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"id":"8968659e-9aed-47aa-b395-85df0895d322", "related_activity_context":"ID: GB-GOV-10-NIHR_GHRG3\nTitle: NIHR Global Health Research Groups: Call 3\nDescription: The NIHR's third Global Health Research call for Groups. UK universities and research institutes were invited to submit applications, working in equitable partnerships with researchers in low- and middle-income countries (LMIC), to develop their ambitions to deliver world-class applied global health research to address under-funded or under-researched global health areas specific to those countries.\nGlobal Health Research Groups are defined as a partnership of specialist researchers within universities and research institutes in LMICs and the UK:\n1. Either new to delivering applied health research globally, or expanding to new global partnerships to deliver applied global health research addressing unmet needs in new health areas or geographies in ODA-eligible countries;\n2. Who, through a planned start-up phase, will develop or expand equitable research partnerships and networks, to undertake LMIC-led needs analysis designed to refine relevant research questions and priorities through engagement with policy makers, evidence users and local communities, as appropriate;\n3. Who will establish a new programme of applied health research delivered through ambitious, structured plans for e.g. scoping studies, needs analysis, economic analysis, pilot studies and potentially trials;\n4. Who are able to develop the strength of the partnership to improve practice and inform policy based on scientific evidence;\n5. Who will set up and deliver a focussed programme of capacity and capability strengthening at individual and institutional level appropriate to the respective goals.. The strategic aim across the Global Health Research Groups programme is to:\n1. Address locally-identified challenges in LMICs through equitable research partnerships between researchers and institutions in the UK and ODA-eligible countries\n2. To generate the scientific evidence that can improve health outcomes for people in low resource setting through improving practice and informing policy.\n3. Strengthen research and research management capacity and capability to support future sustainability of research in partner countries.\n \n ID: GB-GOV-10-GHRG_3_132455\nTitle: NIHR Global Health Research Group on Acquired Brain and Spine Injury (ABSI)\nDescription: The NIHR Global Health Research Group on Acquired Brain and Spine Injury (ABSI) aims to build on the work of our previously funded NIHR global health project which focused on neurotrauma. In addition to examining brain injury, this project has been expanded to include a number of other conditions namely traumatic spinal injury, stroke, brain infection and cerebrospinal fluid disorders and hydrocephalus. To structure the project it has been divided into four themes: mapping care, understanding care, generating and implementing knowledge and capacity building. The project will be managed by 2 lead directors, Professor Peter Hutchinson in the UK and Professor Anthony Figaji based in South Africa. In addition there are 26 coapplicants and a further 18\ncollaborators from a wide range of low- and middle-income countries (LMICs): Brazil, Cameroon, Colombia, Ethiopia, India, Kenya, Malaysia, Pakistan, Philippines, Tanzania, Zambia, Afghanistan, Bolivia, Indonesia, Nigeria, Sri Lanka and Zimbabwe. There is a diverse range of research studies and methodologies within each theme which will be based mainly in the LMIC collaborating sites and overseen by the central management team in the UK and South Africa. The majority of the projects will complete enrolment within 3 years with the final year reserved for preparing reports and dissemination of the data. The aim of the project is to significantly influence health policy. Furthermore the networks and partnerships created will establish a sustainable platform for global health researchers to continue for years to come.. 1. Expand the previously funded NIHR Global Health Research Group on Neurotrauma (focus on traumatic brain injury) to focus on the four overarching themes (Mapping care; Understanding Care; Generating and implementing innovation; Capacity building) consisting of five conditions (traumatic brain injury, traumatic spine injury, stroke, brain infections, cerebrospinal fluid (CSF disorders/hydrocephalus) causing a substantial burden of disease in LMICs\n2. Create training and educational opportunities for LMIC researchers and establish a global health fellowship exchange programme\n3. Ensure nurses, allied health professionals, and patients are an integral part of the working group and lead in developing the projects – an area in need of development in LMICs.\n \n ID: GB-GOV-10-GHRG_3_132731\nTitle: NIHR Global Health Research Group on Oral Health\nDescription: Oral diseases include a range of chronic conditions affecting the mouth and teeth including dental caries (tooth decay), periodontal (gum) disease, and mouth cancers. Despite being largely preventable, these oral conditions are among the most common diseases globally affecting over 3.5 billion people worldwide with disease rates increasing in many low and middle-income countries (LMICs). Untreated oral diseases have significant adverse effects causing severe pain, infection, reduced quality of life, and death. Oral diseases disproportionally affect poorer and marginalised groups, being very closely linked to levels of education and income. Oral diseases share common risks with other chronic diseases including sugar consumption, poor hygiene, tobacco use, harmful alcohol consumption, and the broader underlying social environment (the conditions in which people are born, grow, live, work and age). Increasing attention is also now being placed on the role of multinational corporations who market, promote and sell products which are detrimental to health (commercial determinants). In many LMICs dental services are often inaccessible and unaffordable to large segments of the population but particularly the rural poor.\n\nThis research programme will address the neglect of oral diseases in four \nmiddle-income countries – Kenya, Colombia, India and Brazil. In these countries oral diseases are a major public health problem and there is a pressing need for high quality public health research to promote oral health and reduce oral health inequalities. The research is being co-led by Professor Richard Watt (University College London) and Dr Carol Guarnizo-Herreno (National University of Colombia) and an academic team from the UK, Brazil, India, Kenya and Colombia. In addition collaborators from the US, Australia, Ireland, The Netherlands and Singapore will support the research. \n\nThe overall aim of the programme is to explore the causes of oral health inequalities and to co-produce and pilot interventions to improve population oral health and reduce oral health inequalities in each country. The four-year programme will comprise of three interconnected work packages including: WP1 Oral Health Inequalities; WP2 Commercial determinants; WP3 Oral health system reform and innovation. In addition, the programme will develop local research capacity through an extensive range of training and short courses. Community engagement and involvement activities will fully inform and support all aspects of the planned research. The results from the programme of research will be shared and disseminated across policy, professional, and community networks in each of the participating LMIC countries but also more widely across existing international research and policy networks.. 1. To establish an equitable, effective and sustainable research partnership across the UK academic institutions, participating Low and Middle Income Countries (Kenya, Colombia, India and Brazil), and the other academic collaborators to share respective expertise, experience and local knowledge of oral health.\n2. To develop and undertake a programme of research on oral diseases and their causes to inform the co-production and feasibility testing of public health interventions to reduce oral health inequalities and promote oral health, and reform oral health systems in each country.\n3. To build and develop dental public health research capacity amongst early career oral health researchers in each country through postgraduate training, short courses, and mentoring opportunities.\n4. To establish and develop meaningful communication with local communities in each country to better understand community experiences of oral diseases and use of dental services, and the best ways ahead of promoting sustainable community engagement and involvement in oral health research.\n5. To engage and advocate with key local stakeholders in each country, including policy makers, senior clinicians and leaders of health professional organisations, public health agencies and community organisations on the public health importance of oral diseases and the need for a sustainable oral health research agenda.\n \n ID: GB-GOV-10-GHRG_3_132995\nTitle: NIHR Global Health Research Group on collaborative care for cardiometabolic disease in Africa\nDescription: Background\nAfrican healthcare was developed to focus on infectious diseases like HIV. This means that African healthcare is not set up well to cope with non-infectious diseases becoming more common. The most common non-infectious diseases are ‘cardiometabolic diseases’. These includes heart disease, diabetes and high blood pressure. All of these can lead to early death. It makes sense to tackle cardiometabolic diseases together because they can be treated in similar ways. For example, losing weight and increasing exercise can help with all of them. \n\nAims\nThe aims of this work are to develop care models to improve outcomes and control of common risk factors for cardiometabolic diseases for adults in 3 low-income countries: Ghana, Kenya, and Mozambique. \n\nWorkplan\nResearchers from University of Leicester will work together with researchers and doctors from these countries to determine what healthcare needs are most important to patients and health workers. This will support development of a care model which can be used to provide better healthcare to patients with cardiometabolic diseases. A study involving patients, healthcare professionals and community participants will be conducted prior to design and planning of a randomised controlled trial to test the care model developed. \n\nThemes within this project will focus on training and capacity building and establishing a programme of community engagement and involvement. Capacity building will be tailored to develop future leaders in research management and expertise in sub-Saharan Africa. Community engagement will be utilised to shape delivery of this research programme, maximise impact and build lasting capacity to support future research. \n\nThe primary impact will be a substantial improvement in cardiometabolic health management for those living in Ghana, Kenya, and Mozambique, with improved research and community engagement in healthcare. These benefits will likely translate to substantial economic benefits for the patients, health systems and local healthcare providers.. Objectives: \n•\tTo identify and prioritise healthcare needs for patients with cardiometabolic diseases, in Ghana, Kenya, and Mozambique. \n•\tTo develop a model for people with cardiometabolic diseases, ready to be used in Ghana, Kenya, and Mozambique.