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Results

Unlocking the structure, mechanism and cellular assembly of key multiprotein complexes in human gene transcription. 03 Dec 2014

Human DNA contains ~20,000 genes, giving rise to ~100,000 proteins including isoforms andvariants. This enormous complexity is exploited by the cell to intricately assemble transient andstable multiprotein complexes, critical for cell homeostasis and development, in both health anddisease.Understanding structure is vital to explaining protein function and fundamental to drugdiscovery. Knowledge has improved dramatically over the past decades due to an enormousincrease in the number of structural analyses of individual proteins. Much less is known aboutmultiprotein complexes, often due to technical challenges in their provision and analysis, whichhave yet to be fully resolved.An essential first step in biogenesis is gene transcription. In humans, this process isregulated by complexes comprising often ten or more subunits, which arrange insuperstructures that cooperate at the interface of chromatin, fine-tuned by activating andrepressing modalities.How does the cell manage such complexity? How does it decide when to express whichgenes, and what are the functional architectures involved? How are proteins assembled intomultiprotein complexes, and what are the factors that assist in this process? The same proteinsmay exist in distinct complexes; are there specific mechanisms controlling their commitment?How do errors occur and how can we correct them?These questions are central to biology, which I plan to address in this proposal. We willstudy the archetypical general transcription factor complex TFIID, a multiprotein co-activator,SAGA (Spt-Ada-GCN5-acetyl-transferase) and a multiprotein co-repressor, NuRD (NucleosomeRemodeling and Deacetylation complex) in a comprehensive, integrated approach. As we havedone in the past, we expect to develop innovative tools in the process.My vision is to understand the cellular mechanisms of these protein machines, theirassembly process from gene to functional complex, their interdependence in gene regulationand the factors that control them. I aim to provide and roll-out tools and technologies requiredfor addressing questions of such complexity on a (more) routine basis. Understanding thesemechanisms will clarify how malfunctions can lead to pathologies. This in turn will help developstrategies for the design of new therapeutic interventions.

Amount: £2,232,278
Funder: The Wellcome Trust
Recipient: University of Bristol

Community health volunteers as mediators of accessible and responsive community health systems: lessons from the Health Development Army in Ethiopia 25 Mar 2015

Faced with chronic health worker shortage, many LMICs have invested in community health workers to extend and enhance health care in low-resource settings. This project examines the role of the Health Development Army (HDA), a large multi-purpose cadre comprising locally-recruited and trained community volunteers in Ethiopia, intended to mobilise communities, that complements the existing cadre of more highly trained Health Extension Workers (HEW), with the HDA acting as intermediaries between formal PHC services and the communities they serve. A better understanding the HDA experience offers a means to gain important insights into ways to use community volunteers, working across sectors, to support participatory models of grassroots PHC that both enhance access to care and address the social determinants of health. The project asks first: what role does the HDA play (who are they? what roles do they assume in their communities? How are they perceived by their communities and the health care providers with whom they interact, including the HEW (examining trust, power and knowledge imbalances)? What factors - within and beyond -health systems facilitate or obstruct their activities)? Second, what are the conditions that may increase their potential to improve access to care and address health determinants, including those that lie within the purview of other sectors? Based solidly on theory, it employs a mix of qualitative research methods and is set in one of the Ethiopian regions that pioneered the HDA concept. Evidence generated by the project will exploit a window of opportunity to inform policy in Ethiopia, addressing a recognised need to understand the contributions of the HDA and their relation with the HEW and PHC structures, as well as the scope for expansion to support hard-to-reach populations. It also addresses a growing international interest in the role of community health workers as part of a package of low cost, responsive PHC models.

