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Using mathematical modelling to re-think global pneumococcal immunisation strategies. 18 Oct 2017

Despite the success of pneumococcal conjugate vaccines (PCVs) two major challenges remain. First, serotype replacement has mitigated PCV impact and pneumococci remain a predominant cause of child death. Second, PCVs are among the most expensive vaccines, which threatens sustainability in low income countries as they transition from Gavi support. The fellowship addresses those issues using a combination of epidemiological, statistical and modelling techniques and the collection of key data that leverages ongoing studies. I plan to use machine learning to unravel drivers of heterogeneity in the global serotype distribution of pneumococci, which will enable inference of pneumococcal epidemiology in settings with limited data. I will then use constrained optimisation on models that include the dynamics of serotype replacement into their predictions to inform design of more efficient PCVs that can further reduce the global pneumococcal diseases burden. I further plan to use a set of novel models to estimate who infects infants, a key knowledge gap in the assessment of reduced dose PCV schedules, an approach being pursued as a potential cost saving strategy. Phylogenetic inference in combination with mathematical models will be used to identify common transmission pathways to infants and risk factors associated with them.

Amount: £1,097,366
Funder: The Wellcome Trust
Recipient: London School of Hygiene & Tropical M...

Designing fit-for-purpose regulation for evolving healthcare systems 30 Nov 2017

Healthcare markets in low- and middle-income countries (LMICS) are undergoing dramatic change, with private sector expansion, emergence of new organisational forms and business models, and growing foreign investment. The regulation systems in these countries are inadequate and ill-suited to manage these challenges and future market evolution, and rarely incorporate modern perspectives on regulation which highlight the need for "responsive", "smart" and risk-based regulation, drawing on an expanded range of regulatory strategies, tools and actors. We aim to understand the challenges that recent developments in LMIC healthcare markets pose for effective regulation. We will review recent trends in private sector development and regulation systems in 3 LMICs with rapidly changing healthcare markets. We will assemble a group of scholars and policymakers with expertise in regulatory theory and implementation in a set of middle- and high income countries. We will debate appropriate theoretical frameworks and methods for studying regulatory developments, and consider what concepts and lessons might be relevant to LMICs (taking into account differences in resources, institutions, health systems, and history) and identify critical research questions. Outputs will be a network of scholars, an agenda setting paper, and a proposal for a larger scale project to take these ideas forward.

STRONGER-SAFE: Understanding transmission and optimising interventions for an enhanced S.A.F.E. strategy for trachoma elimination 05 Apr 2017

Trachoma is the leading infectious cause of blindness worldwide. It is intrinsically linked to poverty in both cause and effect. Preventing blindness from trachoma has broad and profound impact on health and well-being. It is caused by repeated infection with Chlamydia trachomatis (Ct). The WHO-endorsed SAFE-Strategy aims to control infection through annual, single-dose, community-wide azithromycin treatment coupled with Water/Sanitation/Hygiene (WASH) and fly-control measures to suppress transmission. However, particularly in hyperendemic regions, the current approach is not having the anticipated impact. There are two critical issues. Firstly, current azithromycin schedules appear insufficient. Secondly, transmission routes are poorly defined and the very limited evidence-base makes it hard to focus WASH interventions and guide programmatic decisions. We propose the following: 1) Conduct intensive observation of human behaviour and hygiene practice, and fly behaviour, combined with Ct infection mapping, to identify major routes of transmission. 2) Develop and test contextually appropriate, practical, targeted WASH and fly-control approaches to interrupt Ct transmission. 3) Our modelling work indicates double-dose azithromycin two weeks apart is much more effective in controlling Ct. In a cluster-randomised trials we will test whether intensified double-dose treatment coupled with targeted transmission-interrupting strategies can control trachoma more effectively.

Amount: £3,785,335
Funder: The Wellcome Trust
Recipient: London School of Hygiene & Tropical M...

