id stringlengths 36 36 | title stringlengths 0 391 | funder stringclasses 125 values | beneficiary stringlengths 3 1.44k | source_id stringlengths 0 41 | abstract stringlengths 6 4.76k | funding_scheme stringclasses 411 values | label class label 8 classes |
|---|---|---|---|---|---|---|---|
gen_a2beb335b2c19415945779006122cb2b | Historic Ice Core | Arcadia Fundation | Harvard University (Department of History) | 360G-ArcadiaFund-4190 | To document and interpret historical environmental data captured in an ice core from a glacier in the Alps. | Other / Strategic | 6project_grants_public |
gen_51ffb2a79c3b97e5808eea7706c86b40 | Historical Ice Core Project | Arcadia Fundation | Harvard University (Department of History) | 360G-ArcadiaFund-3862 | To continue extraction and interpretation of data from an ice core documenting European climate in the last 3,500 years. | Other / Strategic | 6project_grants_public |
gen_84532a96025a151c41c506b0909f1db0 | Mapping Africa's endangered sites and monuments | Arcadia Fundation | University of Cambridge McDonald Institute for Archaeological Research | 360G-ArcadiaFund-4179 | To undertake large-scale documentation of heritage sites in Sub-Saharan Africa and to make the results available online through an open-access database. | Heritage sites / Strategic | 6project_grants_public |
gen_9037569aabc408670819602dc5fb921a | Endangered Archaeology of the Middle East and North Africa | Arcadia Fundation | University of Oxford (School of Archaeology) | 360G-ArcadiaFund-4178 | To document archaeological heritage in the Middle East and North Africa using satellite imagery. | Heritage sites / Strategic | 6project_grants_public |
gen_28cd5e03a4bb3cae7f982846aca64cca | Developing non-destructive methods to read texts in mummy cartonnages | Arcadia Fundation | University College London | 360G-ArcadiaFund-3733 | To assess the feasibility of nondestructive digital imaging technology to read texts on papyri in mummy cartonnages. All data, findings and methodologies will be freely available online for further research. | Other / Strategic | 6project_grants_public |
gen_d254647a09e082ad3fff64a958dced42 | Mosfell Archaeological Project | Arcadia Fundation | Vikingaminjar ehf | 360G-ArcadiaFund-3119 | To excavate and research a Viking-age archaeological site in western Iceland, in partnership with UCLA and the Institute for Viking and North Atlantic Studies. | Heritage sites / Strategic | 6project_grants_public |
gen_c04fe5ad85f80fa4cc536239a3b2653c | Noves estratègies per la identificació i caracterització funcional de marcadors genètics pronòstics en les síndromes mielodispàsiques/leucèmies agudes mieloblàstiques hereditàries de la infància | La Marató de TV3 | Fundació per a la Recerca i la Docència Hospital Sant Joan de Déu - FSJD | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_ed09a2d7b889b6b7ebb6d216f95ffa5c | Transcripció espurial neuronal i desregulació d'estimuladors en l'etiologia de la discapacitat intel·lectual | La Marató de TV3 | Institut de Neurociències - Universitat Miguel Hernández, Alacant | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_bc7dd453c1f52688d7f8a6caef6c825f | iGenCO: anàlisi genòmica exhaustiva i anàlisi cross-òmica per a malalties minoritàries no diagnosticades en una plataforma col·laborativa amigable | La Marató de TV3 | Fundació Privada Centre de Regulació Genòmica - Centre Nacional d'Anàlisi Genòmica CRG | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_24697349f8b239bac8779c79164823ab | Anàlisi preclínica de nous tractaments combinats per a l'atròfia muscular espinal: efectes sobre la supervivència de la moroneurona, la integritat sinàptica i la preservació del múscul esquelètic | La Marató de TV3 | Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré - IRBLL | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_d50aab7938c04a00721ad68ec39b48e0 | Genòmica avançada i lipidòmica per a la identificació de noves causes genètiques de trastorns de moviment hereditaris | La Marató de TV3 | Fundació Institut d'Investigació Biomèdica Hospital Universitari de Bellvitge - IDIBELL | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_3ff7115203df53d8fa39b9a8d0fc7cf8 | Recerca centrada en el pacient: estudi de les necessitats dels pacients, fenotipació clínica i patogènesi molecular en la Neurofibromatosi tipus 2 | La Marató de TV3 | Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol - IIGTP | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_78cb1cf2c7d6dc925f7a0fef7b780a63 | Predisposició germinal a la síndrome de poliposi serrada: caracterització funcional de gens candidats mitjançant CRISPR/CAS i organoides | La Marató de TV3 | Consorci Institut d'Investigacions Biomèdiques August Pi i Sunyer Hospital Clínic - IDIBAPS | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_88d28d5312822a31f280d8ae38065215 | Registre PSP: estudi de cohort clínics, recerca de biomarcadors i programa d'educació sanitària | La Marató de TV3 | Consorci Institut d'Investigacions Biomèdiques August Pi i Sunyer Hospital Clìnic - IDIBAPS | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_ca3954694330d0a3e7ee6306fb525012 | Avaluació de la teràpia cel·lular mitjançant cèl·lules RPE corregides genèticament en mamífers inferiors i superiors per al tractament de les distròfies hereditàries de la retina | La Marató de TV3 | Fundació Centre d'Investigació Príncep Felip, València - CIPF | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_273b3526c051fc57cb7499a85e9939b0 | Desenvolupament de tractaments personalitzats en malalties genètiques rares causants de parkinsonisme pediàtric | La Marató de TV3 | Fundació per a la Recerca i la Docència Hospital Sant Joan de Déu - FSJD | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_23a1ebbe1a5b48198d16a092724ca799 | Gliotransmissors i receptors de cannabinoides en l'origen dels dèficits cognitius i de plasticitat sinàptica en la malaltia de Huntington | La Marató de TV3 | Universitat de Barcelona - Facultat de Medicina i Ciències de la Salut UB | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_e970d2f4a3853f9ade61576486c865b2 | Fenilcetonuria: de la infantesa als adults a través del connectoma cerebral, canvis cardiovasculars, característiques metabòliques i de la microbiota intestinal | La Marató de TV3 | Consorci Institut d'Investigacions Biomèdiques August Pi i Sunyer Hospital Clínic - IDIBAPS | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_2332d23bbb8ef63941008a54d126aa11 | Eliminar cèl·lules senescents per controlar les comorbiditats de la síndrome de Cushing | La Marató de TV3 | Consorci Institut d'Investigacions Biomèdiques August Pi i Sunyer Hospital Clínic - IDIBAPS | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_57ed88e3460d8d17e2f7ecc951ce51c6 | CoALeS: Optimitzant els resultats a llarg termini de nens amb coartació de l'aorta mitjançant l'aprenentatge automàtic integrant dades des del fetus fins a la infància | La Marató de TV3 | Consorci Institut d'Investigacions Biomèdiques August Pi i Sunyer Hospital Clínic - IDIBAPS | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_cd13f4c0f76706b5327dfba1447f9651 | Rol de l'Apolipoproteïna A-Ib en la síndrome nefròtica idiopàtica | La Marató de TV3 | Fundació Hospital Universitari Vall d'Hebron Institut de Recerca - VHIR | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_88b047ed434aa48cb3e051c75545320c | Alteracions bioquímiques i del neurodesenvolupament en la malaltia de Lesch-Nyhan | La Marató de TV3 | Universitat Autònoma de Barcelona - Institut de Neurociències UAB | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_2ae490f3e0d8d008c2ef8a8b197568fb | Vinculació de defectes cel·lulars amb manifestacions clíniques a la síndrome de Cohe | La Marató de TV3 | Fundació Institut de Recerca Biomèdica de Barcelona - IRBB | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_c5ad294e3c9e525a198175fc5d1a33de | Desoxiribonucleòsids com a teràpia per als trastorns de la replicació de l'ADN mitocondrial: investigació dels mecanismes terapèutics i ampliació del tractament a les mutacions en POLG i altres gens | La Marató de TV3 | Fundació Hospital Universitari Vall d'Hebron Institut de Recerca - VHIR | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_dd181764041697c1847a204c99f87dbb | La senescència cel·lular, un nou objectiu per combatre i millorar la distròfia muscular de Duchenne | La Marató de TV3 | Universitat Pompeu Fabra - Facultat de Ciències de la Salut i de la Vida UPF | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_56da632247102543f6db1c792fc6cf64 | ArmTracker: Un sistema portable per avaluar la funció motora de les extremitats superiors durant la vida diària per a pacients amb distròfia muscular de Duchenne i atròfia muscular espinal | La Marató de TV3 | Fundació per a la Recerca i la Docència Hospital Sant Joan de Déu - FSJD | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_2a1351d508232816089aa626b6a0f35e | Noves aplicacions terapèutiques a l'acondroplàsia | La Marató de TV3 | Institut de Neurociències d'Alacant - CSIC | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_0fe9a1b96faaea357edaf6e0020fdfbc | Estratègies terapèutiques per a la cistinúria | La Marató de TV3 | Fundació Institut d'Investigació Biomèdica Hospital Universitari de Bellvitge - IDIBELL | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_fe4629edda25bf14463826678909efbe | Anàlisi del sistema de complement en la preeclàmpsia greu i la síndrome de Hellp com a diana terapèutica | La Marató de TV3 | Fundació Recerca Clínic BCN – Institut d’Investigacions Biomèdiques August Pi i Sunyer | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_1b9c9efd175958b432c7076bca4ea7f2 | Impulsa la integració de cèl·lules trasplantades per regenerar retines amb Retinitis Pigmentària | La Marató de TV3 | Fundació Privada Centre de Regulació Genòmica - CRG | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_c390f6babf37d6cbd2839d9f36e62632 | Caracterització dels esdeveniments moleculars inicials de la carcinogènesi associada a la síndrome de Deficiència Reparadora Constitucional (CMMRD) per millorar el seguiment i la prevenció del càncer | La Marató de TV3 | Fundació Institut d'Investigació Biomèdica de Bellvitge - Institut Català d'Oncologia ICO IDIBELL | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_c8717fcadd4774609732c2701a365967 | Cap a la millora de l'assistència clínica i la cura de la linfangioleiomiomatosi: estudi integrat de biomarcadors i teràpies | La Marató de TV3 | Fundació Institut d'Investigació Biomèdica de Bellvitge - Institut Català d'Oncologia ICO IDIBELL | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_5925e086069db4d1407a102e737a9015 | Modulació de la senyalització retrògrada mitocondrial com a tractament de la síndrome de Leigh | La Marató de TV3 | Universitat Autònoma de Barcelona - Facultat de Medicina UAB | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_86fd243d84483acbd886ef13ddb3e97a | Alteracions de la tiroide en pacients amb un defecte heretat de la maquinària de biogènesi del miRNA | La Marató de TV3 | Fundació Institut d'Investigació Biomèdica Hospital Universitari de Bellvitge - IDIBELL | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_663206c605c9db460705e820a865a814 | La malaltia de Lafora: paper de la glia en la producció de glicogen aberrant i neuroinflamació | La Marató de TV3 | Institut de Biomedicina de València, CSIC | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_a055bbdcc9661c7288e98d0eb9766128 | Lipodistròfia i sarcopènia en la síndrome de progèria Hutchinson-Gilford: mecanismes i paper en la progressió de la malaltia | La Marató de TV3 | Universitat Pompeu Fabra - Facultat de Ciències de la Salut i de la Vida UPF | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_dc9d90492ebd8cda59894e15c5db91a4 | Noves teràpies dirigides contra subpoblacions de cèl·lules fibroadipogèniques implicades en la degeneració muscular | La Marató de TV3 | Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau - IRHSCSP | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_e4fed8952425105f1be70b7827e9879b | Disfunció de la barrera hematoencefàlica i modulació de l'estrès oxidatiu en malformacions arteriovenoses cerebrals: Un estudi translacional del dany secundari posterior a la resecció quirúrgica | La Marató de TV3 | Consorci Institut d'Investigacions Biomèdiques August Pi i Sunyer Hospital Clínic - IDIBAPS | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_6dadb4457b4fb6a8864c1306d8b03a75 | Ús de la intel·ligència artificial i la biologia de sistemes per a la diagnosi i l'avaluació de risc personalitzat per a les malalties renals hereditàries, centrat en la síndrome d'Alport | La Marató de TV3 | Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau - IRHSCSP | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_9db9700fca5fafb456ed4746b26b550f | Desxifrant els mecanismes de l'autoimmunitat de cèl·lules B específiques de PLA2R a la nefropatia membranosa primària (PMN) (BCELL-MEM) | La Marató de TV3 | Fundació Institut d'Investigació Biomèdica Hospital Universitari de Bellvitge - IDIBELL | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_eb0fbb3b81d574762d922aff73a767f4 | Inhibició d'ACVR1-PI3K a Fibrodisplàsia ossificant progressiva: noves teràpies per a l'ossificació heterotòpica | La Marató de TV3 | Universitat de Barcelona - Facultat de Medicina i Ciències de la Salut UB | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_76512b0e2edf95a19d3f841af6311e00 | Relació de la infertilitat genètica masculina amb les regions d'unió entre toroides de l'espermatozoide | La Marató de TV3 | Universitat de Girona - Departament de Ciències Mèdiques UDG | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_72417b4ba9fdd32683688094fc261aae | Mecanismes aritmogènics específics del genotip en la síndrome d'Andersen-Tawil | La Marató de TV3 | Fundación para la Investigación del Hospital Universitario La Fe - FIHFE | Not available | La Marató 2019 Malalties minoritàries | 6project_grants_public | |
gen_2bf029061f90f61fd5109956a0489cb1 | A randomised, observer-blind, non-inferiority trial to evaluate alternative human papillomavirus vaccination schedules in young females in West Africa | Medical Research Council | London School of Hygiene and Tropical Medicine | HRCS22_00757 | The trial will investigate the potential future utility of alternative HPV vaccination schedules in West Africa. The schedules aim to reduce the financial and logistical burden of HPV vaccine rollout and to provide new opportunities to optimise coverage. The following questions will be addressed: 1. Does the administration of 1 or 2 doses of a quadrivalent HPV vaccine (qHPV) result in lower type-specific seroconversion rates in 9 to 12 year old females in West Africa compared to a 3 dose schedule? 2. Does the administration of 2 doses of qHPV result in lower type-specific seroconversion rates in 4 to 8 year old females in West Africa compared to 3 doses in 9 to 12 year old females? 3. What are the long term health and economic implication of a reduced dose schedule and/or a younger age of routine vaccination in a low income West African setting? A randomised, observer-blind, non-inferiority trial will be undertaken. 9 to 12 year old females will be randomised to receive 1, 2 or 3 doses of a qHPV over up to six months. An additional group of 4 to 8 eight year old females will be recruited and will receive two doses of qHPV. The following outcome measures will be examined: Primary: - HPV types 16 and 18 neutralising antibody seroconversion rates at 7 months Secondary: - HPV types 16 and 18 neutralising antibody seropositivity rates at 12, 24 and 48 months - HPV types 16 and 18 neutralizing antibody GMT at 7, 12, 24 and 48 months - HPV types 16 and 18 antibody avidity at 7, 12, and 48 months Exploratory: HPV specific B-cell and T-cell responses will also be examined in a sub-set of subjects A sample size of 256 participants per group is based on a reference 3 dose seroconversion rate of 99% and a noninferiority margin of 5%. The figure provides over 90% power to determine the non-inferiority of the primary outcome measure using a 1-sided alpha of 1.25% allowing for multiplicity two HPV types and an attrition rate of up to 10%. | 6.1 Pharmaceuticals / Research Grant | 6project_grants_public |
gen_8d97ad5ca923cbdf97e6e728e3a19b5d | A non-inferiority trial to assess the safety and immunogenicity of yellow fever vaccine dose sparing strategies for campaign and programmatic use | Medical Research Council | London School of Hygiene and Tropical Medicine | HRCS22_00759 | A phase 3, randomized, observer-blind non-inferiority trial will be undertaken to assess the safety and immunogenicity of fractional doses of the yellow fever vaccine when administered to 9-12 month olds in The Gambia. In 2016, the worst epidemic of yellow fever in 30 years occurred in Central Africa on a background of year on year increases in disease despite the availability of a safe and highly effective vaccine. A revised global strategy for epidemic elimination published by the WHO highlighted the critical role played by vaccine supply shortages in the current disease resurgence. These shortages became acute during the recent epidemic when, faced with the impending exhaustion of vaccine stockpiles, fractional (one fifth, 0.1mL) doses of the vaccine were recommended for ongoing emergency campaigns. This trial aims to generate a comprehensive data set on which to base future policy decisions regarding the use of fractional dose of the yellow fever vaccine in infants and children in sub-Saharan Africa. The following research questions will be addressed: 1. Does the administration of a fractional subcutaneous or intradermal dose of a yellow fever vaccine result in seroconversion rates which are non-inferior to those induced by a full subcutaneous dose of the same vaccine? 2. Is there a difference in the geometric mean antibody titres induced by fractional yellow fever vaccine doses according to whether administered by the subcutaneous or intradermal route? 3. Is there a difference in the safety profile of fractional yellow fever vaccine doses according to whether administered by the subcutaneous or intradermal route? Immunogenicity will be compared based on neutralizing antibodies. Local and systemic reactogenicity will be collected according to standard criteria. Other adverse events following immunization will also be recorded. The data are expected to influence future global vaccine policy decisions regarding fractional dose yellow fever vaccine use. | 3.4 Vaccines / Research Grant | 6project_grants_public |