Guideline Adherence in Slums Project - Template-based documentation and decision support for primary healthcare clinics in the private sector. 25 Mar 2015

This study employs an exploratory sequential mixed methods research design with phased, concurrent data collection. The challenges of providing quality healthcare are highly complex especially in LMICs that face multiple health system shortcomings. Phase 1 (Exploration): Understanding the challenges in implementing currently prescribed national (or international/WHO) guidelines in low-resource urban settings. This aspect will be addressed by a set of in-depth interviews (IDIs) with the following set of stakeholders involved in the implementation of guideline recommendations: Phase 2 (Implementation): This phase includes two intervention elements: a) Developing CPG-based templates (in rubber stamp format) for a set of commonly encountered conditions in adults. b) A clinical audit and feedback system to review and aid providers in their adherence to CPGs (and templates). Phase 3 (Paths to scale): This phase will explore scaling of the intervention using IDIs with clinic managers, managers of social enterprise clinic chains and FBOs, health managers of county governments, healthcare financiers, funders and policy makers. This research approach explores both, the technical aspects of quality improvement interventions and also issues that affect the adoption of such interventions. Understanding the context in which the research is being conducted (eg. clinic financing, provider incentives, etc.), and also the paths to scale (and impact) is a central to our proposal and aims to maximise the chances of success of any larger research and/or implementation project in the future.

Amount: £32,640
Funder: The Wellcome Trust
Recipient: Misc Kenya

Feasibility Study: Effectiveness of Public Health System (Programmes/Policies)in Combating Severe Population Health crisis in Ukraine. 25 Mar 2015

This study is intended to accumulate knowledge to design properly the future full-scale project "Study on the Role of Public Health Programmes/Policies in Combatting Severe Population Health Crisis in Ukraine". Full-scale research project will analyse the relative effectiveness of public health measures in Ukraine over the period from 1990 to 2014, to form the evidence base for the development of an integrated public health system and its successful implementation. The development study is needed due to the scarcity of relevant knowledge on public health in Ukraine and lack of easy access to the necessary data, and thus knowledge on whether the data is suitable for such evaluation. The main objective of the development study is to assess the past programmes/policies in as to their evaluability based on their history, design, context, and implementation and the availability and quality of the data. The research will involve four Work Packages - scoping the data sources, in-depth interviews with key stakeholders and informants, preparation of data and analysing its quality, conducting an iterative research process based upon the Evaluability Assessment approach. It will take place in Canterbury and Kyiv from May 2015 till April 2016 performed by multi-institutional and multi-disciplinary research team led by Stephen Peckham which includes senior researchers with experience in conducting large surveys, qualitative studies, statistical and economic analysis and health systems and health policy research.

Amount: £33,530
Funder: The Wellcome Trust
Recipient: University of Kent

Whole System Change in South Africa: Understanding the experience of health system transformation in the Western Cape province (WholeSyst-SA). 25 Mar 2015

Over the last twenty years South Africa has implemented a broad array of changes within its health system in order to improve its ability to offer good quality health care at reasonable cost to vulnerable population groups. Whilst there is national recognition that performance improvements have fallen short of expectations, the Western Cape province is reputed to have performed relatively well. The proposed exploratory and formative research will examine this province's experience since 1994, comparing it with wider national experience and considering the lessons for future monitoring and evaluation of health system development, including related research needs. The project's objectives will be addressed through a sequenced set of data collection activities, comprising review of existing policy documents and research reports, elite interviews with policy-makers, and analysis of routinely collected health system data for the Western Cape and other provinces. The Western Cape experience will be set against wider national experience, including specific comparison with two other provinces which will be purposefully selected to allow reflection on insights generated by initial analysis of the Western Cape experience. The project will be guided and supported by a steering committee comprised of policy-makers, managers and researchers, who will together tease out wider lessons - including those concerning future provincial monitoring and evaluation activities. The project, therefore, is itself an example of the embedded research identified as important for health policy and systems research.

Amount: £33,558
Funder: The Wellcome Trust
Recipient: University of Cape Town

Development and evaluation of system dynamics methods to engage with policy makers on the prevention and control of diabetes in a middle income region. 25 Mar 2015