\n•\tTo investigate the practical implications of delivering the model developed in this research and the parameters required to design a randomised controlled trial (RCT).\n•\tTo maximise impact, uptake and implementation of the Group activities, by putting in place enablers to secure sustainability beyond the funding.\n \n ID: GB-GOV-10-GHRG_3_133066\nTitle: NIHR Global Health Research Group on Introduction and evaluation of vaccines to reduce childhood diarrhoea in sub-Saharan Africa\nDescription: The NIHR Global Health Research Group in Gastrointestinal Infections will apply world leading infection and vaccine research to improve health outcomes from childhood diarrhoea in Eastern and Southern Africa. Diarrhoea kills about half a million children under 5 years of age each year, and most of these deaths occur in Africa and Asia. The highest rates of diarrhoea deaths occur in sub-Saharan Africa. In children who survive a diarrhoeal illness, malnutrition, poor growth and impaired brain development commonly follow. \n\nVaccines represent a critical public health tool to reduce this disease burden. Informed by a longstanding research programme in Malawi undertaken by the Lead Investigator, vaccination against a virus called rotavirus has helped to reduce diarrhoeal illness and deaths in African children. But the benefit has not been equal across countries. In some populations, vaccination does not work well, or vaccination is not administered at the optimum age or not at all. Vaccines being developed against other organisms causing diarrhoea, including a bacterium called Shigella, offer hope that suffering and death can be further reduced. \n\nMore research is required to enable current and future vaccines to bring improved and equitable benefit to all children. The Global Health Research Group in Gastrointestinal Infections will address inequalities in diarrhoea burden by combining expertise in epidemiology, laboratory science, \nsocial science, mathematical modelling, statistics, health economics and policy. This multidisciplinary programme, jointly led by the University of Liverpool and the Kamuzu University of Health Sciences, will extend the scientific depth and the geographical scope of our research beyond Malawi. New partnerships will be developed in Kenya (Kenya Medical Research Institute) and Ethiopia (Addis Ababa University), countries in which childhood diarrhoeal morbidity and mortality is high and where vaccination to reduce this burden is a priority. Responding to input from key stakeholders including Ministries of Health and Community Leaders, research will be undertaken in each of Malawi, Kenya and Ethiopia in order to: \n \n• develop sustained engagement with communities and key stakeholders to provide greater national and regional visibility of gastrointestinal infection research;\n• estimate the burden of vaccine preventable diarrhoeal diseases; \n• predict the clinical impact and cost-effectiveness of vaccination; \n• work with policy makers to inform vaccine introduction and evaluation;\n• build capacity in gastrointestinal infection and vaccine research through Masters training programmes run by the partner organisations. \n\nThrough close links with each Ministry of Health and ongoing community engagement, the Global Health Research Group in Gastrointestinal Infections will ensure its research findings are translated into policy for public benefit. Development of a cohort of researchers and public health practitioners with expertise in gastrointestinal infections will sustain this work in the years ahead. The Group’s impact will include enhanced and more equitable use of current and future vaccines to prevent diarrhoea and its consequences, particularly among disadvantaged children in sub-Saharan Africa. . 1. To facilitate sustained engagement between regional and national authorities and local communities together with other key stakeholders, to provide greater visibility of gastrointestinal infection research in Malawi, Kenya and Ethiopia. This will create increased awareness of gastrointestinal infections among clinicians, policymakers and the public. \n2. To estimate the clinical and cost burden of diarrhoeal diseases presenting to health facilities. This will inform national estimates of disease burden attributed to key, vaccine-preventable diarrhoeal diseases.\n3. To predict the clinical impact and cost-effectiveness of vaccines against leading causes of childhood diarrhoea. These data will be shared with Ministries of Health to inform policy.\n4. To create sustainable systems to measure the burden of gastrointestinal infections and the outcome of vaccine interventions. This policy framework will inform population-wide vaccine introduction and evaluation against diarrhoeal diseases.\n5. To develop a cohort of African scientists with expertise in gastrointestinal infection research. This cohort of trained staff and students will help to sustain this work in the years ahead.\n \n ID: GB-GOV-10-GHRG_3_133128\nTitle: NIHR Global Health Research Group on Adolescent Health and Wellbeing in Malawi \nDescription: Our research will focus on the health and wellbeing of adolescents in Malawi from 2022 to 2026. We will work hand in hand with adolescents (10–14 years old) from rural (Mchinji) and urban (Blantyre) backgrounds to understand their lived experience, and the challenges they face in their day to day lives. We will then work with adolescents, parents and guardians and other interested parties to develop promising approaches to improve their health and wellbeing. These interventions will focus on three areas (1) gender, sexual and reproductive health rights, (2) aspirations and wellbeing including mental health, and (3) water, sanitation and hygiene. Work in these areas will be supported by research on the policy and economic environment in which adolescent health and wellbeing sits. \n\nThis is a collaboration between the University of Strathclyde (UK), Kamuzu University of Health Sciences (Malawi) and the Malawi University of Business and Applied Sciences. The research will be transdisciplinary, meaning that our team of researchers from different disciplines (social care, education, sexual and reproductive health, environmental health, mental health, health economics, and health systems), and will work hand in hand with adolescents, family and community members, health workers, policy makers, and other organisations to design, implement and evaluate the research. \n\nWe are focussing on adolescent health and wellbeing because the United Nations estimate that there are more young people (10-24 year olds) alive today than at any other time in human history, the majority of which live in low and middle income countries such as Malawi. Within these settings, adolescence is affected by several health and wellbeing burdens that are worsened by poverty. However, adolescents are often the most neglected group in health care service provision, particularly those in early adolescence (10–14 years), a time considered critical in shaping their future lives. In Malawi, despite efforts to prohibit child marriage, and expand youth-friendly health services, there has been limited progress towards meeting the needs of adolescents. For example, rates for completion of primary school remain low (44% male; 37% female), and pregnancy rates for adolescents remains high. These factors have worsened because of the COVID-19 pandemic which has affected both schooling and health access. \n\nWe hope that our approach will bring immediate benefits to adolescents, as well as benefits throughout their future adult lives and for the next generation of children. We aim to identify new approaches that will ensure more effective peer, parental and multisectoral support to enable young people to maximise their life chances.. Objectives\nOur vision offers a programme of transdisciplinary applied health research to be undertaken in a range of contexts in Malawi that will aim to generate new knowledge on the best preventive and nurturing strategies for adolescent health and wellbeing. \n\nOverarching Aim: \nTo understand the psychological, sociocultural, socioeconomic, educational, political and geographical contexts which influence adolescent health and wellbeing, and to explore which interventions and policies can best support these in the future.\nOverarching Research Objectives:\nThese summarise the overarching objectives of the Global Health Research Group on Adolescent Health and Wellbeing in Malawi, and are supplemented by Work Package specific objectives as outlined in the table below:\na)\tDetermine the psychological, sociocultural, socioeconomic, educational, political and geographical contexts which both positively and negatively influence adolescent health and wellbeing across rural and urban populations (WS3),\nb)\tExamine and understand the current status of adolescent health and wellbeing, and how this is influenced by water, sanitation and hygiene (WASH), sexual and reproductive health rights (SRHR) and community engagement (WS3-6),\nc)\tCo-design, test and evaluate context appropriate intervention strategies to improve adolescent health and wellbeing (WS4-6),\nd)\tCo-develop recommendations through community engagement to inform evidence based adolescent health and wellbeing strategies (WS2, 4-6),\ne)\tCo-create and implement a capacity building programme to provide increased research and partner institutional capacity in Malawi (WS1).