gen_85f17067dd28f985da8ab86f1ed276b4 | SUPPLEMENTARY FUNDING OFFER FOR THE MRC UNIT, THE GAMBIA AT LSHTM (resource to support a clinical trial of Hydroxychloroquine and Azithromycin, studies on the transmission and antibody dynamics to SARS-CoV-2 infection, and to further support | Medical Research Council | London School of Hygiene and Tropical Medicine | HRCS22_00851 | This £4.4m award provides resource to support a clinical trial of Hydroxychloroquine and Azithromycin, studies on the transmission and antibody dynamics to SARS-CoV-2 infection, and to further support surveillance activities funded by BMGF. Including PaTS-COVID CLINICAL TRIAL – led by Professor Beate Kampmann with an end date 31/12/2023 The TransVir project – led by Dr Anna Roca with an end date 30/06/2023 | 2.2 Factors relating to physical environment / P&Cs | 6project_grants_public |
gen_ec150e5ae6f02f91d95e69dbf3004761 | Enhancing the Unit Support of Uganda’s Efforts to Contain COVID-19 - part 2 | Medical Research Council | MRC/UVRI and LSHTM Research Unit Uganda | HRCS22_00854 | Following the initial rapid successes in supporting the national diagnostic capacity and to characterise the viruses, the Unit now recognizes its ability and responsibility to continue working as a close partner and reliable ally of the Government in ramping up the response to prevent the further spread of this deadly disease. The Unit could have a significant impact in curbing the COVID-19 outbreak in Uganda and the region and to further develop the global understanding of the disease as below: to prioritise research capacity and resources towards COVID-19 research - to support the Ugandan national response to the COVID-19 outbreak, which includes diagnostics, sequencing and clinical support - to lead and contribute to COVID-19 research activities with local and international partnerships - to remain operational as much as possible during the outbreak, this includes the delivery of non-COVID-19 related projects - to continue delivering the Unit restructuring that addresses the Unit’s financial and structural crisis - to deliver capital projects as expected | 2.6 Resources and infrastructure (aetiology) / P&Cs | 6project_grants_public |
gen_a193486af86348a1286693130ae7f4fb | Community surveillance for SARS-CoV-2 and COVID-19 in the general and in high risk populations in Uganda and assessment of the wider impact of infection and of pandemic mitigation. | Medical Research Council | MRC/UVRI and LSHTM Research Unit Uganda | HRCS22_00855 | In collaboration with MoH, we will undertake rigorous community SARS-CoV2/COVID-19 surveillance in high-risk and general populations, to identify infected individuals with and without symptoms. This would provide a robust foundation for answering critical scientific questions relating to the pandemic, including on transmission dynamics, burden and distribution of infection (including identifying vulnerable groups, such as older people or those with HIV/TB). In addition, with extensive background data and linkage to health facilities, we will determine clinical outcomes as well as understand the wider impacts of pandemic spread and associated mitigation strategies. This provides a resource in which to embed further work, including mechanistic research. The proposed study will last 18 months, covering the early and later stages of the pandemic, allowing for detection of secondary epidemic waves and to begin to examine the longer-term effects. | 2.1 Biological and endogenous factors / P&Cs | 6project_grants_public |
gen_5c848934184f9fe38c34ba0042d3855a | Excess mortality during the COVID-19 pandemic in The Gambia: a denominator based analysis within the HDSSs | Medical Research Council | London School of Hygiene and Tropical Medicine | HRCS22_00861 | The COVID-19 pandemic is causing an unprecedented global burden of mortality. Mathematical models predicted that most West African countries, one of the poorest regions in the world, would exceed 100,000 COVID-19 cases by June 2020. As a result, most countries reacted pragmatically closing borders after the first few cases were confirmed. Official number of COVID-19 cases in Africa show that the expectation has been unmet leading to the idea that COVID-19 severity is disproportionally lower in the continent. The effect of the COVID-19 pandemic, however, goes beyond the official number of cases and deaths. On the one hand, COVID-19 testing is insufficient and, therefore, cases underestimated. Also, limited health resources available are being allocated to the CVODI-19 response which compromises further other health services. Behaviour of people towards health systems may have also changed due to fear of the pandemic. The Gambia, a small West Africa country (2.2 million inhabitants), has 3,626 cases confirmed (September 21st) and 108 deaths. Approximately two thirds of these deaths have occurred in the community and the testing was conducted post-mortem. The MRCG @ LSHTM has 20% of the population under surveillance as part of the Health & Demographic Surveillance Systems (HDSSs). We propose to utilize our HDSSs to assess the excess mortality during COVID-19. To differentiate between the direct and the indirect excess deaths and explain the observed results, we are planning to: (i) conduct analysis of mortality stratified by age group, (ii) perform verbal autopsies to identify causes of death; (iii) carry out COVID-19 serological surveys and correlate hot spots with increased mortality. Rationale: In many high income countries, COVID-19 excess mortality is being quantified showing that the global harm of the epidemic expands beyond the official number of COVID deaths. The overall effect of the COVID-19 in West Africa is unknown. COVID-19 mortality, direct and indirect, is difficult to quantify in this region as there are no official death’s register. We rely on official numbers of COVID-19 deaths but, with the limited testing, cases and associated deaths may be largely un-diagnosed. Deaths mostly occur outside of health facilities a situation that may worsen should health systems become overwhelmed. Un-resourced health systems are less resilient to increased burden and therefore, the risk of collateral damage becomes exacerbated. As highlighted by the WHO, community-based surveillance is critical to have a holistic picture of the COVID-19 deaths in economically constraint regions. The HDSS is a unique resource to quantify excess mortality in African countries. Because The Gambia is a small country, we can have as much as 20% of its population under demographic surveillance which will give a robust picture of the overall effect of COVID-19 in the country. We have the opportunity to quantify direct and indirect effects, and identify their drivers. The strength of this study, in addition, is the combination of historical and prospective data and the serology component. https://www.worldometers.info/coronavirus/country/gambia/ https://ourworldindata.org/excess-mortality-covid | 2.4 Surveillance and distribution / P&Cs | 6project_grants_public |
gen_627b7f0839b8fa1e3d89099c280a44e6 | Population differences in vaccine response (POPVAC)-2: the impact of environmental exposures and selected interventions on waning of vaccine-induced immune responses | Medical Research Council | MRC/UVRI and LSHTM Research Unit Uganda | HRCS22_00901 | We propose that parasite infections contribute substantially to population differences in vaccine response; and that their effects are mediate We will test this hypothesis through four linked objectives among Ugandan adolescents. An immunisation programme comprising relevant live and inert vaccines will be given over one school year, with primary endpoints one month postimmunisation. A secondary endpoint at one year will assess response waning. 1. We will compare vaccine response profiles in urban adolescents (low parasite burden) with two rural cohorts, chosen for high schistosomiasis and high malaria prevalence. 2. We will establish whether current parasite infections have causal effects using individually-randomised, placebocontrolled interventions targeting the dominant infection in each rural cohort. Sample sizes will be robust, powered to detect vaccine response differences of 0.14log10 between study arms (modest effects compared to preliminary data). 3. We will assess herpesvirus-specific antibodies (Luminex), viral loads (droplet digital PCR) and cellular responses (ELISpot); and microbial translocation (MT; PCR for bacterial 16s ribosomal DNA, ELISA for lipopolysaccharide and other biomarkers). Markers of viral activation and MT will be related to parasite exposures and vaccine outcomes. 4. We will investigate pre-immunisation immunological characteristics using simple biomarkers and cell phenotyping, and with in-depth studies (including by mass cytometry) in smaller, representative groups; and link findings to both parasite exposures and vaccine outcomes. Our data will be integrated using causal mediation analyses to determine how urban-rural environment, parasites, "transkingdom" effects and immune responses relate to determine vaccine responses partly by "transkingdom" pathways (activation of herpesviruses; intestinal translocation of microbial products), and ultimately by pre-immunisation immune characteristics of the host. | 3.4 Vaccines / P&Cs | 6project_grants_public |
gen_b614a0b9e47755a15c752f3d8bef3ecb | Evaluating the implementation of the Peer Educator Intervention for improving adolescent health in India's National Adolescent Health Programme | Medical Research Council | Public Health Foundation of India (PHFI) | HRCS22_00921 | India is home to 243 million adolescents, yet they remain an understudied population in India with lack of data on the health indicators for this age group and current levels of knowledge on adolescent health issues and effective approaches on reaching marginalized adolescents. In 2014, the Ministry of Health and Family Welfare (MOHFW), Government of India launched a comprehensive National Adolescent Health Programme (Rashtriya Kishor Swasthya Karyakram-RKSK), to emphasize on community-based health promotion and strengthening preventive, diagnostic and curative service across health system related to 6 strategic health priorities. RKSK includes a peer educator (PE) programme, which seeks to ensure that adolescents benefit from sustained peer education and is expected to improve knowledge, attitudes and life skills of adolescents. The PE programme is also expected to change parental and community norms towards the need for adolescent friendly health services, leading to increased attendance to Adolescent Friendly Health Clinics (AFHCs) and subsequently positive adolescent health outcomes. This study will evaluate the impact and process of PE intervention as an integrated component of the RKSK and also explore its interaction with other RKSK components. It will further undertake economic analysis of costs related to implementing PE intervention for guiding scale up. This implementation research will be conducted in 4 high priority districts of 2 Indian states (2 each in Madhya Pradesh & Andhra Pradesh). Mixed methods approach will evaluate the process of the PE programme and its effects on primary outcomes at the adolescent (knowledge, attitudes, life skills, practices) and parental (attitudes, communication) levels as well as impact on PE skills and attendance at AFHCs. The research project also aims to provide guidance to MoHFW on modifying, scaling up and sustaining the PE programme and share findings with countries adapting RKSK. | 8.4 Research design and methodologies (health services) / Research Grant | 6project_grants_public |
gen_7bcd0ff5f84840c02583f9d7b525f059 | A randomised controlled trial (RCT) to evaluate a scalable active case finding primary care-based intervention for tuberculosis using a point-of-care | Medical Research Council | University of Cape Town | HRCS22_00923 | A startling statistic is that more than 40% of TB cases in endemic countries are "missing" (~4.2 million cases globally remain undiagnosed or unreported)! Most of these undiagnosed cases, which continue to transmit disease, are concentrated in the peri-urban 'slums' and 'shanty towns' of large African cities. Without addressing the 'missing cases' the TB epidemic will never be controlled. However, the lack of suitable diagnostic tools has been a major hurdle in finding the 'missing cases'. However, we have recently shown that community-based screening with molecular diagnostic tools (Gene Xpert) is highly effective in detecting these missing cases (Calligaro & Dheda, Lancet Infect Dis, 2017; XACT I study). This has now been superseded by a new simple to use portable, battery operated, point-of care (POC) version of Xpert (OMNI). For the first time we have a highly sensitive tool that is ideally suited for community-based active case finding (ACF). We have now validated this tool in a NIH-funded RCT in Cape Town (XACT II study; n= 5500 participants). The results show that Xpert is feasible at community-based POC and works much better than POC smear microscopy. However, we now need to validate the methodology and results in different settings to enable uptake and policy recommendations for primary care. Moreover, we now need to optimise the ACF model and determine where Xpert should optimally be located. Thus, we propose conducting a RCT to evaluate the feasibility and impact of primary care-based Xpert performed at POC compared Xpert performed in a centralized laboratory (XACT III). This study will set a new standard of care for ACF and likely revolutionize TB detection, moving it out of clinics and into the community. Furthermore, this project will enable, for the first time, the bio-phenotyping of TB patients in the community who have minimal or no TB symptoms using novel technologies including cough aerosol sampling and whole genome sequencing. | 2.5 Research design and methodologies (aetiology) / P&Cs | 6project_grants_public |
gen_18ae9effe140ccabece4c4174c5756cf | Two decades of primary health care expansion in Latin America: evaluation and forecasting study for health-related SDGs | Medical Research Council | Federal University of Bahia (UFBA) | HRCS22_00924 | A strong Primary Health Care(PHC) is essential for achieving Universal Health Coverage(UHC) and should be an integral part of and coordinate multi-sectoral actions addressing economic and social determinants of health, acting synergistically with social interventions such as cash transfer programmes(CCT) and social pensions(SP). The evidence of PHC effectiveness in LMICs is sparse, with most studies conducted in North America and Europe, moreover PHC's long-term effects and synergistic interactions with social assistance interventions have rarely been evaluated. We will perform a multi-country study in Brazil, Colombia, Ecuador and Mexico (BCEM) with the aim to: 1)Evaluate of the effects of PHC coverage on all the range of notifiable diseases, hospitalizations and mortality (overall, for specific causes and age-groups) over the last two decades using ecologic longitudinal data at municipal level in each BCEM from 2000 to 2018. We will also measure the effects of duration of PHC coverage (expressed as the average coverage of the previous years) and the presence of long-term effects (with lag and age-cohorts analyses). 2)We will evaluate the synergistic effects of PHC with the other healthcare system components (secondary and tertiary levels of care),CCT and SP on the full range of health outcomes at the municipal level. We will also measure as local factors, such as human development index(HDI) or local administration capacity, affected the effectiveness of PHC, paying attention to the heterogeneity of effects within and between countries.3)Using individual-level data from national health cohorts, surveys and censuses and multilevel modelling we will evaluate the granularity of PHC effectiveness on health outcomes in all BCEM.4)Using an integrated microsimulation approach we will forecast the effects of PHC coverage changes, calibrating the best implementation scenarios for achievement of health-related SDGs and reduction of health inequalities in BCEM up to 2030. | 8.1 Organisation and delivery of services / Research Grant | 6project_grants_public |