The study will target English speaking middle-income countries in the Caribbean Community (CARICOM) who participated in the Heads of Government Port of Spain Declaration on NCDs (POSD). An on-going data analysis on mortality, morbidity and risk factor trends across the 20 CARICOM member states is underway, alongside detailed new data collection to define current policy responses to NCDs. This work will be used to inform which countries have sufficient data and strong stakeholder contacts for the development of a system dynamics model. Jamaica will be included as well as two other countries. The study will use mixed methods, gathering primary data through qualitative methods and secondary quantitative data. These data will then be applied to the design and implementation of a system dynamics model for policy evaluation. The qualitative phase will use in-depth semi-structured interviews with stakeholders identified through work with the on going POSD evaluation. The data will then be used to develop the first draft of a conceptual model using the Centers for Disease Control diabetes model as a basis. A quantitative data collection phase will collect evidence on diabetes prevalence, risk factors, determinants, outcomes, and health system response for the countries of interest. This review will provide the necessary information to quantify the relationships described by the conceptual model. Following the initial data collection phase, a model building workshop including all relevant stakeholders and investigators will work intensively to further refine the conceptual model until a consensus is reached. The final conceptual model will then be tested and validated. The final phase will involve a series of simulations evaluating policies for the prevention and management of diabetes. The results will be used engage policy makers and to evaluate the utility of the system dynamics methodology in adoption of policy.

Mentoring and measurement for better maternal and newborn survival: developingan intervention to put accountability into practice in Tanzania. 25 Mar 2015

We aim to develop, pilot and assess options for maternal and newborn death surveillance and response in a consultative manner, together with local stakeholders. We will use qualitative research methods including stakeholder interviews to maximise feasibility and acceptability. In a joint process with the regional health secretariat we will review ongoing surveillance data for maternal and newborn deaths and audits in the facilities and develop a mentoring-based approach to improve quality of care. Previous learning from the EQUIP study and from the "collaborative approach" to quality improvement will guide this work. Alignment to local structures, costs and feasibility will be central to the development work, including national training materials for maternal and perinatal audits prepared by the Ministry of Health. We will also review abstraction tools, and review of matrices for analysis.

Supportive supervision of mid level health workers in rural Nepal for improved job satisfaction, motivation and quality of care. 25 Mar 2015

Many low-income countries are suffering from a shortage of health workers in rural areas. In response to this, tasks are being shifted to mid level cadres who are often working without adequate management and support mechanisms. These cadres require emotional and clinical support in order to develop and retain their skills, and an enabling environment to provide good quality care. The evidence base about the impact of supportive supervision on primary health care is weak, and there is a need to develop the theory about how supportive supervisions may work. We will conduct action research with central and district level stakeholders, and health workers to describe and explore the difficulties facing mid level health workers, and discuss current weaknesses in existing supervisory mechanisms. We will also explore supervision preferences of mid level health workers, and the effect of gender and difference in cadre on supervisory needs through qualitative interviews in three districts. We will critically examine pilot interventions and conduct a realist review of the national and international literature to identify potential interventions which could be implemented for mid level health workers in rural Nepal. Findings will be fed back and discussed in a working group, and interventions presented to a wider group of stakeholders at a workshop. Cost information will also be prepared and presented at this workshop. After participatory prioritisation of interventions, we will develop an evaluation methodology and theories of change, which we will present at a dissemination meeting. We will seek funding for the implementation and evaluation of the prioritised supportive supervision interventions, and identify pilot districts in which to test interventions. We will disseminate our methodology and interventions among academic and practitioner audiences.

Amount: £33,367
Funder: The Wellcome Trust
Recipient: University College London

Exploring the potential of Open Source solutions to deliver Clean, Clear Information for Health Service Improvement. 25 Mar 2015

This mixed-methods health systems research project aims to use semi-structured interviews with managers and clinicians involved in Electronic Health Record (EHR) system implementation. Interviewees will be identified through a snowballing technique until saturation of new information from interviewees is reached. A specific case study will be performed of an individual EHR implementation project in Machakos County that uses open-source EHR software (OpenMRS) to identify the barriers and opportunities of using open-source EHR software in the county public health system in Kenya. The results of the case study will inform the development of an innovative in-silico simulation of the Machakos County health system as it would be envisaged in the planned roll out of open-source technology to support clinical care, centralised data collection and on-demand registry services (such as the Master Patient Index and a Master Facilities Index). Finally, a co-design workshop will be held with key EHR stakeholders in Kenya (including policy-makers, researchers, hospital administrators, clinicians, patients, EHR vendors, IT companies, programmers and consultants). The workshop will aim to bring together the results of the survey, case report and simulation with experience from across Kenya to develop a set of research objectives to inform the development of the next stage of research aimed at development and re-use of clean, clear information from data gathered by EHR systems to improve health systems broadly while fostering growth of innovative health services research.