\n \n ID: GB-GOV-10-GHRG_3_133135\nTitle: NIHR Global Health Research Group on Improving equitable access to quality care after injury in low or middle income countries\nDescription: Each year 5 million people die due to injuries like road traffic accidents, burns, falls, or violence. Of these deaths, 90% occur in low- or middle-income countries (LMICs) and 40-50% of people who survive are disabled or unable to work. Delays that occur in accessing quality healthcare contribute substantially to death or disability after injury. The World Health Organization has stated that strong health systems that provide quality care for injured people are needed to prevent death and disability. Evidence is urgently required to understand how best to improve health systems to provide quality care after injury.\n\nIn this project, we will partner with colleagues from Ghana, South Africa, Rwanda, and Pakistan, to collect and analyse data from injured persons to understand what the delays to equitable access of quality care after injury are and how can these be overcome to reduce death or disability. We will also collect information on costs of care. These data will be used to develop an injury pathway map to show where it is most beneficial to intervene to reduce delays in accessing quality care after injury. In partnership with stakeholders in each country, we will develop solutions for future study in these, and other similar countries.\n\nAdditionally, we will research how to bring multiple different stakeholder groups together to influence policy to improve access to quality care after injury and embed research findings into policy.. In each country to:\n1. Collect data to inform whether post-injury care is of high quality and equitable.\n2. Develop an injury pathway map to show points of intervention to improve equitable access to quality healthcare after injury.\n3. Develop a road map to bring stakeholders together to improve policy for improving equitable access to quality healthcare after injury.\n4. Work with multiple stakeholders to co-develop solutions to test in future studies to improve equitable access to quality healthcare after injury. \n5. Conduct community engagement and involvement work to ensure that communities are informed about and inform our work.\n6. Deliver capacity building to build research capacity in partner countries.\n \n ID: GB-GOV-10-GHRG_3_133144\nTitle: NIHR Global Health Research Group: The Shire Valley Vector Control Project (Shire-Vec)\nDescription: The Shire Valley Vector Control Project (Shire-Vec) will address the balance between food security and infectious disease in expanding irrigated land in southern Malawi. \n\nThe goal of Shire-Vec is to reduce the burden of endemic vector-borne diseases (VBDs) while maintaining or improving equitable economic benefits for smallholder farming communities. \n\nWe will focus our research on a new 40,000-hectare irrigation scheme in southern Malawi; the Shire Valley Transformation programme (SVTP). \n\nConstruction on the SVTP began in 2020 and will continue throughout the decade. This provides a real-time natural longitudinal experiment to determine \ni.\tthe impact of land-use transformation on vector-borne diseases\nii.\thow local smallholder farming practices will change on the ground and how this influences risk of vector-borne infection\niii.\tpractical solutions for integration across both public health and agriculture\nOur primary diseases of interest are malaria and schistosomiasis due to the unequivocal link between irrigation and their host-vector life cycle, but we include provisions to look at the impact on emerging VBDs such as arboviruses.. Objectives: \n1.\tStrengthen vector-borne disease surveillance and research capacity between the agriculture and public health sector. \n\nWe will bring together stakeholders from across public health and agriculture via the Technical Vector Control Advisory Group of the Ministry of Health in Malawi. \n\nWe will achieve real impact by engaging with local farming communities of the lower Shire Valley via a dedicated Community Engagement and Involvement team and the establishment of a Community Advisory Group. \n\nFinally, a cohort of pre- and post-doctoral Malawian trainees will be recruited and integrated into Shire-Vec to strengthen the future capacity of vector-borne disease research and control in Malawi.\n\n2.\tDetermine the risk of vector-borne disease inside and outside of the irrigation catchment area. \nWe will conduct insect vector and epidemiological surveillance in selected sentinel sites around irrigated farms. \n\nEthnographic research will study behavioural practices in the farming communities and the influence on vector-host contact. \n3.\tPilot locally tailored interventions which tackle either single or multiple vectors, determine their acceptability to the community and establish their value for money.\n4.\tIntegrate vector control into agricultural and irrigation policy, using the evidence generated through Shire-Vec to provide recommendations for mitigating vector-borne disease in future planned extensions of the SVTP beyond 2025 and other national agricultural development schemes.\n \n ID: GB-GOV-10-GHRG_3_133205\nTitle: NIHR Global Health Research Group: A syndemic approach to the prevention of diet- and activity-related NCDs - GDARSpaces \nDescription: A syndemic approach to the prevention of diet- and activity-related NCDs (GDARSpaces) project of the Global Diet and Activity Research Network\n\nProgress on achieving the Sustainable Development Goal 3 non-communicable disease (NCD) targets has been inadequate. \n\nDespite requiring more ambitious, comprehensive and intersectoral approaches to prevention, strategies to address unhealthy diets and physical inactivity have been largely developed by the health sector, without the government-wide and society-wide engagement required to comprehensively address these NCD risks. \n\nThe global diet and activity (GDAR) Network address the rising NCD burden in low- and middle-income countries (LMIC) by generating evidence for sustainable, resilient NCD prevention related to healthy diets and physical activity. \n\nWe recognise that urbanisation acts alongside and synergistically with the impacts of climate change, posing risks to health by influencing diet and physical activity. Collectively we refer to these risks as ‘syndemic hazards’. The concept of a ‘syndemic’ (from ‘synergistic epidemic’) describes the co-occurrence of 2 or more interacting risks. The interaction of urbanisation, climate change, and diet and physical activity behaviours is one such example. Together these forces increase the risks of NCDs. Without considering all these forces, we cannot create effective, sustainable interventions to improve health in LMICs now and in the future.\n\nOur syndemic approach aims to develop interventions that will work in 2 ways: first by reducing the exposure of individuals in cities to these syndemic hazards, and second by reducing the vulnerability of the wider built and food environments to these hazards.\n\nAs the urban poor are most affected by these hazards, we will build understanding of individual exposures by examining how the hazards cluster with household and neighbourhood deprivation. \n\nThe broader questions will be approached by exploring the ways that policy, community and commercial forces shape the built and food environments in these growing cities. This way we can understand exactly how and which environments are most vulnerable.\n\nResearch methods will be varied and tailored to contexts. For example, audits of built and food environments, surveys and focus groups, reviews of policy documents and practice, and collection of household and neighbourhood-level data on diet, PA and NCD risk.\n\nWe will work in Cameroon, South Africa, Kenya and Jamaica, as well as collaborating with UN Habitat, the University of Lagos, Nigeria, the Federal University of Minas Gerais, Brazil and Imperial College’s South Asia study. \n\nContributions of non-academic stakeholders will guide activities throughout the research process and co-design of syndemic interventions. This co-design will draw on existing community and policy actions being taken in response to COVID-19, which is an example of disruption to diet and PA that is made worse by urbanisation and climate change. This will help to identify the policy and community actions and characteristics that can support future interventions.. Objectives: \n1.\tIdentify and characterise exposure to syndemic hazards.\n2.\tUnderstand the adaptive capacity of community, policy and commercial institutions and actors that shape the syndemic.\n3.\tEvaluate the role of COVID-19-mitigation actions by policy and community actors in shaping the food and built environment and the diet and physical activity choices residents can access. \n4.\tCo-design adolescent-focused, syndemic-resilient interventions that promote healthy diets and physical activity.\n \n ID: GB-GOV-10-GHRG_3_133208\nTitle: NIHR Global Health Research Group on developing strategies for hepatitis C in Ethiopia (DESTINE)\nDescription: Clinicians and the Ethiopian Government urgently seek the development of a Hepatitis C Virus (HCV) strategy for Ethiopia. \n\nThey have identified the need for implementation and scale-up of testing and treatment, and development of effective preventive strategies. \n\nThe DESTINE project is a collaboration of experts from the Universities of Dundee and Bristol, 4 Ethiopian Medical schools (Universities of Addis Ababa, Gondar, Jimma and Mekele) together with the Ethiopian Public Health and Armauer Hansen Institutes on behalf of the Ethiopian government. \n\nThe team will investigate the extent of HCV infection in Ethiopia using epidemiological and modelling techniques. \n\nIt will design pathways of care based around treatment pathways designed in the UK but moulded to suit the Ethiopian context. \n\nEthiopian stakeholders and community members will be intrinsic to the project, ensuring that any outputs take account of local attitudes to provisions of services, stigma, regional and ethnic issues around services. \n\nThe work of the project will inform Ethiopian government strategic planning for HCV. It will also enhance associated research skill sets within the 4 major Ethiopian Medical schools, thereby enhancing the research infrastructure in the country. . Objectives: \n1.\tTo estimate how common Hepatitis C virus (HCV) infection is in 4 regions across Ethiopia, namely Addis Ababa, Gondar, Mekelle and Jimma. \n2.\tTo collect demographic data on age, sex, route and stage of infection.\n3.\tTo estimate the risk of new infection, based on route of infection data and surveys of health care practices and other risk factors.\n4.\tTo discover the molecular epidemiology of HCV by region.\n5.\tTo estimate the causal contribution of HCV to incidence of Lymphoma and HCC. \n6.