gen_91b732bf910d7647ee8ecdb4f7c445d1 | The risk of a chronic clinical condition following a previous hospitalisation by a psychiatric disorder: a linkage nationwide study in Brazil | Medical Research Council | Fiocruz (Oswaldo Cruz Foundation) | HRCS22_00928 | This project will analyse electronic data routinely collected within the Brazilian Public Health System (SUS). It involves enriching this type of data by linking them to other Brazilian governmental databases destined to national social protection programmes, which have important socio-economic variables of the individuals. A very large dataset with over 114 million people (The 100 Million Brazilian Cohort), which more than half of the Brazilian population, will be consolidated to the study of multimorbidity and its socio-economic determinants nationwide. Therefore, establishing foundations on the magnitude of the problem, in particular on the most impoverished population and for further studies on this subject in Brazil and other similar middle-income countries. We aim to study the risk of hospitalisation or death by diabetes mellitus, cardiovascular disease, stroke, or tuberculosis associated with previous hospitalisation by the following psychiatric disorders: depression, alcohol and substance use-related, and schizophrenia. We also intend to identify disease clusters and their related patterns, and how these patterns interact over time to influence the formation of such clusters. "Big data" is seen as having great potential to answer numerous questions and CIDACS collection of Brazilian data is unique in low-middle income countries. Our access to this collection of data allows for unprecedented study of morbidity and mortality in a nationwide scope. | 2.1 Biological and endogenous factors / P&Cs | 6project_grants_public |
gen_7b55d04f512318b25e23a3c8846f52b1 | The Khayelitsha Comorbidity Cohort: Establishing a multimorbidity cohort with integrated clinical, genomic and epidemiological data in South Africa. | Medical Research Council | University of Cape Town | HRCS22_00931 | There is high multimorbidity in South Africa, consisting both infectious and non-communicable diseases. Elucidating diagnostic, therapeutic and prognostic genetic drivers of morbidities can help tailor preventative and therapeutic patient care at both population and individual levels, and requires research into associations between genetic factors, complex patient phenotypes, and how these factors work in concert to impact complex clinical phenotypes in African individuals. The Provincial Health Data Centre (PHDC) is a health information exchange collating routine health data on a daily basis from 6.6million health care clients in the Western Cape Province (South Africa), compiling a patient-centric longitudinal health profile for every individual, with daily updates available on an ongoing basis. This presents an opportunity to research complete, complex clinical phenotypes with prospective automated health data updates for consenting individuals. The H3Africa Bioinformatics Network has developed an African-specific 2.5million SNP genotyping chip including novel African variants, known disease markers and pharmacogenomic variants. With the appropriate informed consent from participants, individuals' genotypes generated with the H3Africa chip can be linked to complex, longitudinal clinical phenotypes from the PHDC to develop an infinitely-scalable comorbidity cohort. At the seed-stage of the project, nested case-control analyses and genetic epidemiology methods will be used to explore complex genotype-phenotype associations focusing on high prevalence morbidities - diabetes, hypertension and kidney disease - in conjunction with HIV and TB. As the cohort grows, going forward, other morbidities can be analysed. Clinical data will be updated from the PHDC biannually, growing the extent of the clinical profiles over time. Additionally, a framework will be developed for returning clinically actionable findings to the Western Cape government health service. | 4.1 Discovery and preclinical testing of markers and technologies / P&Cs | 6project_grants_public |
gen_eb9b1ecaad9361f9c491f612bf1bc0bb | Exploring treatment burden and capacity for self care among patients with HIV/NCD multimorbidity in South Africa to inform interventions (EXTRA) | Medical Research Council | University of Cape Town | HRCS22_00932 | In Sub-Saharan Africa the rising burden of non-communicable diseases (NCDs) against a background of chronic infectious disease epidemics, most notably HIV, is giving rise to patterns of multimorbidy that are occurring in people of working age, with implications for productivity and social stability. Chronic care for patients with multimorbidity in South Africa (SA) is fragmented, uncoordinated and does not account for increased complexity of the demands on patients. We aim to systematically identify, characterize and understand the workload experienced by patients with HIV/NCD multimorbidity, and their caregivers in SA. This is to ensure that the patient perspective is fully considered in current healthcare reform initiatives to improve primary level chronic care and outcomes. We further aim to explore the relevance and applicability of existing theoretical models of NCD treatment workload-capacity from high income countries and adapt them to inform future research and interventions in the LMIC context of SA. We will use qualitative research methods to: conduct semi-structured interviews with purposively selected samples of patient and carer dyads in urban and rural settings; convene task groups with healthcare decision makers, doctors, nurses and community health workers from the same settings to discuss the findings and consider their implications for local service redesign and interventions to reduce burden and increase capacity; engage policy and decision makers provincially and nationally in stakeholder meetings to influence health reforms. This project will help us better understand treatment and capacity issues in a LMIC context. Our theory-informed qualitative analyses will develop a culturally and contextually appropriate theoretical model of HIV/NCD workload and capacity. This work will contribute to development of individual, peer group and service level interventions that can be validated in a large scale, complex intervention trial. | 7.1 Individual care needs / P&Cs | 6project_grants_public |
gen_810a22d5b07954b690f943dbd1a85ae0 | Developing a Digital Health-enabled Intervention to tackle Multimorbidity in Primary care in India | Medical Research Council | Centre for Chronic Disease Control | HRCS22_00936 | More than a quarter of adult patients attending primary care facilities in India have multimorbidity. However, national health programmes are disease-centric, including the ongoing National Programme for Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), which caters to large population groups in primary care for a range of chronic conditions. The specific objectives of the proposed research work in the Indian state of Tripura are: a) To discover major multimorbidity patterns relevant for NPCDCS in primary care; and b) To develop a digital health-enabled intervention, targeting major multimorbidity patterns, relevant for NPCDCS, to improve targeting and delivery of clinical services in primary care. A digital tool- comprising clinical decision support and electronic health record- is deployed in 40 primary care facilities in Tripura to aid the healthcare team in managing six chronic conditions - hypertension, diabetes, dyslipidaemia, chronic obstructive pulmonary diseases, alcoholism and tobacco use- for the past 29 months. In such patient's record, information on the presence of eight additional chronic conditions is also routinely recorded. This dataset will be used for discovering multimorbidity patterns. Using these inputs, and expert consultations, we will develop a digital health-enabled intervention for the management of multimorbidity following the MRC framework for developing complex interventions. To guide intervention development, a theory of change will be constructed, covering the building blocks of the health system and other contextual factors. Using mixed methods, we will develop a prototype intervention and pilot it in two health facilities for assessing feasibility, developing mitigation strategies for barriers, identifying potential indicators for the process of care and patient-level outcomes, sample size and recruitment feasibility for planning an application for controlled evaluation of the intervention developed in a future trial. | 8.2 Health and welfare economics / P&Cs | 6project_grants_public |
gen_6784b3f85bb352fcededea9a93f951fc | Self-management approaches for individuals with multiple chronic health conditions in rural South Africa | Medical Research Council | University of the Witwatersrand | HRCS22_00938 | South Africans are experiencing a complex, protracted health transition characterised by ongoing burdens from epidemic infectious diseases, particularly HIV/AIDS, rapidly increasing morbidity and mortality from chronic diseases such as heart diseases, stroke, cancer and metabolic disorders and ill-prepared healthcare systems. Levels of multimorbidity, commonly defined as having two or more medical conditions are very high among older South Africans in rural areas with combinations of cardiometabolic conditions, cardiometabolic conditions and depression, HIV and anaemia and combinations of mental disorders as the most common condition groups and multimorbid profiles. As self-management is a critical aspect of the management of chronic diseases, it is important to understand the extent to which individuals with multiple chronic health conditions in South Africa, particularly in rural settings are involved in the self-management of their conditions. Evidence from high income settings shows that self-monitoring of personal health, which is a key aspect of patients' self-management of chronic illnesses, could improve self-management, symptom management and disease regulation, and could lead to reductions in complications, improved patients' coping and attitudes toward their disease, realistic goal setting and an enhanced quality of life. Using a combination of quantitative and qualitative research approaches this project will assess the extent to which individuals with multiple chronic health conditions living in rural South Africa self-monitor their health, what methods they use, and the effect of different self-monitoring approaches on behaviours and health outcomes. The research will be conducted in the Agincourt health and socio-demographic surveillance system study area in Agincourt sub-district in Mpumalanga province, in northeast South Africa. | 3.1 Primary prevention interventions to modify behaviours or promote well-being / P&Cs | 6project_grants_public |
gen_26dae5ea3087e2c13354a6d978362f86 | 2018 - DTA - Gambia (at LSH&TM) | Medical Research Council | London School of Hygiene and Tropical Medicine | HRCS22_01015 | In developing societies characterised by complete absence of vital registration systems, the continuous demographic surveillance (DSS) approach to data collection provides the best opportunity to generate the quantitative and qualitative evidence of disease burden needed for the formulation and/or adjustment of health policies. Against this background and with the aim of providing robust research platforms for the design and evaluation of interventions to reduce mortality and morbidity, the Medical Research Council, The Gambia runs two such demographic surveillance sites, namely the Farafenni and Basse DSS sites. The Farafenni site, established in October 1981 with the aim of monitoring the impact of village-based Primary Health Care on mortality, is located on the north bank of the river Gambia, about 120 km from the capital city of Banjul, and currently has a total population of over 45,000 under surveillance. The Basse DSS site was established in 2007 and covers all residents of the two eastern-most districts of the country south of the river − over 175,000 people. With the long term goal of serving as a platform for multi-disciplinary population-based investigations on tropical infectious diseases, this site currently facilitates the estimation of the burden of diarrhoea and pneumonia. The available data from both Farafenni and Basse surveillance areas reveal dramatic recent declines in under-5 mortality. In fact, the trends suggest that the Farafenni area reached its Millennium Developing Goal 4 target in 2008, well before the planned date in 2015. Mortality has mainly decreased in older children, while neonatal mortality is stubbornly resistant to change, with the consequence that the proportion of neonatal deaths among children under 5 years has steadily increased. Similar trends were also reported from Niakhar DSS site in Senegal and Navrongo DSS site in northern Ghana. Considering that reliably detecting newborn deaths is a major challenge, the problem may be even worse than we realize. Therefore, improving our techniques of measuring neonatal and infant mortality is an urgent priority. Indeed, this is important to determine the most common causes of death and formulate adequate interventions to decrease the burden. The Child Survival Theme in conjunction with the Disease Control and Elimination Theme plans to build on and go beyond the sound track record of mortality data that exists in The Gambia to achieve the highly robust information on levels and causes of neonatal mortality data that we need. Goal and Scope of Work The goal of the proposed PhD project is to: 1. Adopt a methodological strategy to improve the measurement of neonatal and infant mortality at national and regional levels to accurately reflect the magnitude of the burden. One such approach is the intensive follow-up of identified women up to the completion of their pregnancies and beyond; and of their offspring up to 12 months of age. 2. Investigate the extent to which a childhood mortality transition is evident in the West African sub-region and identify the key health and socio-cultural practices or changes in practices that are driving the phenomenon; as well as the factors sustaining the level of neonatal mortality. The approach will be mainly through quantitative analysis of DSS data from sites in The Gambia, with the possibility of broadening the scope to include DSS data from other West African countries, especially the Sahel region. Demographic and Health Survey (DHS) data from countries in the region with at least one such dataset, and other nationally representative local surveys may also be used to complement the analysis. Where possible and deemed necessary, reasonably scaled qualitative approaches can be adopted to answer questions or establish linkages that quantitative methods may not readily provide. | HRCS Research Uncodeable / Studentship | 6project_grants_public |
gen_5221aaeb96a8e0631bf1eb98dab77d07 | Pathogen Genomics, Phenotype and Immunity (PGPI) & Basic Sciences Programme | Medical Research Council | MRC/UVRI and LSHTM Research Unit Uganda | HRCS22_01304 | We propose to monitor the HIV epidemic by characterising the circulating HIV-1 subtypes especially in recent infections and use full length genome sequencing to understand better the increasing recombinant viruses using better bioinformatics tools. We will use molecular in combination with social-epidemiological and modelling approaches to provide novel avenues to monitor epidemic trends and transmission dynamics, and to contribute to targeted interventions through the identification of transmission clusters and hotspots. We will expand our drug resistance (DR) studies to contribute to improved interventions. We are well positioned to provide such data being a National and Regional Reference laboratory for HIV DR and active participants in related national activities. We propose to undertake a comprehensive and systematic analysis of HIV-1 viruses representing the subtypes and recombinant forms circulating in Uganda to elucidate if transmitted/early HIV-1 viruses have recurrent patterns (signatures) that distinguish them from chronic viruses. We will contribute to the studies aimed at understanding whether Zika virus exists among humans, primates and mosquitos in Uganda and conduct studies to molecularly characterize the Zika genome. There is renewed global interest in understanding events surrounding HIV superinfection (SI). However, due to the introduction of test and treat, opportunities to study this phenomenon are very limited. We are uniquely positioned to address this subject, we have a large collection of specimens from high risk populations and hence propose to investigate the host and viral factors associated with SI. This information will contribute to knowledge on protective immune responses. We recently won an NIH RO1 to address this topic and have set up an international collaborative network to address specific questions. The best vaccine induced protection achieved to date against SIV in macaques has been a live attenuated SIV. We propose to study the potential protective immune responses against HIV through PrEP in highly exposed populations. This is in order to explore whether exposure to HIV under PrEP cover could induce immunity equivalent to that afforded by a live attenuated vaccine. This is a proof of the concept that immunity to HIV might be achieved if the initial infections are hampered by chemoprophylaxis, simulating vaccination with a live attenuated virus strain. Gilead has provided the drugs for this study. We will participate in other studies to contribute to HIV Vaccine research and development | 1.1 Normal biological development and functioning / Unit | 6project_grants_public |