Amount: £32,367
Funder: The Wellcome Trust
Recipient: University of Oxford

Verbal Autopsy with Participatory Action Research (VA-PAR): Developing a people-centred health systems research methodology. 25 Mar 2015

People-centred health systems (PCHS) is a recent progressive shift that has moved thinking beyond building-blocks models of health systems towards ones that centralise a human and relational nature. Despite the conceptual advance, empirical methods are lacking. The project seeks to develop methods for conducing and using Verbal Autopsy (VA) consistent with a PCHS approach by combining VA with Participatory Action Research (PAR) in a process connected to the health system at different levels. VA is a health surveillance technique that provides information on levels and causes of mortality in populations where deaths occur outside facilities and/or without registration. PAR is a process that aims to transform the roles of those participating from objects of research to active researchers and agents of change. It systematises local experience through collective analysis to generate valid forms of evidence on the relationships between health problems and their causes. Three phases of research are proposed. In Phase 1, we will conduct a secondary analysis of data gained through the application of the 2012 WHO VA standard in a Health and Demographic Surveillance Site (HDSS) in rural South Africa. Combing data on medical causes with new data on background characteristics of deaths, we will develop improved ways to classify causes in a method suitable for use at sub-district/district level. In Phase 2, local service users and providers will engage in a PAR process to review the results of Phase 1, set priorities for local services, and explore the potential for co-benefits related to empowerment and social inclusion. The final Phase 3 aims to consult at higher levels of the health system to consider how the method could be further applied and evaluated. The overall output is a practical and integrated methodology based on core standards that is contextually relevant and capable of affecting health gains by translating local priorities into actionable public health agendas.

Amount: £33,202
Funder: The Wellcome Trust
Recipient: University of Aberdeen

Developing innovative approaches to improve treatment provision for childhood infection in peri-urban settings: A pilot study in accredited drug shops. 25 Mar 2015

Aim: To develop a health systems strategy and community-based mechanism to deliver integrated Community CaseManagement (iCCM) services to increase access to prompt effective treatment for childhood infections in peri-urban areas Objectives: i. Investigate the feasibility of two alternative community-based mechanisms (community health workers or licensed private sector drug retail outlets) to deliver iCCM in peri-urban areas ii. Develop mechanisms for governance, quality assurance, regulation, linkage with public health system (supervision, referral, health management information system) and financial sustainability, that are acceptable to treatment providers, patients, local and national authorities and regulators iii. Explore the acceptability and perceptions of a private sector delivery strategy amongst providers, users, national authorities and policy makers iv. Assess quality of iCCM services provided by trained drug retailers through a small pilot study, with focus on accuracy of diagnosis and adherence to treatment guidelines Methods: Formative research, key informant interviews, and stakeholder consultations to adapt iCCM approach and explore mechanisms to support two alternative community-based mechanisms (community health workers or drug retail outlets) to deliver iCCM services in peri-urban settings. To be followed by a small pilot study in which 10 licensed drug shops will be trained to diagnose and treat pneumonia, malaria and diarrhoea according to iCCM guidelines. The ability of drug vendors to diagnose and treat children will be evaluated through a mix of methods including: record review, clinical vignettes, participant observation, and re-assessment of a sample of patients by a qualified health worker. Participant observation and focus group discussions will explore the effects of the pilot intervention from the perspective of drug vendors, and exit interviews will examine acceptability to patients and costs incurred by households.