\tTo model the ongoing HCV epidemic in Ethiopia and the health consequences for those infected.\n7.\tTo model the impact and cost-effectiveness of different testing and treatment strategies.\n8.\tTo model the health economic impacts of different care pathways. \n9.\tTo develop sustainable public health strategies to prevent further HCV transmission.\n10.\tTo develop models of care suitable for Ethiopian HCV strategy and health care system, utilising learning from international best practice.\n11.\tTo pilot the efficacy and effectiveness of models of care to inform modelling in different environments in Ethiopia. \n \n ID: GB-GOV-10-GHRG_3_133231\nTitle: NIHR Global Research Group on Advancing Early Diagnosis of Cancer in Southern Africa\nDescription: By 2030, about 24 million people worldwide will develop cancer each year. Most cases will occur in low- and middle-income (LMIC) countries, which may be attributed to aging societies, high prevalence of cancer risk behaviours, as well as the epidemiologic transition and socio-economic inequalities. While more people are getting cancer, services to diagnose and to treat cancer are often not widely available, and there are huge differences in care-seeking and quality of care. Cancer outcomes can be improved by early detection and timely diagnosis. \n\nOur team includes researchers from Queen Mary University London, University of Cape Town in South Africa, University of Zimbabwe and Kings College London. We aim to advance the early diagnosis of cancer in Southern Africa by developing and evaluating e-Tools to improve care-seeking and reduce healthcare delays in two countries: Zimbabwe and South Africa. \n\nWe will focus on cervical and breast cancer in women and colorectal cancer in men and women as these are common cancers and have relatively easy methods for detecting and treating the cancers, especially in the early stages. This research programme will run for 4 years from October 2021.\n\nThe research aims to answer important questions about how to encourage appropriate help-seeking among people with possible cancer symptoms and how to deliver high-quality, accessible and equitable cancer referral and diagnosis services in lower level facilities. It will be undertaken mainly in local clinics and secondary health facilities that are the first place that people go for health services in these countries. Studies will include materials in local languages to increase awareness and access to the services. We will also have a major focus on quality training for junior researchers.\n\nThe questions to be answered include: \nCan we improve timely symptom appraisal and help-seeking among people with possible symptoms of cancer? Can we develop and evaluate an effective digital e-Tool for local primary care workers which will support their service, including patient management and referrals? Can we provide an acceptable and user-friendly e-Tool for patients to promote early diagnosis of breast, cervical and colorectal cancer?\nTo answer these questions we will map current primary care and hospital services for breast, cervical and colorectal cancer in the two Southern African countries. We will then identify key factors influencing patient pathways, from symptom awareness through to referral and diagnosis, and develop two interventions. One will be a symptom assessment and management e-Tool for primary care providers and the other a symptom appraisal and help-seeking e-Tool for the public. We will evaluate the feasibility, acceptability and effectiveness (including cost-effectiveness) of these e-interventions.\nImportantly, we will draw on community engagement and involvement at all stages of the research, and emphasize interventions that are affordable and socio-culturally acceptable to African women and men and local healthcare providers.\nThis research will help health authorities plan how new approaches can be integrated into existing health services in countries like Zimbabwe and South Africa. It will demonstrate which resources are needed to provide accessible, good quality, cost effective services that successfully help people to have a more timely diagnosis of breast, cervical and colorectal cancer. . To advance early diagnosis of breast, cervical and colorectal cancer cancers in Southern Africa we will:\n1.\tIn Workstream 1, assess the current time intervals from breast, cervical and colorectal cancer symptom awareness to referral and diagnosis and the factors influencing these intervals among adult (age 18 and over) men and women in Zimbabwe (low-income country) and South Africa (upper middle-income country) representing Southern African countries at different levels of economic development;\n2.\tIn Workstream 2, develop two e-Tools that promote more timely presentation and referral for breast, cervical and colorectal cancer:\ni.\tA symptom assessment and management e-Tool for primary care providers to enable efficient diagnosis\nii.\tA symptom appraisal and help-seeking e-Tool for the public;\n3.\tIn Workstream 3, evaluate the e-Tools across local settings in Zimbabwe and South Africa, to ensure that they are operationally and economically feasible and equitable, socio-culturally acceptable and support timely referral.\n \n ID: GB-GOV-10-GHRG_3_133232\nTitle: NIHR Global Health Research Group on Implementation of solutions to reduce maternal and neonatal mortality and build research capacity in Sierra Leone\nDescription: In Sierra Leone, 1 in every 17 women will die during pregnancy or childbirth. It is one of the most dangerous places to give birth in the world. This NIHR Global Health Research Group is a partnership between the University of Sierra Leone and King’s College London to develop and implement life-saving maternal health interventions and build research capacity in Sierra Leone.. Within our programme of research our main objectives are: \n1. To determine the impact of scaling up the CRADLE Vital Signs Alert (VSA) device in rural Sierra Leone. \n2. To improve health, psycho-social, educational, and economic outcomes for pregnant under-18-year-olds in Sierra Leone, under the 2 Young Lives mentoring scheme. \n3. To determine whether shock index (heart rate divided by systolic blood pressure, as measured by the CRADLE VSA device) is a better predictor of poor pregnancy outcomes than conventional vital signs in women who are bleeding or have severe infection.\n4. To validate a point of care creatinine device, to detect acute kidney injury in women with bleeding, severe infection or high blood pressure during pregnancy. \n5. To conduct a cost benefit analysis of the CRADLE VSA device to inform subsequent adoption and policy pathway. \n \n ID: GB-GOV-10-GHRG_3_133314\nTitle: NIHR Global Health Research Group on Physical Trauma from Injury & POsT Conflict; iPrOTeCT\nDescription: Conflict resulting in serious, life changing injuries is widespread and accidental injuries through road traffic accidents (RTAs) are increasing in prevalence in Low- and Middle-Income Countries (LMICs). iPrOTeCT focuses on saving limbs after these injuries (surgery and technology), and where limbs cannot be saved, ensuring the best possible functional outcomes for amputees (prosthetics). This provision of the best healthcare and rehabilitation to physical trauma patients saves lives, increases functional outcomes, provides independence, and enhances quality of life.\n\niPrOTeCT will work to benefit those injured in Gaza, Lebanon, Rwanda, Sri Lanka, and Syria initially, but in the longer-term, we will expand the reach of the programme to benefit those in the East, Central and South of Africa and other LMICs who are, or have, experienced conflict or significant increases in accidental injuries. The project is led by partners in the UK (Imperial College London), and Rwanda (University of Global Health Equity), with additional partners in Rwanda (University of Rwanda), Lebanon (American University of Beirut) and Sri Lanka (University of Moratuwa).\n\nWe will explore the patterns of injuries from conflict situations (blast, gunshots), and other trauma (RTAs and non-conflict blast injuries). This knowledge will inform the understanding of the impacts on healthcare services and will influence policy and practice changes. We will use our clinical engineering expertise based on frugal principles to 1) identify technology need, 2) design, develop and test solutions that can be implemented and manufactured locally within the partner countries, and 3) develop a clinical translational plan for sustainability that is relevant and unique to the partner countries. We will create, evaluate and improve capacity building opportunities which will help to improve opportunities and provide long-term benefits for those in research and research management. We will work closely with community groups formed of patients, their families, rehabilitation service practitioners and clinicians. The groups will be facilitated by the Legacy of War Foundation. Their insights will help the team to better understand concerns about treatments, devices and socioeconomic needs and the main outcome will be to help reduce stigma, raise awareness, and support changes in policy.. 1. Establish a global picture of the clinical burden of accidental, conflict and post-conflict injuries and the resulting societal issues.\no Target Sector/Group: Those affected by traumatic injury (conflict and non-conflict trauma) and healthcare providers.\no Expected Outcome: Policy development, Improved medical practice, future healthcare and rehabilitation. Provide rehabilitation/medical recovery roadmap for countries post-conflict.\n\n2. Identify, develop, and share appropriate healthcare technologies.\no Target Sector/Group: Healthcare practitioners in LMICs,\no Expected outcomes: Expand and teach the use of the following technologies:\n Surgical bone reconstruction technologies\n Bone regeneration medicine\n Prosthetic and rehabilitation technologies\n\n3. Co-create, evaluate and improve capacity building opportunities in research, education, global clinical collaboration and research management.\no Target sector/group: Surgeons, clinician, engineers and scientists, research management and administration in LMIC locations\no Expected outcomes: Improved capacity within LMIC institutions on all levels.\n \n ID: GB-GOV-10-GHRG_3_133333\nTitle: NIHR Global Health Research Group on Building partnerships for resilience: strengthening grassroots response to public health crises\nDescription: The aim of The Partnerships for Resilience Group is to develop and strengthen the evidence base for how to improve effective community-led responses to environment-related public-health crises. To do this the Group will establish and capacity strengthen an international partnership to conduct excellent research to inform policy and practice.