Development of an early intervention to support babies with Congenital Zika Syndrome and their families 15 May 2017

On February 1, 2016, Zika virus (ZIKV) was designated as a Public Health Emergency of International Concern by the WHO. ZIKV has now spread to 72 countries and territories, including in Asia, Africa and the Americas. It is now clear that congenital infection with ZIKV in the first trimester can cause microcephaly, and these cases have already been reported in 20 countries. In Brazil, there are 2975 cases of microcephaly suspected of being related to ZIKV . Congenital infection with ZIKV is also linked to other congenital abnormalities, besides microcephaly, including: neurological conditions , ophthalmic abnormalities , hearing loss and bone and joint disorders . Congenital Zika Syndrome therefore extends beyond microcephaly alone. The full spectrum of conditions is not yet known, nor is there an accurate estimate of prevalence of Congenital Zika Syndrome. Congenital Rubella and CMV infection also cause neurological sequelae, including microcephaly, and for these conditions there are approximately twice as many children born with other impairments than those born with microcephaly. , Congenital Zika Syndrome is therefore likely to be at least twice as common as microcephaly alone.

Provision of Seed Grants for Supporting Research in the Ebola Epidemic Region 15 May 2017

These funds will support a research-funding budget, for smaller scale researchon the ground in the epidemic zone. This would be able to cover 3-6 local projects under the guidance of Professor James Grover Whitworth. (Any proposals that are larger in scope or cost should be referred to the Trust to consideration for funding). Following the initial period, the team will ensurethat research can continue along with surveillance as the health systems are rebuilt in the region.

A platform for the transgenic modification of Sandflies (Lutzomyia longipalpis) and Triatomine bugs (Rhodnius prolixus) towards deriving insect vectors refractory to disease agents mediated by CRISPR-Cas9 gene drive 05 Sep 2017

Vector borne pathogens Leishmania, and Trypanosoma cruzi cause devastating human disease (Leishmaniasis and Chagas disease respectively). We contribute to a new strategy by genetically modifying insect vectors, sandflies (Lutzomyia longipalpis) and triatomine bugs (Rhodnius prolixus), leading eventually to transgenic insects resistant to disease agents. We will use two different transgenic approaches, piggyBac and CRISPR-Cas9. PiggyBac is a method for semi random insertion of exogenous DNA into the genome. CRISPR-Cas9 is a new and highly targeted method to manipulate genes in a manner not previously possible. Microinjection of insect embryos with piggyBac plasmids to obtain insects expressing fluorescent markers for subsequent CRISPR-Cas9 knockout experiments facilitating easy monitoring of outcomes. Knockout of fluorescent markers (above), using CRISPR-Cas9 constructs, demonstrating that system components are functional and that we can precisely target genes of interest. Knockout of endogenous genes by CRISPR-Cas 9 that are non-essential or important in sustaining infection in insect vectors. Insertion and expression of exogenous DNA (fluoresence markers) using CRISPR-Cas9 harnessing homology directed repair facilitating inheritance to offspring at levels above mendelian inheritance (gene drive). Pilot outputs offer real prospects for developing powerful approaches of interrupting disease transmission.

Community based interventions to improve HIV outcomes in adolescents: a cluster randomised trial in Zimbabwe 05 Apr 2017

HIV infection is the leading cause of mortality among adolescents in sub-Saharan Africa. Adolescents are the only group in which HIV-associated mortality is rising despite the global scale-up of antiretroviral therapy (ART). Adolescents fare disproportionately poorly across the HIV care continuum compared to other age-groups: the prevalence of undiagnosed HIV is substantially higher, and coverage of and adherence to ART is lower, resulting overall in worse virological outcomes. Current services are thus insufficient for achieving optimal outcomes, and complementary strategies are required to meet the UNAIDS 90-90-90 targets. The aim is to investigate whether a community-based, multi-component intervention incorporating HIV prevention, HIV testing, ART initiation, and ongoing adherence support, can improve virological suppression rates among HIV-infected adolescents in a high HIV prevalence setting The objectives are to: Carry out a cluster-randomised trial in Zimbabwe comparing a) facility level HIV services with b) facility-based services plus the community-based intervention. The primary outcome will be proportion of HIV-infected adolescents in the community with an HIV viral load Evaluate the cost and cost-effectiveness of the intervention. To conduct a process evaluation of the intervention’s implementation, to inform components required for sustainability and scalability

Amount: £3,126,109
Funder: The Wellcome Trust
Recipient: London School of Hygiene & Tropical M...