Determinants of effectiveness of a novel community health workers programme inimproving maternal and child health in Nigeria. 28 Oct 2014

The AIM of this project is to inform strengthening and scaling up of community health worker (CHW) programmes. This will be done by investigating two implementations (with and without conditional cash transfers) of a Nigerian CHW programme, to understand what factors, under what conditions, promote equitable access to quality services, and improve maternal and child health outcomes. We will: 1. Understand of the context and the process of implementation of the interventions; 2. Identify, assess and compare the intervention outputs and outcomes; 3. Develop a model of complex relations between the actors, context, implementation process, outputs and outcomes of the interventions; 4. Develop transferable best practices for scalability and generalizability of the interventions. This five-year study will be implemented in two States in Nigeria - Niger State in the North and Anambra State in the South, identified in consultation with the Federal MOH and SUREP national programme officer. The project is designed as a multidisciplinary and mixed methods study, using qualitative and quantitative methods. Realist evaluation will be an overall platform for the study, which will use economic evaluation, social sciences and statistical analysis. Qualitative data will be collected using in-depth interviews with facility managers, community health workers, PHC staff; facility exit interviews and focus group discussions with service users and their families. Quantitative data will include existing data from HMIS and SURE-P programme and structured facility exit survey with pregnant women. Analysis of quantitative and qualitative datasets will be integrated, to allow in-depth exploration of emerging issues and continuous triangulation of findings. Project results will be disseminated widely through development of policy briefs, presentations at management meetings, newsletters and press-releases, to ensure their uptake in policy and practice in Nigeria and wider.

Amount: £264,983
Funder: The Wellcome Trust
Recipient: University of Leeds

Investigating the determinants of health worker performance in Senegal 28 Oct 2014

The project aims to evaluate whether and how financial incentives conditional on improvements of use and quality of caretargets measured at the facility level contribute to improved health worker performance in Senegal. Through the collectionof a large range of health workers' performance outcomes and mixed research methods, we will be able to meet threeobjectives.The first objective of the proposed research is to generate new knowledge of the effect of Results-Based financing(financial incentives conditional on specific performance targets) for health workers. This will be achieved by addressing thefollowing research questions:(i) Does RBF increase availability of health workers, measured by absenteeism?(ii) Does RBF increase productivity of health care workers?(iii) Does RBF increase quality of care, measured by average consultation time and clinical competence?(iv) Does RBF increase health workers' responsiveness to patients?The second objective of the research will be to understand the extent to which RBF has an impact on individual healthworkers' motivation. Specifically, we will answer the following questions:(i) Does RBF increase the job satisfaction and intrinsic motivation of health workers?(ii) Does RBF reduce the know-do gap of health workers (the difference between what they know and what they do inpractice)?The third objective of the research will be to understand the extent to which the introduction of RBF at the facility levelchanges the work environment and organisation:(i) Does RBF improve resources available in the health facility at the disposal of health workers to treat patients?(ii) Does RBF change staff management style?(iii) Does RBF change the way work is organised in facilities?The last objective of the project will be to disseminate the lessons emerging from the research to a wide audience of localand international policy-makers, as well as to future individual decision-makers in health policy, with the hope to introduceeffective interventions to sustain health workers' motivation and performance.

Health Services that Delivery: Improving care for sick newborns (HSD-N) 28 Oct 2014