\n\nHuman health and wellbeing face severe, interconnected threats from increasingly frequent and disruptive shocks, including outbreaks (some pandemic) of zoonotic infections (e.g. Ebola, Covid19) as well as severe environmental change, heightened by climate change, that lead to changes in food security, disease patterns and disasters. Social science work has shown that resilience for responding to such shocks is most effectively built at community level. However, no good quality data exist on the mechanisms by which effective health responses to crises can be built. The Group will gather evidence with local partners in Ethiopia, Madagascar, Sierra Leone and Uganda, which have experienced – and responded to – a range of public health crises.\n\nCentral to our approach is the “co-production” of research actions with affected communities. We will gather evidence and conduct case study analyses to develop prototype approaches to developing community-led approaches to emergency-response. We will then test and evaluate these using participatory methods. We will refine and finalise our Prototypes in the light of our findings and then widely disseminate them to key decisions makers in governments and international agencies in order to improve the resilience and effectiveness of responses to public health crises.. Our overarching strategic aim is to develop and strengthen a newly expanded international partnership to conduct research to inform policy and practice that improves effective community-led responses to public-health crises.\n\nOur five objectives, are to:\n1) Synthesise evidence on how communities, local health systems and other formal and informal entities have responded to health crises, and with what effect:\n2) Develop effective approaches for public health crisis-response at grassroots:\n3) Evaluate models for effective community-led responses to public-health crises. \n4) Formulate guidance and create dialogue with stakeholders on how to strengthen local resilience for effective responses to public health crises.\n5) Strengthen and consolidate sustainable partner research and management capacities to strengthen policy and practice in crisis-response.\n \n ID: GB-GOV-10-GHRG_3_133382\nTitle: NIHR Global Health Research Group for Improving Oesophageal Cancer Survival in Kenya: The Hub and Spoke Model\nDescription: Cancer care is an increasing burden on the limited health resources in Kenya and improved early detection could decrease both mortality and complex treatment costs. The Christie NHS Foundation Trust and The University of Manchester have signed Memoranda of Understanding to support a long-term partnership with Kenyatta University Teaching, Referral and Research Hospital and Ministry of Health, Kenya to improve cancer outcomes with a specific focus on early detection within Kenya and East Africa. This programme of work supports a joint partnership to improve early detection of oesophageal squamous cell carcinoma (OSCC).\n\nIn Kenya, OSCC is the 3rd most common cancer with the highest mortality of all cancers at 4400 deaths per year. Although present-day therapeutic interventions of surgery, chemotherapy and radiotherapy can positively influence disease prognosis, OSCC remains a highly lethal disease in Kenya with 99% case fatality rate due to late recognition of symptoms by the patient and general practitioner and advanced disease presentation. OSCC therefore needs better early detection strategies to diagnose cancers at a much earlier stage whereby 40-50% of Kenyan patients could potentially be cured with surgery.\n\nPotentially influenced by a combination of genetics, lifestyle, socio-economic and environmental factors, striking variations in incidence and survival exist across geographic confines whereby Western and Central Kenya have the highest OSCC incidence. Cancer survival also varies as a function of geography within Greater Manchester (GM) with great variation in the proportion of GM’s cancer patients that present with late-stage disease across different locales and poor survival. The similarities in needs of Nairobi and Manchester to reach out to at-a-distance and socially deprived communities allows for reciprocal learning and research co-creation. This includes an unmet need to use African-specific genomics to improve our understanding of OSCC carcinogenesis to offer bespoke cancer aetiologic information to aid long-term prevention strategies. The latter approach is currently blocked by the preponderance of non-African genomic OSCC data in which risk factors may differ in the Western world.\n\nOur programme of work will benefit from engaging with a range of communities and stakeholders across the clinical cancer care ecosystem in Kenya. Partnering with and complementing the work of key local patient and community partners such as the Kenyan Network of Cancer Organisations will help to reduce the stigma associated with cancer, and inform best future joint actions through a Kenyan lens. This programme will lead to the earlier reporting and understanding of symptoms leading to better treatment and enhanced survivorship. Together, with the personnel and infrastructure build for research diagnostics and pathology at KUTRRH, this will start important stepchanges needed to embed a system-wide and research-driven earlier detection programme for all cancers. This project sets out an initial and systematic approach to understand and engage the communities we seek to support, with long-term goals for improving cancer care. With strong\npartners, there is clear succession planning to enable sustainable success beyond this 3-year grant.. 1. Engagement: Co-develop enhanced community engagement strategies to establish equipollent partnerships and improve county-level access to cancer early detection services for OSCC.\n2. Digital Transformation: Co-create a research-based digital 'hub and spoke outcomes unit' with inward OSCC clinical data from counties to KUTRRH hub and outward harmonised OSCC care protocols to distant spoke counties.\n3. Molecular Pathology and Biology: Co-build a pathologist and pathology capacity to support early detection programmes and inform on bespoke Kenyan cancer biology relevant to future prevention studies.\n4. In year 3, submit an application to become an NIHR Global Health Research Unit.\n \n ID: GB-GOV-10-GHRG_3_133384\nTitle: NIHR Global Health Research Group on Depression and Anxiety in Youth in African Countries - “African Youth in Mind”\nDescription: African Youth in Mind (AYMI) will bring together researchers, youth and a range of government and non-government stakeholders to learn how best to treat depression and anxiety in youth aged 15-24 in Ghana and Zimbabwe. We will build capacity on youth-focussed mental health interventions in these two countries and also in Malawi. \nDepression and anxiety prevent youth from productivity and innovation and from reaching their full educational and social potential. This is critical in African countries, where 60% of the population are aged under 25. Depression and anxiety are key risk factors for self-harm and for suicide, which is the third leading cause of death globally in this age group. Various treatments which help with thinking, behaviour and emotions are known to be able to restore health and functioning for depressed and anxious youth. These could feasibly be delivered by non-specialists in low-resource settings.\nOur plan is to work with youth and caregivers to adapt and test a stepped care intervention for youth with depression and anxiety, which is tailored to the needs of communities in Ghana and Zimbabwe. We will build on lessons from African innovation, especially the Zimbabwean Friendship Bench. Based on country priorities and context, we will shape the intervention in Ghana for those aged 15-18 enrolled in Ghana’s free senior high school system and in Zimbabwe for youth aged 15-24 in schools, colleges and community health settings including sexual health services. We will then evaluate the clinical and economic benefits of the intervention through running a clinical trial in senior high schools in Ghana. \nBy the end of our program, we aim to have four completed PhDs for African early career researchers in youth mental health (in Zimbabwe, Ghana, and Malawi), two post-doc fellowships completed, and ten publications in open access journals, with at least 80% of these to be first or senior authored by an African researcher. Our longer-term vision is a strong interdisciplinary group of African-UK researchers in youth mental health, and for our stepped care intervention to be taken up by governments and NGOs to improve youth mental health.. 1. To provide essential context about needs and strengths of youth and of organisations and systems supporting youth in our research communities. \n2. Develop and agree implementation theory for delivering youth mental health interventions, and the pathway to primary mental health care and specialist care for youth with more complex needs.\n3. Inform content and implementation of relevant interventions, and measurement of clinical outcomes.\n4. Learn about youth and caregiver views of mental health and mental health interventions.\n \n ID: GB-GOV-10-GHRG_3_133391\nTitle: NIHR Global Health Research Group on Transforming Parkinson’s Care in Africa (TraPCAf)\nDescription: The largest proportionate growth of people aged over 60 is occurring in low- and middle-income countries (LMICs), such as those in sub-Saharan Africa (SSA). Already coping with a large burden of infectious diseases they now face a large increase in age-related diseases such as dementia and Parkinson’s disease (PD). There are very few medical specialists. We estimate half the people with PD (PwP) in the world are not diagnosed. Effective symptomatic drug treatment is available, though not a cure, but access is very limited in SSA. People undiagnosed, and others not treated, will have a much poorer quality of life and a significantly reduced life expectancy. We have treated people in SSA who were virtually bed bound and within days were back working on their farm. We showed similarly dramatic short term impacts for a physiotherapy cueing intervention before drug treatment was available locally. There is a lack of awareness about PD among the general public and health professionals, so people often don’t recognise symptoms or access medical help and, even when they do, may not be correctly diagnosed. Some PwP see traditional, or faith, healers and many seek no help at all, mistaking the symptoms for old age and feeling nothing can help. Even those diagnosed face the challenge of obtaining affordable and sustainable drug treatment.