gen_a346b078bc8447e355fc08f394c7f98b | Cancer Epidemiology | Medical Research Council | MRC/UVRI and LSHTM Research Unit Uganda | HRCS22_01305 | We will build on our work showing that the malignant and non-malignant consequences of oncogenic infections (including HIV) are a major cause of morbidity and mortality in Uganda and that lifestyle risk-factors such as tobacco are currently relatively less important in this setting. We will i) examine the transmission dynamics of oncogenic infections, ii) initiate preventive interventions and, iii) conduct aetiological research on specific cancers. For example, the determinants and immune correlates of suppression and transmission of Kaposi’s sarcoma associated herpesvirus (which exists at higher prevalence in our rural cohort than has been reported anywhere else in the world) will be studied. Working within our population platforms, we will: i) examine the impact of a national HPV vaccination scheme on circulating subtypes of HPV; ii) assess the feasibility of H. pylori eradication in a population in which infection is ubiquitous; iii), conduct a feasibility study of Hepatitis C Virus cure and iv) develop further work on understanding liver disease and progression of chronic infection with Hepatitis B virus. We will also seek external funding to conduct a randomised-controlled trial of low-technology methods (a package of post-harvest measures) in combination with a bio-control approach to reduce aflatoxin levels, which we have previously shown to be an important exposure. Comparative research on the epidemiology and aetiology of haematological malignancies in Uganda and in the UK will be further developed, in conjunction with studies of the HIV-related cancers Kaposi’s sarcoma and conjunctival carcinoma. | 2.1 Biological and endogenous factors / Unit | 6project_grants_public |
gen_5258662cd625c5edeaef01b3b601f0a9 | HIV Epidemiology and Prevention Programme | Medical Research Council | MRC/UVRI and LSHTM Research Unit Uganda | HRCS22_01306 | This Programme has two broad areas within which there are specific projects. a) Prevent acquisition of new infections in general and in key populations: i) assess knowledge and preferences for biomedical HIV prevention interventions and adherence to oral PrEP and determine best recruitment and retention strategies for research among adolescents and young women ii) assessing the long term safety profile and adherence of dapivirine vaginal ring in an open-label trial while continuing to assess HIV incidence; iii) work on assessing the impact and adherence of Test-and-Treat as prevention; iv) HIV combination prevention including PrEP among fishing communities, as well as modelling of HIV combination prevention and estimation of the cost-effectiveness, and the impact on HIV incidence; v) continuation of research on evaluating HIV vaccines in early phase I and II trials and phase IIb/III efficacy trials, and new microbicides. b) Improve survival and quality of life among those infected i) mental health care interventions; ii) research on health systems for chronic disease; iii) investigate the effect of hormonal contraceptives on recurrent bacterial vaginosis (BV), vaginal microbiota and inflammatory markers among women at high risk for HIV in Kampala; iv) collaborate with The AIDS Support Organisation (TASO) to identify research questions on topics such as ART toxicities. | 3.1 Primary prevention interventions to modify behaviours or promote well-being / Unit | 6project_grants_public |
gen_0a054175559d216008aed7a04fb9a7d5 | Social Aspects of Health across the Life Course Programme | Medical Research Council | MRC/UVRI and LSHTM Research Unit Uganda | HRCS22_01307 | The aim of the programme is to further our understanding of the social aspects of health and wellbeing for specified individuals and populations to inform the design, implementation and evaluation of interventions, as well as contribute to policy development. We will work primarily across the HIV and Non-Communicable Disease themes in close collaboration with the associated programmes. The main geographical focus is Uganda but the programme will contribute to cross-Africa studies and intervention development as appropriate. Our methodological and theoretical work will be of international relevance. The proposed programme builds on core elements of our past work by investigating health across the lifecourse. We anticipate that the programme, which embraces health economics, will continue to grow and will provide training and mentoring to Ugandan and international staff and students. Translational research is an important aspect of all our work and we aim to contribute to the development and testing of interventions. This programme will focus on different stages of the life course and specific populations: 1) Children and adolescents; 2) Key (at-risk) populations; 3) People 50 years and older. | 2.3 Psychological, social and economic factors / Unit | 6project_grants_public |
gen_751d569f08353ba050a0647369486076 | Immunomodulation and Vaccines | Medical Research Council | MRC/UVRI and LSHTM Research Unit Uganda | HRCS22_01308 | Our goal is to understand the impact of infection exposure on human immunological programming and health. Our overarching hypothesis is that chronic and cumulative infection exposure influences immunological mechanisms through active processes (during current infection), lasting epigenetic modifications, and genetic selection; that (therefore) some effects do not immediately respond to treatment; and that effects critically impact upon major health outcomes including vaccine responses and susceptibility to pathogens, allergy-related disease and metabolic conditions (Figure 8.8). The main focus of our work is on vaccine responses, addressing the role of infectious exposures in striking population differences in vaccine immunogenicity. We also support studies on the role of chronic infection in allergy-related and metabolic disease susceptibility. Building on recent findings, exploiting unique platforms that we have established, we aim to determine the effects of infectious exposures (prenatal, cumulative life-time and current, active exposures) on health outcomes comprising: 1. Vaccine immunogenicity 2. Infectious disease susceptibility – focussing on oncogenic viruses 3. Asthma phenotypes and allergy-related effector mechanisms 4. Infection, inflammation and cardio-metabolic risk To obtain deeper insights into mechanisms by which infections have their effects, we plan complementary studies (for which funding is available, or being sought elsewhere) on the mediating role of the microbiome and on the mediating role of epigenetic modifications In addition, the programme supports related studies on tuberculosis and schistosomiasis, and genetic studies. | 2.1 Biological and endogenous factors / Unit | 6project_grants_public |
gen_52a5b102a24708a9cddba7e2411d41b9 | Thematic Support - Disease Control and Elimination | Medical Research Council | London School of Hygiene and Tropical Medicine | HRCS22_01342 | The theme answers scientific questions related to the control and elimination of infectious diseases by designing large epidemiological studies and clinical trials (i.e., individually and cluster randomized). These projects target, beyond clinical cases, asymptomatic infections as these are key for maintaining transmission at community level. To control and eliminate diseases of public health importance in the region, DCE needs access to large population and geographical areas. The knowledge of population structure provided in part by the three HDSS run in The Gambia, gives DCE a unique knowhow for implementing cluster randomized trials, mainly in rural areas, to evaluate interventions aimed at system-wide changes or to avoid contamination between arms. Access to community for other studies and trials is through governmental health facilities. The DCE scientific strategy focuses on unravelling the interactions between hosts, pathogens, and vectors and at evaluating interventions aimed at interrupting transmission and/or reducing the disease burden. Both components can inform each other and provide new elements for understanding the dynamics of transmission and identifying new targets for interventions. DCE has a multidisciplinary approach combining epidemiological research with strong laboratory support (formerly for diagnosis but increasingly for more sophisticated molecular analysis). The core component of epidemiology and laboratory sciences is complemented, whenever possible, by social sciences investigating the human factors influencing the epidemiology of the diseases, the uptake and coverage of interventions as well as health economic research to ensure that successful interventions are promptly translated into practice. Research areas: - Malaria. The malaria research activities contribute to a better understanding of malaria epidemiological trends and transmission dynamics needed for better targeting interventions for both control and elimination of malaria. - Invasive bacterial infections (IBI) remain major causes of morbidity and mortality in childhood with an even higher burden among neonates. The research activities on this area have contributed to a better understanding of etiologies responsible for IBI in The Gambia, community transmission and risk factors. In addition, we have designed context specific trials to decrease neonatal sepsis and associated mortality and have evaluated the impact of new country-wise implementations for children. All the studies and trials have a component to assess trends of antimicrobial resistance (AMR) on bacterial isolates. On this area, the Unit has also pioneered research on S. pneumoniae before and after the implementation of Pneumococcal Conjugate Vaccines (PCVs). - Diarrhoeas are a leading cause of morbidity and mortality in children. During the last years, we have quantified burden of disease and main aetiologies responsible for diarrhoeas in The Gambia. Our work led to the introduction of Rotavirus vaccine. Trials to evaluate new interventions are also part of our remit. The Theme conducts research on the links between infections and chronic diseases (such as group A Streptococcus infection and rheumatic heart disease or hepatitis B and liver cancer). Lately, the theme has built a large portfolio on epidemiological research of SARS-CoV-2 and COVID-19 disease. | 2.2 Factors relating to physical environment / Unit | 6project_grants_public |
gen_1c1f10369e15ef6c883222fc86d56fee | Thematic Support - Vaccines and Immunity | Medical Research Council | London School of Hygiene and Tropical Medicine | HRCS22_01344 | The Vaccines & Immunity (V&I) Theme aims to contribute to the evidence‐based development and delivery of vaccines through integration of laboratory science with clinical trials and longitudinal cohort studies, including for tuberculosis. Using cutting‐edge immunological methods and bioinformatic approaches, we investigate host responses in individuals of different ages and dissect the interactions between host and pathogen under vaccine or disease pressures. We have worked towards a better understanding of the ontogeny of immunity to inform the next generation of vaccines, and we have a large portfolio of clinical trials to assess safety, immunogenicity and efficacy of novel vaccines and to nurture trust in these interventions. There are several specific workstreams: 1. New interventions to protect pregnant women and their infants against vaccine‐preventable morbidity and mortality Amongst the interventions to improve the unacceptably high morbidity and mortality in women and young children, vaccination of pregnant women could be a valuable approach; this concept is already established for neonatal tetanus in Africa and for influenza and pertussis in high‐income settings. New vaccines aimed at licensure for use specifically in pregnancy are on the horizon (RSV, Group B streptococcus) and our theme is playing an active role in their assessment and implementation through clinical trials and embedded laboratory science to learn more about the immune responses the vaccines induce. 2. Optimising vaccines, schedules and delivery against key pathogens affecting the health of women and children Our research supports the WHO’s Immunization agenda to make sure that ultimately, everyone, everywhere, at every age, can fully benefit from vaccines. We run clinical trials that lead to licensure of highly protective and more cost‐effective vaccines, e.g against causes of bacterial meningitis and pneumonia, viral diseases e.g. cervical cancer, polio, and we work towards optimisation of vaccine delivery and -schedules. We use geospatial mapping methods and social science approaches to understand why not all children in the region receive timely vaccinations. 3. Understanding immune ontogeny through systems biology Systems biology provides new tools to unravel the complex interactions between the different immune compartments; vaccination represents a controlled intervention which allows probing in unprecedented depth the pathways for immune development. We conduct in depth multi-omic analyses of different immune compartments, incl mucosal immunity using optimised laboratory protocols that require minimal blood volumes. 4. Tuberculosis (TB) in adults and children The Gambia remains endemic for TB, with a prevalence rate of 128/100 000 and an average of 3,800 new cases per year. We are ideally placed for in‐depth immunological and microbiological analyses, using a well characterised household contact cohort (the TBCC) approach which facilitates long‐term follow up and has resulted in longstanding track record in TB transmission dynamics research. We work towards identification of novel biomarkers of TB susceptibility and risk of progression to inform correlates of protection which in turn will serve vaccine development, and to develop novel diagnostics, prevent childhood TB and understand long‐term TB sequelae. | 3.4 Vaccines / Unit | 6project_grants_public |
gen_3e61604abee26d4995a2066e84b82471 | Thematic Support - Nutrition Planetary Health | Medical Research Council | London School of Hygiene and Tropical Medicine | HRCS22_01345 | Emerging nations such as The Gambia suffer a double burden of malnutrition: rates of undernutrition in mothers and young children are gradually diminishing but remain a major threat to health and well-being; meanwhile rates of overweight and obesity are escalating rapidly with the attendant risks of diabetes and hypertension. The Nutrition & Planetary Health (N&PH) Theme focuses on discovery science in 5 focus areas to better identify diet-disease pathways in order to devise and test more effective next-generation interventions. Early Growth & Development: Having identified pre- and very early post-natal effects on cognitive outcomes this sub-theme is trialling novel supplementary feeding approaches to optimise brain development. Iron, Infection & Anaemia: Having recently identified novel pathways by which hepcidin-mediated blockade of iron uptake contributes to iron deficiency our research is trialling novel interventions focussed particularly on very early iron supplementation of breast-fed babies. The effects of early life iron deficiency on immune function and vaccine responses are key topics. Nutritional Genetics & Epigenetics: We have demonstrated that a mother’s nutritional status at the time of conception influences the methylation of certain genomic regions. We hypothesise that this constitutes a system to sense the external environment, record the information and adapt the developing fetal phenotype accordingly. We have evidence that these loci are under genetic control and can alter life-long risk of disease. Reaching a fuller understanding of the mechanisms and sequelae of these changes may help inform future nutritional guidance and/or interventions for mothers-to-be. Nutrition-Related Chronic Diseases: Burgeoning levels of overweight and obesity, and an ageing population in Africa are leading to multiple chronic diseases. Our research aims to characterise the nature and causes of diabetes, hypertension, sarcopenia and fractures in both rural and urban populations with a view to guide the development of Africa-specific therapeutics. Planetary Health: In response to the growing threats posed by climate change and planetary degradation we are rapidly growing a portfolio of research aimed at designing local and pan-African adaptive strategies built upon a clearer understanding of the complex interactions between agriculture and food systems, alterations in land use, and human-animal interactions. | 2.1 Biological and endogenous factors / Unit | 6project_grants_public |
gen_5d6cc9261b9cda9d26f4a30e61c0c880 | Surveillance & Epidemics Preparedness | Medical Research Council | London School of Hygiene and Tropical Medicine | HRCS22_01347 | Surveillance & Epidemics Preparedness | HRCS Research Uncodeable / Unit | 6project_grants_public |