Context: Blinding corneal infections (Microbial keratitis, MK), caused by bacteria or fungi, are a major ophthalmic public health problem in low and middle-income countries. There are multiple critical issues: delayed presentation, traditional eye medicine use, limited health-worker training, limited availability and efficacy of anti-fungals, diagnostic uncertainty. Eyes are lost through progressive corneal ulceration and perforation, mediated by human and pathogen-derived proteases. Proposed Research: Randomised controlled trial (RCT) of topical chlorhexidine 0.2% vs. topical natamycin 5% for fungal keratitis. Pilot trials of chlorhexidine, a cheap and readily available antiseptic, suggest it might be at least as effective as natamycin (current standard). RCT of topical ilomastat 0.08% vs. placebo, to reduce corneal perforation from MK. Ilomastat, a potent matrix metalloproteinase inhibitor, reduced severe ulceration in animal models and earlier human clinical trials. Full-scale treatment trials are needed for translation into practice. Cluster RCT of early intervention package (topical chlorhexidine, smartphone-assisted diagnosis, treatment, referral support) vs. standard practices, to reduce blindness from MK through reducing delay between infection onset and initiating intensive treatment, with an agent covering fungi and bacteria. Evaluation of diagnostic approaches for identifying causative organism in MK (clinical, automated image-analysis, confocal microsopy, PCR) and testing potential isothermal point-of-care tests.

Amount: £3,117,091
Funder: The Wellcome Trust
Recipient: London School of Hygiene & Tropical M...

Immunity dynamics and epidemiology of cross-reactive pathogens 22 Feb 2017

Infections such dengue fever, Zika and influenza generate a substantial public heath burden. It is therefore crucial to understand the biological mechanisms driving individual-level infection and immunity, and how these shape population-level epidemiological dynamics. However, such viruses can cross-react with antigenically similar pathogens, which makes it challenging to analyse immune responses and the implications for future outbreaks. This project aims to address this knowledge gap using a combination of novel mathematical methodology and empirical data. First, I plan to quantify the contribution of different biological mechanisms to observed antibody responses against arboviruses and influenza. In particular, I will combine a unique longitudinal study of dengue and Zika in Fiji with novel mathematical models to reconstruct individual infection histories, and examine potential interactions in immune responses to these viruses. The work will also generate statistical tools for next generation seroepidemiological study design. This will make it possible to perform power calculations when pathogen cross-react and/or assays lack sensitivity/specificity. Finally, I will investigate how herd immunity generated by prior infection history shapes the antigenic evolution of influenza and re-emergence of arbovirus strains. This will improve our understanding of pathogen invasion and potential for future outbreaks.

Estimating the burden of dengue, chikungunya and Zika in Latin America 19 Apr 2017

Since the mid 1990s, Latin America has seen a resurgence of arboviral disease. All four serotypes of dengue are now endemic and recent invasions of chikungunya and Zika viruses threaten to also persist. New strategies are urgently needed to combat co-circulation of arboviruses and the diseases they cause. Estimates of arbovirus burden are crucial to ensure these new strategies are optimally prioritised, targeted, measured and evaluated, however traditional passive surveillance suffers some key systemic biases. This research aims to improve the estimates of arboviral burden in Latin America by quantifying the main biases and gaps in passive surveillance data. This will be achieved by comparing passive data to equivalent metrics generated from applying mathematical and statistical models to community-based seroprevalence and routine laboratory testing data. Final burden estimates disaggregated by virus, disease severity, country and year since 2010 will be generated by leveraging information from multiple data types and propagating their uncertainty. Engaging Ministries of Health to explain, investigate and ultimately improve these estimates will be an important final output to achieve impact. Beyond the project, these burden estimates can be used to design rational strategies against what is rapidly becoming the biggest public health priority in Latin America.

E cigarettes:history, evidence and policy 30 Sep 2017

The role and regulation of electronic cigarettes is currently a matter of widespread public and policy debate . Forms of regulation have varied by country even though the scientific research is common to all countries . What has led to this disjuncture between science and policy? This project builds on existing discussion and preliminary examinations of the subject from the three initial collaborating countries, the UK, the US and Australia. These three countries have taken a different national stance to e cigarettes regulation and harm reduction through nicotine. Our hypothesis is that these divergences build on historical differences between the 3 countries over tobacco and in health policy more generally. Our key goals are: 1.To undertake outline research in the three countries according to a common format to examine the recent science policy relationship in the area of e cigarettes . 2. To hold a workshop in the UK involving public health interests and policy makers involved with e cigarettes to feed into the research. 3.To hold a meeting of country participants in London to discuss research outlines, develop an initial publication and a plan for a funded programme of comparative historical policy research in a wider range of countries.