\n\nThis research will enable us to gain important information on PD and effectiveness of treatment in Africa. We will test ideas for helping diagnosis and management, and develop support including patient and carer information. We will strengthen research capability in PD in Africa. We are linking with a current research study looking at the genetics of PD worldwide, including Africa. . We plan to work with colleagues in Tanzania, Kenya, Ghana, Nigeria, South Africa, Ethiopia and Egypt to:\n\nImprove Diagnosis\n1. Develop aids to diagnosis for non-specialist doctors, such as questionnaires appropriate for LMIC settings, and equipment that measures slowness of movement and tremor, the two major symptoms of PD. We will utilise new techniques such as scripted videos recorded on smartphones and then analysed by movement disorder specialists in Africa, UK or Europe, and also investigate chemicals in blood, sweat and urine as early signs of PD. \n2. Provide training for doctors, nurses and therapists to improve diagnosis and management.\n3. Develop and trial services for diagnosis and management of PD by non-specialists.\n4. Undertake community based studies of the number of people with PD (prevalence) in Tanzania, Ghana, Nigeria and Kenya, testing different diagnostic methods.\n\nImprove care \n5. Develop a database of PD outpatients in sites in the different countries to enable description of their characteristics.\n6. Look at the effectiveness and side-effects of preparations of Mucuna pruriens (MP), a tropical plant, compared to Levodopa (standard drug treatment) in Tanzania. Evidence from an on-going Ghana study suggests MP is affordable, effective and side-effects are limited.\n7. Assess the response to drug treatment, with low-cost home monitoring with wearable movement sensors in PwP who consent.\n8. Work with patient and carer support groups to understand lived experience, raise public awareness via standard media techniques and social media.\n9. Collaborate with the Investigators on a large genetic project to collect blood and saliva samples for genetic analyses, as well as stool samples for microbiome analysis.\n \n ID: GB-GOV-10-GHRG_3_133712\nTitle: NIHR Global Health Research Group on Promoting Children’s and Adolescent’s Mental Wellbeing in sub-Saharan Africa.\nDescription: There is an urgent need to improve children's and adolescents' wellbeing in sub-Saharan Africa. The mental wellbeing of children and adolescents is poor, and their educational attainment is low. Little is being done to improve their mental wellbeing, and there are few services for those in need. The WHO recommends preventative mental health interventions in schools. Mindfulness has proven to be an acceptable and effective use of resources in countries like the UK. Mindfulness involves a combination of breathing exercises, visualisation, body awareness, and relaxation. Practising mindfulness makes children and adolescents happier. It improves their attention span, helps them manage stress, increases their sense of wellbeing, improves their communication skills and their school performance. Teaching mindfulness also improves the mental wellbeing of teachers. There is a need to know if mindfulness improves the wellbeing of children and adolescents in Sub-Saharan Africa, and if it would be a good use of government resources. \nWe will deliver the project in Ethiopia and Rwanda between 2022 and 2026. Rwanda and Ethiopia are two of the poorest countries in the world. The wellbeing of children is poor in both countries, and school attainment is low. Researchers from Ethiopia, Rwanda, and the UK will collaborate on the project. Our research team includes health experts, social scientists, and teacher educators. We have an international advisory board, including government officials from both countries. Community members, including parents, teachers, children, and adolescents, will help us design the mindfulness intervention.\nWe will research ways of providing an affordable and acceptable mindfulness intervention that improves children's and adolescents' wellbeing. We will work with parents and policymakers to agree on delivering and testing it. Teacher-educators working with primary school teachers will develop an appropriate mindfulness intervention and these will train other teachers in their schools. Teachers will deliver the intervention as part of the primary school curriculum so that it reaches all children. We will test the intervention to provide policymakers with high-quality evidence on how well it works, and the costs and benefits of delivering it in all schools. The testing will include talking to children and adolescents, their teachers, and parents about their experiences of the intervention. We will also test children's and adolescents' mental wellbeing before we deliver the intervention and after, to see what improvement it makes. We will compare children who received the mindfulness training with similar children who did not to control for the effects of other simultaneous changes in children’s lives. We will provide feedback on all our findings to policymakers in Rwanda and Ethiopia. This will include the findings from an 'economic model' showing the potential cost savings and benefits of introducing mindfulness practices in all schools. We will tell international organisations such as the WHO and the United Nations Children's Fund about our findings. We will disseminate the findings through our website and social media in French and English. We will invite relevant organisations from across Sub-Saharan Africa to regular webinars disseminating information about the project. A training programme will educate the next generation of researchers in transdisciplinary health research. Early career researchers will be involved in every stage of the research, from design to publication of the findings. \nImproving children's and adolescents' wellbeing will enable them to enjoy their childhood and develop to their full potential. It will also improve their lives as adults, making them happier, less likely to develop mental and physical illnesses and better able to play a full role in society. Also, it reduces healthcare expenditure.. 1. Identify policies for promoting the well-being of children and adolescents in Ethiopia and Rwanda, and examining how they are being implemented and their effectiveness. \n2. Identify and build networks of policy actors, teacher educators, teachers, parents, and community members that have a stake in improving the well- being of children and adolescents.\n3. Train teacher educators and teachers in mindfulness and in teaching it to children.\n4. Develop a mindfulness intervention led by Rwandan and Ethiopian educators for delivery in schools. The intervention to be designed designed to promote the wellbeing of children and adolescents, and to be acceptable to policy actors, teachers and communities, including children and adolescents.\n5. Evaluate the intervention's effectiveness, including its acceptability to communities, children and their families, and teachers.\n6. Generate evidence on the intervention's affordability and effectiveness and how it can be scaled up.\n7. Sustainably build capacity and capabilities for interdisciplinary applied health research for delivering interventions to improve the well-being of CYP.\n8. Provide an enhanced understanding of the distinct mental health challenges that face adolescent girls and boys and how these challenges are affected by gender-based discrimination.\n \n ID: GB-GOV-10-GHRG_3_133850\nTitle: NIHR Global Health Research Group on Perioperative and Critical Care\nDescription: Background: More than 600,000 patients die after surgery in Africa each year, a death rate which is twice the global average. Those patients who develop complications after surgery but survive, have a reduced overall life expectancy, reduced quality of life and significant financial hardship. Poor patient outcomes primarily result from failings in perioperative care and critical care (before, during and after surgery) rather than surgery itself. Meanwhile, a three-fold increase in procedures is required to meet the needs of 1.2 billion people across Africa who cannot access safe affordable surgical treatment. As health systems work to increase the number of surgical procedures, we anticipate a further increase in complications and deaths after surgery. Without effective perioperative care, the positive impact of increasing provision of surgery will be limited, as will any net improvements in health for individuals and societies. We will establish sustainable research infrastructure in Africa and build on our world-leading applied research in a range of health-system contexts to develop effective solutions to this problem.\n\nAim: To develop centres of research excellence in four African nations within the African Perioperative Research Group (APORG) of 705 hospitals in 42 countries, creating equitable partnerships to deliver an international research programme and improve the safety and quality of perioperative and critical care across Africa.\n\nImpact: Our research findings will inform changes in healthcare which could reduce deaths after surgery to the global average across Africa, saving 300,000 lives each year, improving long-term health and reducing financial hardship.. 1. Develop research leadership and capacity in four African nations Establish research hubs in four African universities with managerial, financial and governance infrastructure to become centres of research excellence, with a pan-African research design centre to lead international clinical trials. We will develop current and future research leaders and research professionals through training programmes, mentoring and PhD fellowships. Ultimately these hubs will become training centres for future African research professionals in our field.