gen_169e22356dc4b88fd40cec2691d1c7be | A randomized controlled trial of influenza vaccine to prevent adverse vascular events. | Medical Research Council | McMaster University | HRCS22_01393 | The goal of this study is to assess whether inactivated influenza vaccine can reduce adverse vascular events in high risk participants. We will address the question by randomizing patients at high risk for adverse vascular events to either annual inactivated influenza vaccine or to placebo over three influenza seasons. Participants will aged 18 years and over and have New York Heart Association functional class II, III and IV heart failure. Patients will be randomized to either influenza vaccine or placebo. We will enroll 3,500 participants from centres in seven countries: Philippines (the lead centre), Mozambique, Sudan, Uganda, Saudi Arabia, Malaysia, China. The primary outcome is a composite of cardiovascular (CV) death, non-fatal myocardial infarction (MI), non- fatal stroke, and hospitalization for CHF. We hypothesize that the intervention will lead to a 25% risk reduction in the primary outcome. This proposed randomized trial has important implications for the management of patients at high risk for major adverse vascular events. Although the influenza vaccine is recommended annually for groups with diabetes and cardiovascular disease in many counties, uptake of these recommendations is relatively low. Cardiologists in most jurisdictions do not routinely recommend annual influenza vaccine for their patients as a strategy to reduce future adverse vascular events such as acute coronary syndrome or stroke. Uptake of influenza vaccine in patients with heart disease varies by country but in study sites is 11% on average. Rigorous demonstration of influenza vaccine leading to a reduction in major adverse vascular events would represent a landmark study. | 6.1 Pharmaceuticals / Research Grant | 6project_grants_public |
gen_5ab0b550e0335ea1d235ab2fdfad6605 | Designing and evaluating provider results-based financing for tuberculosis care in Georgia: understanding costs, mechanisms of effect and impact | Medical Research Council | Curatio International Foundation | HRCS22_01486 | The study will first inform how the problem is conceptualised and the intervention is designed in collaboration with the policy makers at national level. Once piloting is started, the research will seek to answer the following research questions: (1) What is the impact of provider-focused Results Based Financing (RBF) on patients' adherence to tuberculosis treatment and treatment outcomes of both Drug-Susceptible (DS) and MDR patients in Georgia? The impact of RBF will be evaluated using a quasi-experimental trial design. Eligible facilities will be randomly selected in 20 districts, then randomly allocated to intervention and control groups. The study population will include nurses and physicians involved in TB primary care and TB patients (DS & MDR-TB cases), who provide TB treatment to approximately 500 patients, which represents 12% of the expected total newly registered TB patients. The intervention will be RBF with provider incentives, complementing the existing patients' incentives. The comparison will be of intervention (RBF) and control groups (existing funding model), considering the variety of the contexts (e.g. semi-urban/urban, and public/private facilities). The outcome measures will be adherence to TB treatment and treatment success rate. (2) Is the RBF intervention cost-effective? Cost-effectiveness analysis will generate evidence on the costs of the intervention by comparing the existing model with the added supply side RBF intervention. (3) How does it work, for whom and in which conditions? and (4) How should RBF be modified to optimise national roll-out for this and possibly other health services? To identify the mechanisms of change and the context factors that enhance or undermine the effectiveness of the RBF intervention, we will carry out realist case studies in a sub-set of sites. This theory-informed trial design will allow us to assess how and why the RBF scheme leads to the observed results, for whom and in which conditions. | 8.1 Organisation and delivery of services / Research Grant | 6project_grants_public |
gen_477397e7c8c420cc5e7032dc13932cb8 | Examining the level and variation in the efficiency of county health systems in Kenya, and how it can be improved | Medical Research Council | KEMRI Wellcome Trust Research Programme | HRCS22_01633 | This research aims to measure the level of efficiency of the 47 county health systems in Kenya, and to examine its determinants. It also aims to examine the potential for efficiency gains and how this can in turn result in increased fiscal space for the Kenyan health sector. Further, the research aims to test the application, and explore methodological refinements of current efficiency measurement methods to LMIC settings, and at sub-national levels of the system (such as counties/districts) rather than health facility level (such as hospitals). We will use two frontier methods to measure the technical efficiency (and its determinants) of county health systems. First, we will use the double bootstrap Data Envelopment Analysis technique. Data envelopment analysis (DEA) is a non-parametric mathematical linear programming technique that has been widely used in low and middle income countries (LMICs) due to its flexible nature. Stochastic frontier analysis (SFA) is a parametric econometric approach that uses regression analysis to estimate a production or cost function, that accounts for error, but can be computationally complex. Bootstrap DEA will generate bias corrected efficiency scores, which will then be subjected to truncated regression analysis to examine the determinants of efficiency. To further explore the determinants of efficiency, we will select 2 counties that are found to be efficient and 2 inefficient counties that are lower than the 75th percentile in efficiency rank, and carry out in-depth qualitative inquiry through in-depth interviews and document reviews. This component of the study answer questions about how identified factors interact with and influence health system efficiency, and how these might be leveraged on to improve health system efficiency. Lastly, we will examine the potential for efficiency gains using DEA, and excel based models | 8.1 Organisation and delivery of services / Research Grant | 6project_grants_public |
gen_d6012a09ab0cfb33779eeb031a1e7faf | Infection, inflammation and hepcidin-mediated iron deficiency anaemia in African children | Medical Research Council | London School of Hygiene and Tropical Medicine | HRCS22_01722 | The 2016 Global Burden of Disease analysis estimates that 1.225 billion people suffer from iron deficiency anaemia (IDA) and it is the fourth largest contributor to years lived with disability (YLD) globally. The burden is concentrated in sub-Saharan Africa and South Asia. Iron is crucial for neural development and early deficiencies during fetal and infant growth cause irreparable damage to brain development. Until now IDA has been largely attributed to diets low in iron and to infections such as malaria and intestinal helminths. However carefully controlled trials of iron supplements (often with deworming and malaria control) have very poor efficacy in Africa. The discovery of hepcidin - the master regulator of iron - throws a new light on the causes of IDA and may guide future therapeutic pathways. We have recently shown that even low-grade inflammation is a major contributor to ID in rural African children due to hepcidin/ferroportin-mediated blockade of intestinal absorption of iron. IDA is likely further exacerbated by EPO resistance. This project seeks to identify the sources of persistent low-grade inflammation in well and sick Gambian children. It will additionally try to understand the complex interacting mechanisms linking iron absorption, distribution and erythropoiesis to the effects of inflammation mediated through hepcidin, erythropoietin (EPO) and the newly discovered hormone erythroferrone (ERFE) which signals to the liver that the bone marrow requires iron. Finally we will conduct a randomised controlled trial to test whether it is possible to circumvent the hepcidin-induced blockade of iron absorption by administering iron in the form of haem. Another arm of this trial will be a proof-of-principle trial to assess the impact of reducing inflammation by co-administering azithromycin and galacto-oligosaccharides with iron. These studies, if successful, would suggest the need for a radical revision of current policies to combat IDA | 2.1 Biological and endogenous factors / Research Grant | 6project_grants_public |
gen_67a03f2d3ada67b73f7de4f7d46706a0 | Phase III, Multicentre, Randomized, Double-blind, Placebo-controlled Study to Evaluate Efficacy of Probiotic Supplementation for Prevention of Neona | Medical Research Council | Indian Council for Medical Res (ICMR) | HRCS22_01846 | Neonatal infections (pneumonia, septicaemia, meningitis) are responsible for more than a quarter of the 1 million neonatal deaths every year in India(1). Low Birth Weight (LBW) is a very important indirect cause of death in neonates, accounting for 40% to 80% of neonatal deaths (2-3). Management of neonatal sepsis with antibiotics faces the problem of drug resistance and immune-modulation/immune-potentiating with the use of probiotics may prove to be an option. Available evidence suggests a beneficial effect of probiotics treatment on reducing the incidence and all -cause mortality due to NEC (4-5.). In our pilot study supplementation with probiotics VSL#3 in LBW infants was associated with a non-significant overall 21% reduction in the risk of suspected sepsis (PSBI). In the post-hoc analyses using physician's diagnosis of sepsis as the outcome measure, there was a 33% overall reduction in risk of sepsis. However, in the un-prespecified sub-group of infants weighing 1.5-1.99 kg, there was a 100% reduction, with no cases observed in the group receiving probiotic supplementation (6). Following on from the evidence on VLBW and premature infants and based on the positive results of the above mentioned pilot study, we propose to test the hypothesis, with sufficient power and a precise definition of the outcome measure to conclusively evaluate the role of probiotics among LBW infants in a multicentre double blind placebo controlled trial. | 3.3 Nutrition and chemoprevention / Research Grant | 6project_grants_public |
gen_7a537b0ab3b7752ee4525651213e3ff3 | High Dose Oral Rifampicin to Improve Survival from Adult TB Meningitis - (HARVEST) Trial | Medical Research Council | Infectious Diseases Institute (IDI) | HRCS22_01848 | Tuberculous meningitis, the most severe form of TB, results in death or neurological disability in >50% of those affected, and mortality is 2-3 fold greater in HIV-infected patients. Rifampicin, a primary TB medication, only achieves in cerebrospinal fluid (CSF) 10-20% of the levels observed in blood. We propose a phase III randomized, double-blind placebo-controlled clinical trial evaluating whether ~3.5x higher oral dose rifampicin has a 6-month survival benefit as the primary endpoint, additionally pharmacokinetic measurements and safety are included as important secondary endpoints. This trial builds up a series of phase II trials conducted in Indonesia by our team members which demonstrated that higher rifampicin IV doses were associated with lower mortality. In follow up oral rifampicin phase II trials, based on pharmacokinetic analyses, the optimal oral dose is estimated to be approximately 35 mg/kg/day. In the prior phase II trials as well as in pulmonary TB trials, there were not excess adverse events observed with higher dose rifampicin therapy at doses of 35 mg/kg/day. To simplify future implementation, we will use a single (flat) increase in rifampicin for all participants of 900mg in Indonesia and 1200mg in Uganda/South Africa, corresponding a total rifampicin dose of approx. 35mg/kg, during the first 8 weeks of treatment. This can easily be added to fixed dose combination therapy provided by most national TB programs. | 6.1 Pharmaceuticals / Research Grant | 6project_grants_public |
gen_38515e5f983819c08693833c505a0c33 | Integrating Refugees into National Health Systems: Enhancing Equity and Strengthening Sustainable Health Services for All. | Medical Research Council | American University of Beirut | HRCS22_01945 | This study will employ a comparative case study approach focusing on three countries currently hosting large numbers of refugees: Lebanon (1.1m), Jordan (655,624), and Uganda (940,800). We plan to focus on Syrian refugees in Lebanon and Jordan, and South Sudanese refugees in Uganda. Our research will seek to: (i) understand the perceptions and experiences of stakeholders (international, regional, and national) as well as host populations and refugee populations towards refugees' integration into national health systems including how these stakeholders understand the meaning of integration and how desirable various actors believe it to be (ii) identify the factors that have shaped the adoption and implementation of policies supporting the integration of refugees into national health systems in these three countries (iii) assess how the pattern and extent of refugee integration has affected health services received by both refugee and host populations and (iv) assess financial flows and the financial sustainability of services. We will then convene national, regional and international policy and decision-makers to reflect upon the findings from these analyses, and identify their implications for future policy and practice. Within each of the three country cases, we will employ a mixed-method, qualitative and quantitative, approach that will be tailored to match local circumstances. We plan to identify timelines for the development of refugee policies (generally and in regard to access to national health services) and will conduct a policy analysis to understand how policies and practices evolved and why. We will then use existing datasets and primary data collection within district level cases, to explore how different aspects of refugee integration into national health systems over time has affected availability, access to health services, quality of health care, and felt experiences of seeking care, as well as financial sustainability. | 8.1 Organisation and delivery of services / Research Grant | 6project_grants_public |
gen_231b7e92191f4ab00b09286a127ea22f | Adolescents' Resilience and Treatment nEeds for Mental health in Indian Slums (ARTEMIS) | Medical Research Council | The George Inst for Global Health India | HRCS22_02027 | The proposed trial will be a hybrid effectiveness-implementation cluster randomised trial with wards/blocks (only urban slums will be included) being the unit of allocation. The trial will implement a mobile-technology enabled mental health services delivery model for adolescents living in slums in two Indian cities - New Delhi and Hyderabad. Duration of the trial will be for 36 months. It will train primary healthcare workers and doctors to screen, diagnose, and manage adolescents suffering from depression and increased suicide risk, and also inquire and manage those identified at high risk of intimate partner violence leading to stress/depression. Besides task sharing, the complex intervention will also include an anti-stigma campaign. We hypothesise that: (1) a community-based anti-stigma campaign will lead to significant improvements in community's behaviours toward adolescents with mental disorders; (2) a mobile device-based decision support system for primary health care staff will significantly lower depression and suicide risk in adolescents. Forty wards (only slums will be included) will be randomized to intervention or control group and we aim to recruit 2560 adolescents into the study, in total. Standardized tools will be used to screen for depression and suicide risk and management will be done using evidence-based WHO guidelines. The primary outcomes will be assessed at the end of 12 months of intervention. Process evaluation will be done throughout the intervention, but the detailed evaluation will follow the intervention. Economic evaluation will use statistical modelling to ascertain cost-effectiveness. If successful, the trial could be scaled up across other areas of India or even other low and middle income countries with the help of the government and other key stakeholders. | 6.6 Psychological and behavioural / Research Grant | 6project_grants_public |
gen_5b435c65b1c8580ae6b51a0e381e3cf8 | Crowdsourcing with adolescents in Senegal to address social norms limiting their access to sexual and reproductive health services | Medical Research Council | London School of Hygiene and Tropical Medicine | HRCS22_02034 | The overall aim of this research project is to co-develop an intervention with adolescents aged 15 to 19 in order to address the social norms that limit their access to available sexual and reproductive health (SRH) services. The proposed research will take place in two regions of Senegal, one peri-urban area in Dakar region and one rural area in Kedougou region (South West Senegal). These regions are experiencing rapid population increases due to urbanisation and a thriving gold mining sector, respectively. In parallel with urbanisation and migration, there is likely to be an increase in sex work and other high-risk sexual behaviours. With SRH needs of adolescents already underserved, the health systems and health authorities of the two regions will need to plan an increase of service delivery and uptake to meet increased demand. In this project we will use qualitative formative research and crowdsourcing, an innovative approach to intervention co-development. Specifically, we will examine sexual and reproductive health policies and programmes available to adolescents living in the two regions. We will conduct focus group discussions and semi-structured interviews with adolescents and SRH service providers to explore the norms underlying barriers to service use. We will collect stories of service use and through a panel of adolescents from each region will select the most important three barriers to access. We will then launch an open call for one-month to crowdsource ideas on interventions to address the selected social norms. Adolescents will be able to submit an intervention idea to one or all of the key barriers. The winners of this call, selected in collaboration with an established steering committee, will be supported in further developing an intervention to increase uptake of sexual and reproductive health services. The steering committee will rank the final interventions, with a winning entry selected based on established criteria | 3.1 Primary prevention interventions to modify behaviours or promote well-being / Research Grant | 6project_grants_public |
