART have much higher rates of people continuing to pick up their treatment. This study aims to fill knowledge gaps about the factors that influence whether people stay in care, focusing on the ART programme in the Western Cape Province of South Africa. The results of the research will help us work with policy makers in the Department of Health and leaders of community-based organisations to design a larger project that will involve implementing a country-wide programme to achieve more continuous care for people with chronic lifelong conditions. The study will involve researchers from different disciplines who are trained in medicine, the analysis of health systems and policies, social anthropology, public health and pharmacy. We will adopt a method that analyses existing numerical data monitoring how regularly people are collecting the ART drugs at clinics, and other HIV-related data. This will be used to identify which health facilities are performing better than others in terms of keeping people on treatment and engaged in their clinical care. We will focus our work on facilities serving poor populations who are socially marginalised. We will then go on to do more in-depth research in a few facilities which we have assessed as "good performers" and "bad performers" respectively. We will look in more detail at the information about HIV care and also look at indicators of whether people with diabetes are staying in care, using diabetes as an example for non-communicable disease. We will also collect information by observing practices in clinics, and interviewing staff and patients. Interviews will be conducted with decision-makers in the provincial and national Departments of Health. We will investigate the reasons for differences in performance and identify constraints to positive performance. We suspect that the facilities that are managing to keep patients in care, have more innovative organisational practices and have in addition forged partnerships with community-based organisations. This can then help to better support people to take part in managing their chronic illness themselves as well. Such "selfmanagement" is an important factor in poorer settings where the health system cannot provide intensive support from health professionals. We will identify generic factors that are helping to keep people on ART in care and that, if adopted more generally, could contribute to improving care for other chronic conditions also. We will have a workshop with the Department of Health and other stakeholders to discuss how the lessons learned can improve the programmes for chronic disease at national level. This will assist in the design of a bigger intervention and a further research proposal.

Amount: £24,123
Funder: The Wellcome Trust
Recipient: University of Sussex