Vacation Scholarships 2017 - London School of Hygiene & Tropical Medicine 16 Jun 2017

Vacation Scholarships 2017 - London School of Hygiene & Tropical Medicine

The trends in the usage of blood pressure lowering medication during the period 2000-2015 27 Apr 2017

High blood pressure is a leading cause of cardiovascular deaths worldwide. This risk factor has become so common that it has been declared a global public health crisis by the World Health Association. Despite availability of evidence-based and cost-effective drugs, uncontrolled high blood pressures remain a problem. Thus, it is important to understand how these drugs are used at the population level, as this may help understand some of the reasons for uncontrolled blood pressures. The Clinical Practice Research Datalink is a repository of electronic health records from primary care in the UK. A prepared dataset of ~1 million people using BP lowering medication between 2000-2015 will be used. This dataset includes information on number and types of blood pressure lowering drugs individuals used per year, in addition to demographic factors. I will analyse the following trends over time; 1) the prescribing frequency of certain categories of blood pressure lowering drugs, 2) the mean number of drugs per person and 3) polypharmacy in the treatment of high blood pressure. My key goal is to learn how to conduct a research study, and to make a high quality contribution to our knowledge on prescribing for the treatment of high blood pressure.

Evaluating the World Health Organization-Europe’s Evidence Informed Policy Network 25 May 2017

In 2012, the World Health Organization Regional Office for Europe (WHO-Europe) launched the Evidence Informed Policy Network Programme (EVIPNet-Europe) to promote evidence-informed policy-making (EIP) in its member countries. EVIPNet-Europe facilitates establishment of Knowledge Translation Platforms (KTPs) in each member country, comprised of government policy-makers. KTPs are then supported toward using evidence to design and implement national health policies. The overall aim of my Secondment Fellowship project is to evaluate EVIPNet-Europe, and by doing so contribute to knowledge on how to most effectively use research evidence to influence policy. The key goals of the project will be: To evaluate EVIPNet-Europe in selected WHO-Europe countries using a quantitative monitoring and evaluation framework. Outputs will include a report for WHO-Europe and a journal article. To qualitatively analyse the impact of EVIPNet on policy-making, identifying factors that influence this impact. I will use a case study of alcohol policy in Moldova, gathering perspectives of local policy-makers on EVIPNET’s effectiveness, acceptability and sustainability in their context. Outputs will include a report for WHO-Europe and a journal article. To gain personal experience of how research evidence is used in policy-making, and how I and other researchers can improve the impact of our research on policy.

Women Against Sexual Exploitation and Violence Speak Up Project (WASSUP) 11 Dec 2017

To support the development of the WASSUP project.

Amount: £20,000
Funder: Suffolk Community Foundation
Recipient: Volunteering Matters

ANCHOR Project 30 Nov 2017

Supporting the ANCHOR programme - a young persons intervention around early intervention and prevention.

Amount: £15,164
Funder: Suffolk Community Foundation
Recipient: Volunteering Matters

The Loop 01 Nov 2017

To deliver 3 Progress Group programmes to help improve peoples mental wellbeing.

Amount: £1,910
Funder: Suffolk Community Foundation
Recipient: Volunteering Matters

Grant to Chatteris Branch, Royal British Legion 09 Mar 2017

George Clare VC: A town commemorates

Beyond Transitions 21 Jan 2017

Volunteering Matters will use the grant to support younger people with disabilities in Blaenau Gwent by providing them with skills and empowering them during the transition from education to further education, employment or training. This grant for £5,000 will fund volunteer expenses, mentor training, stationery and telephone costs, promotional materials, evaluation, and administration support.

Amount: £5,000
Funder: The Big Lottery Fund
Recipient: Volunteering Matters
Region: Wales
District: Blaenau Gwent - Blaenau Gwent