gen_d7e769cf811f27ab80003e2763b868a1 | Project HASHTAG: Health Action in Schools for a Thriving Adolescent Generation | Medical Research Council | Stellenbosch University | HRCS22_02037 | Background. Adolescents suffer a high burden of disease, mostly injuries and mental disorders. Universal school interventions offer opportunities to address early symptoms and risk factors. We conducted a systematic review and meta-analysis of such interventions, finding that most are 'single-issue' interventions from high-income countries, focused on substances or violence. Aim. Project HASHTAG aims to address the evidence gap by developing and adapting a multicomponent gender-sensitive intervention in low- and middle-income countries targeting negative health outcomes by promoting positive mental health; preventing common mental disorders; and preventing risk behaviours in young at-risk adolescents. Methods. Project HASHTAG will comprise two strategies: 1) a school assessment, planning and action process, Thriving Environment in Schools (TES), to improve school climate; and 2) a group psychosocial intervention, Thrive Together (TT), to equip adolescents 11-12 years old with skills identified as effective components in reducing negative health outcomes. The study will be conducted in 2 low-resource settings in South Africa and Nepal. The development phase aims to co-produce a TES outline and TT draft, together with adolescents, parents, teachers, and other stakeholders in 2 schools per country. This will be achieved through focus groups, interviews and observations, to inform the work of an intervention development group. The aim of the feasibility phase is to assess the feasibility and acceptability of the TT and TES strategies, outcome measures, and intervention processes. To achieve this, we will implement and evaluate both strategies in 4 schools per country, using baseline and follow-up quantitative assessments to measure mental health and risk behaviour outcomes. Qualitative interviews and observations will be conducted to assess acceptability, feasibility, fidelity and barriers to the programme. Process data will be collected to assess feasibility. | 3.1 Primary prevention interventions to modify behaviours or promote well-being / Research Grant | 6project_grants_public |
gen_10a932e9e6a618e716ff107d92257b7f | Prevention of Addiction and Mental Ill Health in Adolescents in Georgia (PAMAd) | Medical Research Council | Curatio International Foundation | HRCS22_02050 | The study will first inform how the PAMAd service (package of interventions) is designed in collaboration with potential service beneficiaries (CA and their family members), service providers, main stakeholders and policy makers at national level and also generate evidence on effectiveness of CA targeted service (clinical effectiveness and unit costs of PAMAd service). Proposed research project will use pre and post-test design without control groups (Shadish WR, et al.2002) with nested process evaluation. A controlled design will not be feasible because the research is being undertaken within a developing EC supported service with well-estabished plans and a strict timeline. This offers an unique opportunity for implementation research in a real-world setting that will be an integral part of the PAMAd piloting/development work. This will allow exploration of how the interventions are developed and conducted, mechanisms through which the interventions produce change, and what contextual factors may act as barriers or facilitators to PAMAd implementation. This will be mixed methods research. Quantitative interviews with structured questionnaires will be used to determine socio-demographic status, living conditions, measure outcomes to determine effectiveness of the service and to collect cost data on service. Qualitative data (from in-depth interviews and focus group discussions) will be used to obtain depth of understanding and more comprehensively address the research questions. Data will also be collected on utilization of mental and physical health services, and social services; financial, economic and other barriers to care for common mental health and drug related problems, drug related risks awareness and risk behaviors. Qualitative data from service users and providers, different stakeholders will capture all factors important for duplication of the service in different areas and make it clear for decision makers how feasible its introduction will be. | 3.1 Primary prevention interventions to modify behaviours or promote well-being / Research Grant | 6project_grants_public |
gen_302b609aa9fa8f72caa8fd286ec6784b | A Novel High Intensity Short Interval Dance Intervention for Non Communicable Disease(NCD) Prevention in Asian Indian Adolescent Girls-THANDAV | Medical Research Council | Madras Diabetes Research Foundation | HRCS22_02201 | The proposal aims to study the effect of the THANDAV intervention on physical activity, fitness levels,body weight and fat % in Asian Indian adolescent girls using digital technology. High intensity interval training (HIIT) is a form of cardiovascular exercise plan alternating short periods of intense aerobic exercise with less intense recovery periods. Effective HIIT regimens can range anywhere from 4 to 20 minutes. Research has shown that HIIT regimens produced significant reductions in whole body fat mass, weight and improvement in cardiovascular fitness in both adults and adolescents. Various socio- cultural (such as not being allowed out late in the evenings) and environmental factors (such as lack of availability of safe places to exercise) prevent Asian Indian adolescent girls from exercising. Moreover, the term exercise has a 'male connotation' in India and exercising outdoors can lead to cultural 'inappropriateness'. However, dance is a culturally acceptable form of exercise, especially for girls. It is actively encouraged in the adolescent age group and is culturally looked upon as healthy, fun, appropriate and 'cool'. We thus incorporated the principles of HIIT in various Indian dance forms to produce this novel intervention called 'THANDAV'. The 10-min THANDAV routine will be developed in association with seasoned choreographers to ensure the ease and safety of the steps being performed. There will be a 2-min high intensity (80-100% of max heart rate (HR)) portion followed by a 30-sec low intensity (40-60% max HR) and four such repetitions will constitute a single 10-min routine. The 'THANDAV' website will offer details about the project and educational content after registration. Once women/girls are part of this online community, it will enable them to post their queries, talk about their experiences, watch 'THANDAVITES' dance videos and share their own on this webpage. | 3.1 Primary prevention interventions to modify behaviours or promote well-being / Research Grant | 6project_grants_public |
gen_ea5cc4d087289dbef89e168db4e2f55f | BRIGHT-SAM: BRaIn development, Growth and HealTh in children with Severe Acute Malnutrition | Medical Research Council | National Institute for Medical Research | HRCS22_02203 | The use of ready-to-use therapeutic foods (RUTF) for community-based management of children with severe acute malnutrition (SAM) is well-established and saves lives. However, current RUTF formulations result in a low ratio of n3/n6 essential fatty acids (EFAs) and other data show that low levels of the n3 EFA, docosahexaenoic acid, are associated with impaired cognitive function. An RUTF has been developed with an EFA content which should improve n3/n6 EFA ratio. We will test this for acceptability among children with SAM and their caregivers and we will assess the EFA profile and variability before and after the interventions, and compare with that of control children. Current recommendations for SAM treatment include provision of psychosocial (PS) interventions to help caregivers improve cognitive function of their children. However, to date these have had little impact: interventions shown to be efficacious have been too intensive and costly for scale-up and those scaled-up widely for children without SAM had little benefit. A short intervention focussing on the most high-risk children may have greater benefit. We will work with caregivers, local health staff, and local organizations working to promote child development to design a short, focussed PS intervention which can be offered in parallel with RUTF for community-based SAM treatment. Our long-term plan is to conduct a well-powered 2X2 factorial clinical trial of the novel RUTF and the PS intervention to determine their individual and any synergistic effects on cognitive development of children with SAM. The development project will aid this by: finalising the interventions, determining contextual factors influencing intervention delivery and uptake, determining variability in EFA and development outcomes to aid sample size calculations; engagement with local health care staff managing SAM and providers of child development interventions to ensure that our interventions are appropriate and locally own | 6.1 Pharmaceuticals / Research Grant | 6project_grants_public |
gen_ba9307636ff18b8eadc0086dabc9c349 | Development and application of Novel, Integrated Tools for monitoring and managing Catchments | European Commission | Ajuntament de Manlleu; AZIENDA GARDESANA SERVIZI SPA; Brunel University London | CORDIS-689341 | INTCATCH will instigate a paradigm shift in the monitoring and management of surface water quality that is fit for global waters in the period 2020-2050. INTCATCH will do this by developing efficient, user-friendly water monitoring strategies and systems based on innovative technologies that will provide real time data for important parameters, moving towards SMART Rivers. The business model will transform water governance by facilitating sustainable water quality management by community groups and NGOs using a clouds data linked to a decision support system and eco-innovative technologies. The INTCATCH project will use demonstration activities to showcase eco-innovative autonomous and radio controlled boats, sensors, DNA test kits and run-off treatment technologies. Actions which develop and evaluate these in a range of catchments will address the important innovation barriers to uptake, notably, a lack of knowledge of new technologies and their capabilities, identified by the European Innovation Plan (EIP) on water. By conceptually moving the laboratory to the ‘field’, the monitoring techniques that will be developed aim to supersede the inefficient, time dependent, costly and labour-intensive routine sampling and analysis procedures currently deployed to understand the quality of receiving waters. It will compliment routine monitoring that is required for baseline datasets, but also enable cost-effective impact and management investigations. INTCATCH will incentivise stakeholder innovation in monitoring and will facilitate new financing for innovation through its innovative franchise business model and empowerment of community groups and NGOs. The market ambition is that the INTCATCH business will facilitate an eco-innovative approach to deliver good quality water bodies across Europe and beyond. This will support green growth, increase resilience to climate change and capture greater market-share for Europe’s innovative industries. | H2020-EU.3.5. / 3.5 Societal Challenges - Climate | 6project_grants_public |
gen_a0a5d8eb64de7917cb1d2f4aab919d29 | Latent rheumatic heart disease in West Africa: a pilot multi-country study | Medical Research Council | London School of Hygiene and Tropical Medicine | HRCS22_02207 | This trial development grant (TDG) aims at generating epidemiological and feasibility data data to inform the design of a multicentric trial in West Africa to test the efficacy of penicillin to prevent the progression of latent RHD towards overt clinical disease. This is urgently needed to formulate long awaited guidelines for the management of latent RHD. There is little information on the burden of RHD in West Africa as most of . This TDG will determine the prevalence of latent RHD in three West African countries (Senegal, The Gambia, Nigeria), by carrying out mass screening at community level using handheld EC (HHEC) by non expert users. Study activities are divided in two phases, i.e. a training phase (3 months) and a screening phase (4 months). Two trainees from each country (1 expert cardiologist +1 nurse/midwife) will follow a 2-week intensive training on HHEC in Uganda. Each pair of trainees will become trainer for 3 additional health staff in its own country and continue on-site practical training for 6-10 weeks under the supervision (online) of the Ugandan expert. At the end of the training, each study team should have four trained non-expert staff (including 1 nurse, 1 midwife, and 1 community health worker) with two operators scanning in parallel. In each site, a total of 3,000 school children (5-18y) and 3,000 adults aged 19-40 years (pregnant and non pregnant women and their partners/relative men) will be screened in a pre-defined peri-urban community. Each suspect RHD case identified by HHEC will be referred for standard EC by a cardiologist. Confirmed latent RHD will be referred for regular EC monitoring while symptomatic RHD will be referred for appropriate care at the nearest teaching hospital. Quantitative and qualitative data will be collected on the feasibility and acceptability of the proposed approach in each site through continuous engagement with stakeholders and end users. | 4.2 Evaluation of markers and technologies / Research Grant | 6project_grants_public |
gen_a1d385019124dfb077ba0df187b90886 | Enhancing brain development by early iron supplementation of African infants: An enabling pilot study | Medical Research Council | London School of Hygiene and Tropical Medicine | HRCS22_02208 | Growth and organisation of the human brain is maximally active in late fetal life and early infancy. Breast milk contains very little iron and babies born to iron deficient mothers lack the full endowment of hepatic iron that usually subsidises the needs for growth and brain development in early infancy. We have recently shown that, by 5m of age, breastfed infants in rural Africa have extremely low levels of circulating iron with 95% lying below the US reference range. There is extensive evidence from human and animal studies that early iron deficiency causes irreversible deficits in psychomotor development and cognition. Hence, we plan to conduct a large-scale RCT that will introduce iron supplements much earlier than in prior and on-going trials. To inform a go/no go decision and to refine the trial design we first need to conduct an enabling trial that will address the following key questions: Can provision of a daily iron supplement as paediatric drops starting at 6wks of age reverse the profound decline in serum iron and other measures of iron status seen in rural African infants? Can we introduce supplementary iron without undermining exclusive breast-feeding? Would iron supplementation at this age alter the infant gut microbiome potentially causing diarrhoea? Does iron supplementation (through competition for divalent metal transport systems) impair zinc and/or copper status; and hence indicate a need for triple supplementation? These questions will be addressed in a pilot 'experimental medicine' two-arm RCT comparing daily iron versus placebo in 100 rural Gambian infants receiving intervention or placebo from 6wk to 5m. | 4.1 Discovery and preclinical testing of markers and technologies / Research Grant | 6project_grants_public |