Neonatal mortality now accounts for over 40% of all child mortality in many countries. Yet prior research in low-incomesettings suggest that sick newborns often do not receive the interventions they need to ensure their disability free survival.Sick newborns require multiple interventions, given repetitively for multiple days and so their care is especially sensitive tothe major deficit in the nursing workforce found in the majority of low-income countries. To reduce this deficit and constrainworkforce costs task-shifting, moving responsibility for delivering interventions from professional to lower level workers,may be a solution. Particularly as the interventions delivered may be time consuming but not complex (eg. assistedfeeding). Yet such apparently rational approaches may be poorly designed or implemented leading to their rejection inpolicy or practice.Our overarching objective, employing frameworks to guide development of complex interventions, is to undertake researchMR/M002772/1 Page 3 of 7 Date Saved: 14/01/2014 14:57:31Date Printed: 14/01/2014 15:36:21SummaryIn simple terms please describe your proposed research in a way that it could be publicised to a general audience [up to4000 characters].with key Kenyan stakeholders to design a contextually appropriate and feasible task-shifting intervention to improvedelivery of essential neonatal interventions in facilities. This new arena for research on task-shifting in low-income settingswill demand use of innovative methods and an integrated, multi-disciplinary approach. In parallel we will focus on buildingcapacity for health systems research in Kenya enhanced by the creation of new academic partnerships spanning businessschools to clinical epidemiology. Learning lessons from this approach we aim to develop this participatory research modelfor work on other questions and in other settings.We will develop 4 broad areas of work that inform each other during design, conduct, analysis and interpretation. These willspan: stakeholder engagement and analysis; assessing existing capacity and future needs for interventions for a populationof 5 million; exploration of what is actually required of the workforce to deliver interventions and opportunities for taskshifting;and examination of the regulatory, professional and social context within which task-shifting might be introduced.This programme of work will strengthen researcher - policy maker engagement, result in at least 3 Kenyan PhDs, developinnovative methodological approaches through new partnerships, and generate considerable generalisable knowledge. Ourspecific objectives (indicative of planned outputs) are:1. To examine the regulatory environment and position and influence of key stakeholders on task-shifting debates inneonatal care at the start of the project and explore how such positions change with participation over the lifetime of theproject2. To define with government and key stakeholders a core package of services for sick newborns requiring facility basedcare in Kenya3. To assess current capacity to provide this package in Nairobi County facilities (in all sectors) and to estimate current useof services and contrast this with estimated need derived from epidemiological models at a population level (Gap 1)4. To quantify which interventions needing delivery by nurses are provided safely in representative facilities (Gap 2)5. To characterise neonatal nursing task frequency and duration and the skill level required for delivery to identify thosesuitable for task-shifting6. To explore workplace contexts and managers', professionals' and parents' perspectives to further inform design of anacceptable task-shifting strategy7. To develop illustrative models of the human resource costs of delivering agreed interventions for Nairobi County (closingGap 1 and Gap 2) while varying coverage and task-shifting options to inform stakeholder discussions on design of a taskshiftingintervention that considers affordability, feasibility, access and equity8. To draw lessons on how researchers can engage in a dynamic collaboration to inform improvements in health systems

Amount: £329,756
Funder: The Wellcome Trust
Recipient: University of Oxford

Learning from health systems strengthening in maternal and newborn health in China to accelerate progress for saving lives in Africa. 28 Oct 2014

The aim of this project is to examine China's progress in reducing maternal and neonatal mortality to draw lessonsapplicable to the MNH context in sub-Saharan Africa. The focus will be on understanding the health systems inputs andoutputs that have enabled progress towards comprehensive obstetric care in health facilities, particularly for the rural poor and those living in remote areas, and the financing mechanisms that facilitated reimbursement of hospital delivery charges. We will contribute knowledge in three areas: 1. We will assess implementation strength, an emerging approach to programme evaluation which aims to characterise the intensity of programme effort required to achieving programme goals. This will be done through a quantitative analysis of the relationship between health system inputs/outputs, contextual factors and maternal and neonatal mortality across all 3255 counties in China between 1996 and 2013, using routinely available data. Multilevel statistical models will identify thresholds for MNH health systems indicators, incorporating time varying covariates where possible. 2. A case study in eight counties in Western China will provide an in depth understanding of the relationship between MNH inputs that are more difficult to capture through routine data, including the mix and levels of the midwifery workforce, referrals, levels and allocation of health care financing, and selected service coverage and outcome indicators. Eight counties will be selected purposively to reflect various levels of maternal and neonatal mortality, matching counties as far as possible within provinces on contextual factors. Data will be collected at province, county and facility levels and methods will include document review, in-depth interviews with key stakeholders and facility and patient surveys. 3. We will adapt lessons from China's experience in MNH to low income countries, by analysing the transferability of policy lessons from China to Tanzania.