\n\n2. Delivering research to improve outcomes after surgery across Africa Building on our successful international global health research, we will deliver a programme of observational studies of patient care, interviews with patients, staff and other stakeholders, large dataset research and large clinical trials across four key themes:\n1) Developing realistic and sustainable models of Essential Critical Care\n2) Improving identification of patients with life-threatening complications after surgery\n3) Preventing and treating life-threatening bleeding after childbirth\n4) Building linked national health data platforms (health registries) to assess the impact of Projects 1 to 3 and improve patient outcomes after surgery through international clinical audit and research\n\n3. Engage patients, communities and policy-makers Led by teams in Africa, we will establish meaningful community engagement at local, national and pan-African levels allowing us to work together to produce the research which is most relevant to patients. We will develop links with civil society, policy-makers and health professionals across partner nations and to ensure our research impacts patient care.\n \n ID: GB-GOV-10-GHRG_3_134325\nTitle: NIHR Global Health Research Group on homelessness and severe mental illness in Africa (HOPE)\nDescription: In HOPE, we will seek to address the needs of people experiencing homelessness and severe mental illness (SMI) in Ethiopia, Ghana and Kenya. People with SMI are over-represented in homeless populations globally, but this is a major concern in low- and lower middle-income countries. However, there is no high-quality evidence to show which interventions are effective in these settings. In HOPE, we will create a new partnership of researchers, policy makers, community members and people with lived experience of SMI and homelessness. We will work in a capital city (Addis Ababa) in Ethiopia, a regional city (Tamale) in Ghana, and a rural county (Makueni) in Kenya to understand the different approaches needed across varied settings. \nIn phase 1, we will carry out a number of activities to understand priorities, needs and opportunities for intervention. We will map existing contexts, conduct a survey and ethnographic study with people who are homeless and have SMI, interview stakeholders, synthesise global evidence and experience on interventions for this group, and prioritise potential interventions. \nIn phase 2, we will work with stakeholders to select, co-produce and test intervention packages to optimise feasibility and acceptability. We will support and empower people with lived experience of SMI and homelessness to participate. The intervention package will seek to address a range of needs, from basic needs, to mental and physical health, family support, livelihoods and social inclusion. A cornerstone will be peer support. \nIn phase 3, we will test the intervention package with 350 people per site who experience homelessness and SMI. We will follow up participants over six months to see whether they benefit in terms of physical and mental health, experience of discrimination and abuse, housing status, family reintegration, functioning and social inclusion. We will identify ways to implement at scale and ensure sustainability. \nBy the project end, we will have: (1) developed evidence-supported interventions to improve the lives of people who are homeless and experience SMI; (2) collaborated with the World Health Organization to produce a manual on how to adapt and implement the programme in low-resource settings; (3) developed methods and the capacity of early career researchers and other stakeholders; and (4) built a strong collaboration of multi-sector partners to sustain in-country work and longer-term high-quality future research on this neglected topic. . 1) Establish a partnership of researchers, implementers, policymakers and people with lived experience working collectively to improve the lives of people who are homeless and have SMI. \n2) Synthesise global evidence on existing initiatives and obtain global expert consensus on priority actions and approaches.\n3) Work in distinctive settings in Ethiopia (capital city), Ghana (regional capital) and Kenya (rural county) to:\na. Identify the priority needs and valued outcomes of those who are homeless and have SMI, and opportunities and challenges for effective intervention. \nb. Integrate global and local evidence to select and co-produce interventions that target priority needs, and pilot test for acceptability and feasibility. \nc. Evaluate the impact of interventions on the human rights and diverse outcomes valued by people who are homeless and experience SMI, and generate evidence on intervention costs, implementation processes and outcomes.\nd. Pioneer the development of methods and ethical frameworks for research engaged with people who are homeless and have SMI. \n4) Impact global policy and practice through translation of evidence into a WHO ‘how-to’ guide to adapt and implement programmes for people who are homeless and have SMI in diverse low-resource contexts.\n5) Build sustainable capacity across partners that responds to local priorities, enhances existing capabilities, supports south-south and south-north exchange of expertise and develops both individuals and systems.\n \n ID: GB-GOV-10-GHRG_3_134342\nTitle: NIHR Global Health Research Group on HIV-associated Fungal Infections (IMPACT-AIDS MYCOSES)\nDescription: Invasive fungal infections are a growing global threat to human health, affecting >150 million people and accounting for up to 1.5 million deaths per year. However, this burden is under-appreciated and medical mycology is chronically underfunded. Research into improvements in diagnosis and treatment and implementation of this research are essential to reduce death and disability. HIV remains a leading cause of morbidity and mortality in low- and middle-income countries (LMICs) causing an estimated 500,000 to 1 million deaths annually, the majority in sub-Saharan Africa and South East Asia. Four HIV-associated fungal infections - cryptococcal meningitis, talaromycosis, Pneumocystis pneumonia (PCP), and histoplasmosis - are responsible for 250,000 deaths per year, and up to 20% of all HIV-associated mortality. The World Health Organization (WHO) has recognized that HIV deaths cannot be further reduced until these major fungal complications of advanced HIV disease are effectively addressed. Our NIHR Global Health Group aims to capitalise on the opportunities presented by recent clinical research advances in cryptococcal meningitis to improve the diagnosis and treatment not just of cryptococcal meningitis, but also the three other major HIV-associated mycoses of public health importance. Our group brings together leading academic researchers, clinical and public health leaders, non-governmental organisations (NGOs) including Médecins Sans Frontières and the Drugs for Neglected Diseases initiative, and community and patient representatives, to improve the diagnosis and treatment of these HIV-associated fungal infections and ensure that these improvements are made widely available to populations most commonly affected in Africa (Democratic Republic of Congo, Mozambique, Guinea, Malawi, Botswana, South Africa), and South East Asia (Vietnam). Our partnership will be equitable, with leadership shared across six work packages delivered over 4 years from 2022 through to 2026, insights from qualitative research, guidance from a steering committee and community advisory boards, and priorities set at initial meetings led by LMIC partners. In addition to the direct impact of the work, we will liaise with national, regional, and international bodies (ministries of health, major NGOs, UNITAID, WHO) in order to effectively scale the results and impact of our work.. 1. TREATMENT: To implement novel, short-course treatment for HIV-associated cryptococcal meningitis in routine care in African and South East Asian countries, building on the results of two landmark trials, ACTA and AMBITION-cm, completed by partners in our consortium, both of which demonstrated improved survival with regimens that are practical and affordable in resource-limited settings. And to support preliminary work using a single high-dose liposomal amphotericin B treatment approach in talaromycosis and to lay the foundations for future studies in histoplasmosis.\n2. PREVENTION: To optimize the screen-and-treat strategy, to identify and treat early cryptococcal disease, before it becomes clinically apparent, in Africa and South East Asia. Semi-quantitative tests will be evaluated for cryptococcal antigen screening, and the pharmacokinetics of pre-emptive treatment with sustained-release flucytosine will be determined, within the ongoing EFFECT trial. Screening will be evaluated to prevent talaromycosis, cryptococcosis and histoplasmosis in South East Asia and histoplasmosis and emergomycosis in Africa. \n3. HEALTH ECONOMICS: To generate essential economic data to support the different screening and treatment approaches being investigated for cryptococcosis, histoplasmosis and talaromycosis. These individual and, if appropriate, combined analyses will be crucial evidence in our efforts to effect the policy changes needed to reduce mortality from HIV-associated fungal infections. \n4. DIAGNOSTICS: To initiate a programme of earlier-stage, laboratory-based work on HIV-associated Pneumocystis pneumonia (PCP), and to develop a clinical cohort and sample bio-bank as a resource to develop and test novel diagnostic tests for PCP, which constitutes the major barrier to reducing PCP deaths.\n5. TRAINING: As integral to the work proposed, to support a comprehensive training and capacity strengthening programme in clinical (epidemiology, health economics and/or public health), and laboratory research, and including 3 laboratory MSc, 2 taught MSc and 3 PhD places. Training will be enabled by a recent strategic UK-African partnership based at the University of Cape Town (UCT), South Africa between the UK MRC Centre for Medical Mycology and UCT, and will build on our extensive experience of training and capacity strengthening within existing multinational projects. Our goal is to train and mentor clinicians and researchers who will help drive and develop this partnership beyond the initial 4-year period.\n6. ENGAGEMENT: To ensure that the voices of people living with advanced HIV disease and community representatives are meaningfully included and heard across the entire scope of work, we will develop strategies and tools to increase patient health literacy around HIV-associated fungal infections, collect qualitative data to learn from the experience of patients with HIV-associated fungal infections and facilitate meaningful engagement through our community advisory boards. We acknowledge and affirm that successful implementation of our work is dependent on the engagement of patients and communities.