gen_083eac5a74b0e6bfb598c735024c8b1e | MICA: The third, Intensive care bundle with blood pressure reduction in acute cerebral haemorrhage (INTERACT3) trial | Medical Research Council | George Institute for Global Health | HRCS22_02216 | INTERACT3 is an international, multicentre, stepped-wedge, cluster randomised, blinded outcome assessed, clinical trial (Phase III-IV). The objective is to determine the effectiveness of a goal-directed care bundle of active management involving intensive BP lowering, glycaemic control, early treatment of pyrexia, and reversal of anticoagulation, against a practice of usual care, on the standard clinical outcome of functional recovery in patients with acute spontaneous ICH. The primary outcome measure is an ordinal shift analysis of all 7-levels (scores) on the modified Rankin scale (mRS, categories 0 to 6: 0=no symptoms, 1=no significant disability, 2=slight disability, 3= moderate disability, 4=moderate severe disability, 5=severe disability, 6=death) at 6 months. Secondary outcomes include early functional neurological recovery (according to a shift analysis of scores on the National Institutes of Health stroke scale [NIHSS] at 7 days), health-related quality of life (HRQoL) using the EuroQoL Group 5-Dimension self-report questionnaire (EQ-5D) at 6 months, duration of hospitalisation, and residence. This research will be conducted through a global network of investigators from nine LMICs. The stepped-wedge cluster randomised design has been chosen to avoid contamination, facilitate hospital-wide implementation, and maximise adherence as the complex intervention under investigation becomes usual standard of care. A consecutive recruiting approach is involved to minimise bias in patient selection into the study. A mixed consent process is proposed according to local/national rules and regulations. Besides an individual standard consent for the data collection and follow-up, a cluster guardian consent is required for patients to receive the randomised care bundle to be implemented for acute ICH patients across multiple wards as a systems of care approach. | 4.1 Discovery and preclinical testing of markers and technologies / Research Grant | 6project_grants_public |
gen_02d755937309fe0aa9ab4c6e6679d88a | A feasibility and pilot trial of enteral probiotic administration in preterm infants admitted to a neonatal unit in Nigeria | Medical Research Council | University of Ibadan | HRCS22_02219 | Our proposal is based on a fixed effects meta-analysis of 23 RCTs of preterm infants in 10 LMICs (n=4,783; Deshpande 2017). Probiotics reduced all cause mortality (RR 0.73 [95% CI 0.59 to 0.90]; P=0.003), necrotising enterocolitis (RR 0.46 [0.34 to 0.61]; P<0.00001), late-onset sepsis (RR 0.80 [0.71 to 0.91]; P=0.0009) and time to full enteral feeds (-1.95 days; [-3.44 to -0.45]; P<0.00001). No adverse effects were ascribed to probiotics in the systematic review and there are only limited case reports of adverse effects in preterm/VLBW infants. Based on global clinical trial evidence, probiotic administration has becoming routine in many neonatal units in industrialised countries. The meta-analysis included only two studies in Africa (Egypt and South Africa) and neither may be representative of other neonatal units in the sub-continent. Probiotics effects likely differ according to host characteristics, exposure to environmental microbes and nosocomial pathogens, antibiotic use and feeding practices. There is an urgent need to test this intervention in low-resource settings with the highest rates of neonatal mortality. For selection of probiotic for neonates, network meta-analysis advises the inclusion of Lactobacilli and Bifidobacterium spp. to simulate the gut flora in the healthy, breast-fed infant and use of multistrain preparations that have greater beneficial effects including the prevention of NEC. For this initial study, we have selected a product that contains three probiotic strains (L acidophilus, B infantis, B bifidum) suspended in oil, manufactured in South Africa and with a long shelf life at room temperature. This probiotic is used extensively in highly vulnerable infants in neonatal practice in the UK and no significant safety concerns have arisen. This proposal aims to ultimately address the evidence gap regarding the potential health benefits of probiotics in preterm/VLBW infants in a low resource setting in sSA. | 6.1 Pharmaceuticals / Research Grant | 6project_grants_public |
gen_a06c36db975df5a6d6dea4884511fd99 | Concentration and fragmentation: analysing the implications of the structure of Georgia's private healthcare market for quality and accessibility | Medical Research Council | Curatio International Foundation | HRCS22_02313 | To inform decisionmakers on how to engage effectively with the private sector, better evidence is needed of how healthcare markets are structured, the risks of different market structures for patients and for the health system as a whole. This evidence can help design health system policies to (i) shape the market to avoid excessive concentration or fragmentation, and (ii) design appropriate private sector engagement strategies, including by healthcare purchasing agencies. Our study will generate new evidence on the structure of the healthcare market in Georgia, a lower-middle income country where the health system is highly privatized. Applying economic theories of market performance we will: - Describe the Georgian healthcare market in terms of business models and the extent of vertical and horizontal integration. This will use publicly available information (national statistical yearbook, company financial reports, national health accounts), social insurance claims data and key informant interviews - Analyse the demand, supply and policy factors driving the observed market structure and business models, and elaborate a set of "theories of harm" about the risks of concentration and fragmentation and their potential influence on health system outcomes by different provider types. - Assess quantitative, and where necessary, qualitative evidence about the risks of fragmentation and concentration, looking at the extent to which individual outcomes such as price and intensity of treatment, and system level outcomes such as accessibility, approaches to quality assurance and the costs of contracting and regulating, differ by provider business model and market structure. - Conduct structured policy dialogues to test our interpretations of the data and identify potential policy levers to shape the private healthcare sector, engaging key stakeholders from government and the private sector. | 8.1 Organisation and delivery of services / Research Grant | 6project_grants_public |
gen_0bf4b85a5197144f7d0e838e27c6cc26 | Understanding male engagement in child health and nutrition in urban informal settlements: A formative participatory exploration | Medical Research Council | KEMRI Wellcome Trust Research Programme | HRCS22_02326 | Improving child health requires primary prevention, quality health services and community action. Whilst there is recognition that the health system encompasses both the suppliers of policy, services, and interventions, and the communities and households intended to benefit from them; in health systems research the focus has primarily been on the supply-side with little attention given to the demand-side of this equation. Gender roles and relations play an important role in child health and nutritional status. In many sub-Saharan African (sSA) settings, childcare and health is primarily a female domain with men largely absent or only involved in perceived severe or serious cases. Similarly, intentionally or unintentionally, child health programmes in sSA countries predominantly focus on women. While women are perceived as responsible for children, paradoxically they must negotiate decision-making and resources with other family members, including men. By exclusively focusing on women without considering family dynamics or the broader social context, these programmes may inadvertently reinforce harmful gender divisions and practices related to child health and nutrition. Evidence suggests that programmes targeting women might be more effective if men's roles are considered and transformed to affirm more equitable gender relations. Furthermore, following treatment in the formal health system, ill or recovering children are 'discharged back' into their homes and communities. Without proper understanding of the intricacies and dynamics operating at the household and community levels, hospital-initiated interventions are likely to be less effective and sustainable. Focusing on user-centred perspectives and the demand-side of the health system, the proposed work seeks to answer if and how participatory approaches can strengthen male involvement in child health and nutrition for better outcomes. | 8.1 Organisation and delivery of services / Research Grant | 6project_grants_public |
gen_81a0a381f6ec9b4b97c27b89eff7cc00 | Identifying the health systems changes necessary to sustain and scale up the integration of mental health services into primary care in Lagos, Nigeria | Medical Research Council | Lagos State Univ Coll of Med LAUSCOM | HRCS22_02328 | STATEMENT OF THE PROBLEM: There are policy and ethical implications of developing effective heath programmes without sustainability and scale-up. This feasibility study aims to identify the strategies to facilitate the health system changes necessary to sustain and scale up mental health services in primary care in Lagos, Nigeria. SPECIFIC QUESTIONS TO BE ADRESSED BY THE PROJECT 1) what is the state of implementation of the MeHPriC Project and what are the factors that are currently underlying its implementation?; 2) What are the dynamic interactions between the different components of the programme as regards contexts (inner and outer), implementation processes, implementation actors and intervention outputs and outcomes?; 3) How do these components influence the sustainability of the programme; and 4) What strategies may be required to facilitate the changes necessary for sustainability and scale-up METHODOLOGY There are 5 phases of the study. 1. In Phase 1, Through review of policy documents and in-depth interviews we will develop specific hypothetical pathways that link the programme inputs to processes, outputs and outcomes within the health system 2. In Phase 2, we will conduct a quantitative survey amongst the stakeholders to assess readiness to change, sustainability, feasibility and acceptability 3. In Phase 3, we will conduct a brief process and outcome evaluation of the implementation, and through in-depth interviews, and institutional ethnographies, we will examine the stakeholders' perception about the health systems constraints to delivering, scaling up and sustaining the intervention. 4. In Phase 4, we will conduct a Theory of Change (ToC) workshop to identify health system changes that will improve sustainability in the delivery of the intervention. 5. In Phase 5, we will analysis and present the project report to the funders and the stakeholders | 8.1 Organisation and delivery of services / Research Grant | 6project_grants_public |
gen_5d4c4c5a7b7e619832e8031f838701a4 | A systems approach to examining health sector responses to cholera epidemics in Kenya | Medical Research Council | Strathmore University | HRCS22_02329 | Technical Summary Kenya has experienced an increased disease burden due to cholera outbreaks characterized by continuous transmission in the refugee camp settings of Garissa and Turkana, and sporadic transmission in cities such as Nairobi and Mombasa. However, while inquiry has been made regarding how the health sector has responded to and how populations have been impacted by epidemics such as cholera, not enough attention has been paid to causal relationships between the unique components of the health systems leading to an inadequate understanding of how the building blocks of the health systems interact in disease surveillance and epidemic response. Consequently, this research effort focuses on examining the health sector responses to these epidemics, developing a systems-theory-based description of the said responses, and based on the results, provide recommendations that may help break the epidemic's continuous and cyclical nature. The study will be conducted in Turkana and Garissa in Kenya, as well as in Nairobi. These are counties that have diverse levels of health system sophistication and recent experiences of cholera epidemics. Moreover, the study draws on several systems analytic frameworks - specifically Rasmussen's Risk Management Framework and its attendant AcciMap, the Analytic Hierarchy Process tool, and Cognitive Work Analysis - to determine the actors and their decisions, as well as their inter-relationships, linkages and dependencies. Thus, the study appropriates systems-oriented research techniques and applies them in a novel fashion to the assessment of health service delivery. The findings of this study are expected to guide interventions aimed at improving disease surveillance and epidemic response, and to act as a primer for the research community by assessing the utility of systems-thinking approaches in such settings. | 8.1 Organisation and delivery of services / Research Grant | 6project_grants_public |
gen_616b48f87f61ad34e5d97364ab410e72 | Examining effects of decision-making space and its practices on health systems performance in Tanzania | Medical Research Council | University of Dar es Salaam | HRCS22_02342 | Many low and middle income countries (LMICs), including Tanzania, have been implementing decentralisation since 1990s as a process to strengthen health systems and its performance through improved efficiency, quality of services and a means of promoting democracy and accountability. While decentralisation is widely practiced in LMICs empirical studies have predominantly focused on understanding the extent of the decision-making authority provided by the central government to the authorities at the lower levels. A few studies which have examined the actual use of decision-making space have focused on the influence of decentralisation on one or few health systems functional areas rather than addressing multiple functional areas. Other studies have only been conducted in a few districts making it difficult to explore how the exercise of the decision space vary across the districts and the factors that account for the variations. Additionally, studies examining the evidence for the effectiveness of decentralisation on improving health system performance are scarce and results are mixed. We aim to better understand how and if decentralized local authorities use decentralisation opportunities for improving health systems performance. Specific objectives are to: (i) analyse the decision-making authorities transferred from the central government to institutions at the periphery in the decentralised health system in Tanzania; (ii) assess the actual decision-making space exercised by local government officials and district health managers within the decentralised health system; (iii) assess performance of the decentralised district health systems; (iv) investigate effects of the decision-making space on health systems performance in Tanzania; (v) engage decision makers at the national and district levels aiming at informing policy and improving the practice of decision space within the decentralized health systems | 8.1 Organisation and delivery of services / Research Grant | 6project_grants_public |
gen_eea8f20f4ca1030a45c8a293ee297574 | Understanding the consequences for quality and efficiency of expanding services through the private sector in South Africa | Medical Research Council | University of the Witwatersrand | HRCS22_02343 | The private sector provides a large proportion of health services in many low- and middle-income countries (LMICs), particularly for primary health care (PHC), even for the poor. But the role of the private sector in expanding universal health coverage (UHC) in LMICs is contentious. Supporters of private care provision argue that competition makes private providers more responsive, exert more effort, and provide better quality care. Yet the empirical evidence supporting this is mixed. There is also limited evidence that the demand for care is responsive to quality or costs, a pre-condition for a functioning competitive market. These dynamics are also likely to vary between countries. These questions are central to current policy proposals in South Africa, where the government plans to expand access to quality primary care services by contracting private providers. This study aims to address these questions and inform current policy debates by undertaking a detailed investigation of a self-contained market for PHC services among the urban poor in South Africa. The study has five components: (1) a detailed description of the structure of the market for PHC in Soweto; (2) an audit study of PHC providers in the market using standardised patients, allowing us to describe the relative performance of public and private providers in terms of access, quality and efficiency of treatment; (3) an investigation of the relationship between measures of market competition and performance; (4) a study of the determinants of patients' choices of PHC providers; and (5) a field experiment testing the impact of subsidised care and information about quality on demand. By describing the market structure, the differentiation strategies of providers, and the key determinants of the demand for healthcare, we will provide robust and innovative evidence that will lay out the grounds for designing future regulatory and contracting arrangements with the private sector. | 8.1 Organisation and delivery of services / Research Grant | 6project_grants_public |