Strengthening South Africa's health system through integrating treatment for mental illness into chronic disease care (Project MIND) 28 Oct 2014

Integrating mental health care into primary health care services could reduce the impact of both chronic communicable and non-communicable diseases (NCDs). Like many low- and middle-income countries (LMICs), South Africa (SA) is challenged with how to reduce the high prevalence and impact of communicable diseases and NCDs, including mental disorders for which there are limited services available. Mental disorders are important to address among patients with chronic diseases as these problems are associated with poor adherence to treatment, more rapid disease progression and treatment failure. As treatment failure increases the use of health services and consequently health service costs, chronic disease care in LMICs must be expanded to include mental health care. The integrated delivery of mental health services and chronic disease care has been shown to improve access to mental health care and the mental health of chronic disease patients. However in LMICs such as SA, integrating mental health care into chronic disease services has been delayed by a lack of knowledge of how to include mental health care in chronic disease services so that these services are acceptable to providers and patients and feasible to implement with few resources. The provision of integrated mental health and chronic disease services has also been delayed by questions about whether mental health services should be vertically integrated into chronic disease care (that is provided by dedicated staff who only provide mental health services) or horizontally integrated (that is provided by general health practitioners who also provide chronic disease care). The goal of this project is to answer these questions by assessing current capacity and barriers to integrating mental health services into chronic disease care and by comparing the effectiveness and cost-effectiveness of a vertically integrated and horizontally integrated model of service integration among patients receiving treatment for HIV or diabetes and at risk for treatment failure in Cape Town, SA. Through this project we hope to identify a feasible, acceptable and effective model for integrating mental health services into chronic communicable and non-communicable disease care for patients that is applicable to other LMICs. Findings from this study are likely to be highly relevant for application in other LMICs given similarities between the burden of disease, treatment populations, and treatment systems in SA and other LMICs. The study will comprise two phases. In the first phase, we will conduct 69 in-depth interviews with a range of healthcare providers in HIV and diabetes services to assess barriers to integration and the feasibility and acceptability of our proposed models of service integration (Aim 1). Findings from this phase will be used to adapt our evidence-based mental health service package for optimal integration into chronic disease services. In phase two, a clustered randomised controlled trial will be conducted. We will select 24 HIV and 24 diabetes clinics to randomise to a vertically integrated arm, horizontally integrated arm, or treatment as usual (no integration). We will recruit 25 patients at risk for treatment failure from each of these clinics (total 1200 patients). After study enrollment, a baseline assessment will be completed by a fieldworker. Participants recruited from clinics randomised to either the vertically integrated or horizontally integrated arm will then receive their intervention sessions. All participants, irrespective of their intervention arm, will be tracked for 6- and 12-month follow-up interviews. At these interviews, fieldworkers blinded to their intervention arm will re-administer the baseline assessment and biological specimens will be collected to assess for chronic disease outcomes. Findings from this phase will be used to evaluate the relative effectiveness and cost-effectiveness of our proposed models of service integration.

Amount: £299,592
Funder: The Wellcome Trust
Recipient: South African Medical Research Council

Cardboard Citizens presents: Meta. 30 Jul 2015

Theatre company Cardboard Citizens and a team of cognitive neuroscientists will collaborate to educate and excite 2,000 young people about the development of their brains, and the potential impact this has on their thoughts, feelings and behaviours. Following a period of R&D with young people (aged 13-16) and teachers in East London secondary schools, we will work with a professional creative team, including playwright Sarah Woods and 5 young actors, to create an original piece of Forum Theatre entitled Meta. Meta will combine original, contemporary sound design and digital artistry, lecture-style neuroscience insights and live, interactive theatre to present the story of a teenager facing difficult life circumstances. Post-show forums will support audience members, in light of their new knowledge, to think differently about the situations presented in the play, and try alternative strategies out onstage. Metas project team proposes that, in this way, Forum Theatre could facilitate the development of metacognition (the ability to think about ones own thoughts) and emotional regulation strategies in our audiences adolescents. Meta will tour to up to 20 East London education providers and reach a further 500 members of public through theatre showcases, increasing audience understanding of, and capacity to think differently about, adolescent experience. A thorough evaluation, led by the Neuroscience team, will test Forum Theatre as an artistic tool to support the develop ment of metacognition and emotional regulation in adolescents aged 13-16. An original educational toolkit will support the continued creative education of neuroscience within participating schools.

Amount: £91,621
Funder: The Wellcome Trust
Recipient: Cardboard Citizens