gen_f94b42d390f12bd3822aa39bba3485ff | An inter-disciplinary approach to understanding and intervening on contextual factors that shape HIV-risk for young women and men in South Africa | Medical Research Council | South African Medical Research Council | HRCS22_02420 | Background: South Africa remains the epicentre globally of the HIV-epidemic, driven by harsh contexts of gender inequalities, poverty and community violence. Understandings of how these impact on the syndemic of HIV-acquisition risk, intimate partner violence (IPV), poor mental health and substance misuse, for young women and men remain limited, and there remain no effective HIV-prevention interventions for young people who are out of school. Aim: To understand how contextual factors shape the syndemic of HIV-acquisition risk, in South Africa, and how these can be challenged in participatory interventions to reduce HIV-risk. Methods: To understand the relationship between contextual factors and the syndemic of HIV-acquisition risk we will undertake secondary analysis of South African data sets using spatial epidemiological techniques. We will also recruit 16 youth peer research associates (YPRAs) aged 18-24 from two communities, and through participatory methods understand their perspectives. We will then co-develop with the YPRA an intervention that responds to their needs and priorities, and undertake a mixed methods pilot randomised control trial of the intervention. We will assess feasibility, acceptability and potential effects sizes through this pilot. Outcome: At the end of the project we will have an intervention that is ready for a larger scale evaluation, as well as a better understanding of the contextual factors shape the syndemic of HIV-acquisition risk for young people. Expertise: An experienced inter-disciplinary team of social psychologists, statisticians, social epidemiologists, gender, mental health, and violence experts, and HIV-clinicians. | 3.1 Primary prevention interventions to modify behaviours or promote well-being / Research Grant | 6project_grants_public |
gen_66ee2592e45bfbdb91ec99c697599873 | Nutrition and the epigenome: early environmental factors influencing human developmental programming | Medical Research Council | London School of Hygiene and Tropical Medicine | HRCS22_02477 | A seasonal 'experiment of nature' in rural Gambia has revealed the presence of DNA methylation (DNAm) hotspots sensitive to periconceptional environment. These are enriched for metastable epialleles, endogenous retroviruses and parent-of-origin-specific methylation (PofOm) suggesting establishment in the early embryo. This is further supported by analysis of public IVF and gametic DNAm datasets which show distinctive patterns of early embryo DNAm dynamics along with enrichment for regions hypomethylated in sperm. Several loci are linked to disease outcomes, including obesity, thyroid disease and cancer. Genetic analysis suggests the greater part of DNAm variance at many season-of-conception (SoC)-associated loci is explained by gene-environment interactions, suggesting they may have evolved to sense the environment, record the information and adapt the phenotype accordingly. Such 'programmed' epigenetic states would be maladaptive if there is a mismatch with the postnatal environment, with implications for the developmental origins of health and disease. This grant seeks to establish a unique prospective SoC cohort of 600 babies to assess exposures within +/-15 days of conception in order to: a) define nutritional and other SoC exposures (methylation pathway metabolites; agnostic metabolomics; fecal microbiome); b) understand and characterise key features of SoC-sensitive loci to gain insights into genetic and other mechanisms underpinning their establishment; c) confirm and delineate the role of gene-environment interactions as a potential driver of SoC-sensitivity and look for signatures of genetic selection; d) assess the influence of SoC on the placental transcriptome (trophoblasts/mesenchymal cells) with particular attention to genomic imprinting and PofOm; e) assess effects of the above on placental and fetal growth and development. This work will establish an open-access Early Developmental Epigenetic BioResource for researchers worldwide. | 2.4 Surveillance and distribution / Research Grant | 6project_grants_public |
gen_d6e5a101ac85554bcb081496bea9584c | Understanding and measuring pregnancy-related anxiety in low- and middle-income contexts: A pilot study in northern Ghana | Medical Research Council | University for Development Studies | HRCS22_02499 | Women's anxiety during pregnancy is widespread and has been associated with poor mental and physical health outcomes for both mothers and their children. One type of anxiety which seems to be particularly problematic is anxiety about the pregnancy itself. We know little about pregnancy-related anxiety in LMICs and there are no measures of pregnancy-related anxiety which have been validated for use in any LMIC. To address this gap, we will conduct a systematic review to get a clear overview of levels of pregnancy-related anxiety and relations with maternal and neonatal mortality. We will also conduct a mixed-methods study to measure how pregnancy-related anxiety is conceptualized and to adapt and validate the Pregnancy Related Anxiety Scale among pregnant women in the Northern Region of Ghana. To do this, we will conduct 15 focus groups (n = 150) and collect survey data from 575 pregnant women attending antenatal care in Mion, Savelugu, and Tamale Metropolitan Districts. We will hire one PDRA and 5 RAs to assist with the systematic review and qualitative and quantitative data collection. We will use inductive thematic analysis to analyse the focus group data. We will use exploratory factor analysis, correlations, and t-tests to establish construct validity, convergent validity, and test-retest reliability of the adapted scale. We will also consult with a local advisory committee to ensure the use of appropriate methods and measures, and to establish face validity of our adapted measure. This project is directly linked with UN Sustainable Development Goal #3 (good health and wellbeing). Without a clear understanding of what underlies pregnancy-related anxiety and how to measure it, we cannot develop and implement effective interventions nor can we evaluate whether any implemented interventions are effective. This project will pave the way for future work promoting mental health during pregnancy and reducing associated maternal mortality and morbidity. | 2.3 Psychological, social and economic factors / Research Grant | 6project_grants_public |
gen_fd679e6b38a0acdead398406441f2e81 | Oral Vitamin D supplementation as a safe, affordable treatment for profound vitamin D deficiency in pregnancy | Medical Research Council | CBCI Society for Medical Education | HRCS22_02500 | We aim to address to the extent supplementation with 2000 IU/day vitamin D3 corrects deficiency in pregnant women in India, which has not previously been tested. We propose this is linked to lack of awareness amongst stakeholders of the benefits of offering higher vitamin D doses than current Indian RDA (<500 IU/day). Aim 1: In a pilot study determine whether the highest acceptable level of vitamin D supplementation approved by the Govt. of India leads to repletion of pregnant women at St. John's Medical College Hospital, Bangalore. Study design: Pregnant women (n=186-200) will receive 2000 IU vitamin D/day from end of the 1st trimester to term. Vitamin D status will be monitored in pregnancy [T1, T2, T3] in serum (5ml), and in the baby by sensitive LC-MS. Samples: Cord blood from a subset of babies will be sued to study the impact of maternal intervention on innate secreted cytokine responses as a measure of newborn immunity, powered on our immune data from the USA VDAART trial. Aim 2: Form a cross India network comprising scientists, clinicians, health care workers, policy makers to discuss realizing the known benefits of vitamin D supplementation in pregnancy. We will invite international experts to a workshop to discuss heterogeneity globally and within India on vitamin D dose and supplementation regimens; a meta-analysis of vitamin D studies in India in the context of global vitamin D trial outcomes and a projected review with the potential to influence national strategy are planned. Days 1-2: A closed 2-day workshop discussing whether vitamin D dose and timing regimen is the same across different clinical (e.g. skeletal vs non-skeletal), biochemical and immune outcomes. We anticipate strong representation of vitamin D interests across India. Day 3: This session will be open to all interested parties across India to ensure knowledge dissemination and transfer, and to help understand the depth of interest in vitamin D and existing concerns in India | 6.1 Pharmaceuticals / Research Grant | 6project_grants_public |
gen_91d501031e530c6fbcc381b3f41f57a8 | Capacity building for a Centre of Design, Innovation and Translational Excellence (CITE) for clinical trials of healthcare technologies in SS Africa | Medical Research Council | Makerere University | HRCS22_02505 | Great strides have been taken to reduce global maternal and neonatal mortality. However, due to numerous factors such as limited access to resources including funding, healthcare providers among others, means that maternal and neonatal mortality have remained stubbornly high in sub-Saharan Africa. Advances in technological innovations, including contextually appropriate devices coupled with mobile health technologies offer the opportunity to improve healthcare outcomes in maternal and neonatal health. For instance, improved and timely diagnostics, therapy and monitoring can improve outcomes for mothers with conditions such as preeclampsia, postpartum haemorrhage and pneumonia and hypothermia for neonates. In Uganda, researchers, students and innovators have developed many contextually appropriate solutions with some winning international awards. such devices include: (1) Maternal (postpartum haemorrhage (PPH) Wrap (https://challenges.openideo.com/challenge/reproductive-health/ideas/maternal-wrap-a-first-aid-postpartum-hemorrhage-belt); (2) The EPED strip: The Early Pre-Eclampsia Detection strip (https://bigideascontest.org/winners/early-preeclampsia-detection-strip/); and (3) Mama Ope a smart jacket for early diagnosis and monitoring of pneumonia in children aged between 0 and 5 years (http://mamaope.com/en/). Such great innovations have found a great challenge in translation to useful products due to limited capacity in clinical evaluation and translational expertise in the country. Our aim is to strengthen propose our proposed interdisciplinary Centre of Design, Innovation and Translational Excellence (CITE) in collaboration with University of Edinburgh. We propose to map existing knowledge about the systems and processes for clinical evaluation of locally made Investigational Medical Devices (IMD) amongst key stakeholders in Uganda and to strengthen local research capacity through training on clinical trial design. | 3.5 Resources and infrastructure (prevention) / Research Grant | 6project_grants_public |
gen_1d8b4b877270e7d308fb7e8cf8ccd086 | Reducing infection risks in maternity and neonatal wards through improved environmental hygiene: an exploratory study in The Gambia. | Medical Research Council | London School of Hygiene and Tropical Medicine | HRCS22_02506 | The aim of this research is to explore the links between environmental hygiene and infection risks in maternity and neonatal units in two hospitals in the Gambia. We will use the learning derived from this preliminary work to convene a network of researchers to build the case for a future African trial of this intervention against an infectious outcome across multiple neonatal units. The specific objectives are 1. To establish baseline measurements of environmental contamination in the maternity and neonatal units in two hospitals in The Gambia, including two-weekly variability in such measures; 2. To develop a contextually appropriate cleaning training package specifically for newborn units in LMICs, with a focus on sub-Saharan Africa 3. To pilot this training package intervention in two large hospitals in The Gambia and measure potential impact on environmental cleanliness. 4. To establish a network of researchers and relevant WASH/IPC stakeholders, including the regional Maternal-Newborn Infection network and Infection Control Africa Network (ICAN), and build collaborations to support a future West African trial of the same cleaning intervention across multiple regional neonatal units, bringing together academic partners in West Africa and the UK. Cleaning in newborn care units including NICUs has some important technical differences to cleaning other hospital areas. Due to the intense vulnerability of patients and the delicacy of medical equipment, typically different cleaning staff, chemical agents and physical methods are typically used. We will observe use of cleaning products and techniques, and hand hygiene as well as measure environmental contamination before and after the introduction of a cleaning training package intervention. | 3.2 Interventions to alter physical and biological environmental risks / Research Grant | 6project_grants_public |
gen_a625673d2919a2b7decd897415f181fc | Adolescent mental, sexual and reproductive health and wellbeing policy, program and primary care implementation priorities in West Africa | Medical Research Council | Ghana College of Physicians and Surgeons | HRCS22_02510 | The principal research question of this study is: "what and why are adolescent wellbeing policy and program priorities in countries in West Africa, what mental, sexual and reproductive health services are available at primary health care level for adolescent health and wellbeing; are they proven effective, what and why are the mechanisms by which these services are funded and how efficiently are available resources used to deliver these services". The study design is a multi-country case study in West Africa with the case is defined as: "Country level adolescent mental, sexual and reproductive health and wellbeing policy and implementation priorities, financing, technical and allocative efficiency of primary health care service provision". The three countries purposively selected for this study to reflect the anglophone francophone language divide in the sub-region as well as stable and more fragile contexts are Niger, Burkina Faso and Ghana. Specific groups to be studied will be adolescents (in and out of school) and their families and communities, national and sub-national level policy makers and frontline health workers. Within each country one region and two rural and two urban districts within the region will be selected for the sub-national level study. In each district four sub-district level primary care facilities will be randomly selected along with their surrounding communities. The conceptual framework of the study draws on several policy analysis and econometric frameworks including Leichter's scheme for analyzing context and the political economy framework of 4 I's (interests, institutions, ideas and ideology). Methods of data collection and analysis include desk review, key informant interviews, focus group discussions, participant and non participant observation, conversations, resource mapping, revenue and expenditure records analysis and Data Envelopment Analysis (DEA) or Stochastic frontier analysis (SFA). | 8.1 Organisation and delivery of services / Research Grant | 6project_grants_public |
gen_2355cf34df175e087a29e54d99db74fa | If I Were Thabo: Optimisation and feasibility trial of a gender transformative sexual and reproductive health intervention in South Africa and Lesotho | Medical Research Council | Stellenbosch University | HRCS22_02512 | A key social determinant of sexual and reproductive health-related (SRH) morbidity and mortality in Southern Africa is unequal gender norms. The importance of working with men as well as women using Gender-Transformative (GT) approaches, in order to reduce gender inequality and improve SRH outcomes for all is well-recognised. However, a recent systematic review showed that only 8% of SRH interventions that target adolescent men are GT. We aim to develop and feasibility test a co-produced relationships and sexuality education intervention, If I Were Thabo, for 13-14 years old adolescents, to address gender inequality as a social determinant of SRH. The study will be conducted in the Eastern Cape, South Africa, and Maseru District, Lesotho, two countries where adolescent pregnancy and HIV rates are among the highest in the world. There are two phases to the project; a development phase followed by a cluster randomised feasibility trial. The aim of the development phase is to work with stakeholders to co-produce and optimise intervention materials and outcome measures for use in the trial. This will involve working with adolescents, their caregivers, teachers and other stakeholders to develop materials for the feasibility testing phase. The aim of the feasibility trial is to determine the value and feasibility of conducting an effectiveness trial of Thabo in schools and community groups in LE and SA. To achieve this we will implement the Thabo intervention in both settings using a cluster randomised design in 10 clusters, and measure baseline, 3 month and 9 month outcomes. We will measure self-reported engagement in unprotected sex as the primary outcome. Secondary outcomes will include knowledge, attitudes, skills, intentions relating to avoiding adolescent pregnancy, and self-reported HIV and STI diagnosis. Qualitative interviews, focus groups and observational data will be gathered to assess acceptability, feasibility, fidelity and barriers to the programme. | 3.1 Primary prevention interventions to modify behaviours or promote well-being / Research Grant | 6project_grants_public |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.