\n \n ID: GB-GOV-10-GHRG_3_134440\nTitle: NIHR Global Health Research Group on Global Health and Palliative Care (GHAP): expanding access\nDescription: This research aims to develop ways for people in sub-Saharan Africa to receive palliative care if they need it, focusing on groups that we know are not getting the care they need. 1: In Uganda we want to improve the quality of palliative care for children and young people, by making sure that care focuses on what matters to them. We will work with health centres (a hospital, a clinic and a homecare team) and use a simple checklist that helps children (with their families) identify the problems and concerns that are affecting them most.\n\n2: In Zimbabwe, we want to ensure that adults with cancer, who are not expected to be cured, can receive palliative care as part of their cancer care at the hospital. Patients, families and their health care team will design together a new way of working that will focus on patients’ symptoms and concerns.\n\n3: In South Africa, we want to make sure that adults with long term illness and who have pain, breathlessness, and fatigue, can benefit from palliative care and rehabilitation to optimise function and independence. We will work with patients, families and\nphysiotherapists/ occupational therapists to develop simple ways for patients and families to self-manage their symptoms at home.\nWhy is this being done?\n\nPalliative care is for people who are living with incurable illness that is likely to shorten their lives. Because palliative care can reduce suffering and improve wellbeing for patients and families, it is now seen as an essential part of healthcare for all. But although most people who need palliative care live in poorer countries, that is also where there is less availability of palliative care. We have found that people with incurable illness in poorer countries have a lot of unnecessary suffering, and the numbers of people suffering is rising rapidly. We have found three groups of people who could benefit from better access to palliative care in sub-Saharan Africa: children and young people, patients living with cancer, and people with long-term illnesses using community-based care. The additional challenge is that palliative care has not had enough attention in research and universities, and we must build our skills and networks to address these growing challenges.\n\nWho is doing it?\nWe have consulted with patients and families on developing this research, and they have inputted to our plans. In each partner country, our Advisory Group (of both adults and children) will be part of the research team. Their specific roles will be to help us design the recruitment plans, to promote the study, to design information and consent forms, to help design interventions, to interpret the findings, input to design of the materials that come from our research, and to present study findings. We will ensure each group has a training programme to support their personal development. We will work together to\nevaluate the impact of their involvement to continually improve our approach. The project leads are King’s College London and the University of Cape Town UK. Our other partners are the African Palliative Care Association, Makerere University, Mildmay,\nUniversity of Zimbabwe, and Island Hospice.\n\nWhen is it being done?\nWe will be delivering this project for 4 years from August 2022.. Workstream 1 (integrated child- and family-centred outcome measurement) \n Aim \nTo integrate a child- and family-centred outcome measure (i.e. Children’s Palliative Outcome Scale, C-POS) into routine children’s palliative care at three demonstration sites in Uganda, developing implementation and data usage plans for quality improvement, and to deliver a manual for regional adoption. \n Objectives\ni)\tTo develop a child expert group to advise and act as peer promoters.\nii)\tTo refine C-POS for implementation across age groups and diagnoses.\niii)\tTo develop a quality improvement team within each of our three demonstration sites and identify site-specific integration plans.\niv)\tTo develop a Decision Support Tool (DST) specifying appropriate and feasible clinical responses to real-time data that are feasible and effective within local resources. \nv)\tTo implement C-POS for quality improvement cycles within routine practice in three demonstration sites.\nvi)\tTo determine stakeholder views on quality improvement mechanisms and impact.\nvii)\tTo develop an implementation manual with consortium partners for the region. \n\nWorkstream 2 (integrated cancer palliative care) \nAim\nTo develop a model of integrated cancer palliative care that is tailored to the context of Zimbabwe, and to determine the feasibility of evaluating it using an RCT design. \nObjectives\nPhase 1 Develop the intervention (MRC: “Development”) \ni.\tIdentify patients’, families’ and clinical staff views on acceptable model of integrated cancer palliative care, and on trial methods \nii.\tDevelop a theory of change and manualised intervention programme to standardise delivery \niii.\tAdapt an existing palliative care costing tool using qualitative data from objective i on formal and informal care costs \nPhase 2 Assess feasibility of a hybrid cluster randomised controlled trial (MRC: “Feasibility”)\niv.\tDetermine trial recruitment rates to a RCT for patients and family members\nv.\tMeasure completion of potential family and patient outcome & staff cost data, intervention implementation, and determine staff and family views of the intervention and its processes \nvi.\tConfirm primary outcome measure and potential effect size, identify contamination, and develop full trial protocol if full trial is warranted\nvii.\tDevelop methodological guidance for palliative care trials in LMIC & intervention manual adaptation to partner countries \n\nWorkstream 3 (symptom self-management) \nAim\nThis workstream aims to develop, then assess the acceptability and feasibility of implementing symptom self-management for people living with chronic organ failure (lung, heart, renal, liver disease) attending primary care in South Africa, focusing on the high prevalence symptoms of pain, breathlessness and fatigue.\nObjectives \nIntervention development and modelling objectives:\ni)\tIdentify the active components of the intervention (core and optional), distinct patient sub-groups using systematic review findings\nii)\tRefine salient components of intervention delivery, receipt, implementation and outcomes with key stakeholders\niii)\tDevelop a logic model with contents, mechanism of action and outcomes for the self-management intervention\nAcceptability and feasibility testing objectives:\niv)\tAssess the acceptability and feasibility of intervention delivery focusing on process and implementation measures\nv)\tUnderstand experiences of intervention delivery and receipt, including barriers and facilitators, and utility to patients and professionals\nvi)\tExplore the impact on candidate outcomes for clinical (symptom burden, function, quality of life) and cost effectiveness\nvii)\tSynthesise data to inform the eligibility criteria, primary outcome, sample size and resource requirements for a definitive trial.\n \n ID: GB-GOV-10-GHRG_3_134482\nTitle: NIHR Global Health Research Group on Patient-centred sickle cell disease management in sub-Saharan Africa (PACTS) \nDescription: There is substantial evidence from high-income countries that infection prevention, hydroxyurea and blood transfusions can reduce mortality and morbidity in sickle cell disease (SCD) These are not widely used in sub-Saharan Africa where most patients are not diagnosed and die before 5 years of age. We will put patients in Nigeria, Ghana and Zambia at the centre of our research, involving them in every aspect and empowering them, in collaboration with health workers, to find solutions to, and overcome, the barriers they face in accessing care for SCD. This will be complemented by research in health facilities to optimise the implementation of standards of care for SCD. Our research and complementary capacity strengthening activities will use the implementation research methods of participatory action cycles and standards-based audit. Our research is underpinned by a realist evaluation to understand what worked (or not), why, for whom and in what context, and a comprehensive dissemination and engagement strategy to share with, and learn from, communities, policy-makers and journalists.. TBC during start-up \n \n ID: GB-GOV-10-GHRG_3_134531\nTitle: NIHR Global Health Research Group on Vaccines for vulnerable people in Africa (VAnguard)\nDescription: Vaccination is a central public health intervention: key to smallpox eradication, polio elimination, and control of Ebola outbreaks and the COVID-19 pandemic. But not everyone benefits equally. Some vaccines give weaker protection in people from rural, tropical settings than in those from high income settings: for example, BCG for tuberculosis and oral polio vaccine for polio. Some new vaccines also elicit weaker responses in people living in low-income, rural settings. The biological reasons for this are not fully understood. Also, some people benefit less from vaccines for socioeconomic reasons, such as the social context of the communities they live in, including limited access to accurate information to aid vaccine choices. Social and biological factors can interact to make communities “vulnerable” in terms of vaccine impact. For example, poor people in rural communities with limited vaccine access may also be undernourished or exposed to infections that alter immune responses to vaccination. This needs to be addressed to promote health equity, but also to secure maximum global benefit from vaccines: non-immune communities are foci for recurrent disease outbreaks.\nVAnguard brings together African and UK experts in vaccine research, implementation and stakeholder and community engagement, to work in Uganda and Kenya to\n1. Investigate how biological factors (such as infections, nutrition) influence vaccine responses\n2. Explore how communities perceive and access vaccines, what influences them to take up vaccines for themselves and their families, and how this relates to social vulnerability, biological health status and vaccine information\n3. Bring together biological and social data, and engage communities, to work out how vaccination can best be optimised for vulnerable communities, thereby also benefitting entire populations.\nFirst, we shall work with national stakeholders (such as Ministries of Health, and vaccine-related non-governmental organisations), review literature, and work on samples from previous studies, to identify Ugandan and Kenyan communities likely to have most difficulty in getting the best out of vaccination programmes (“vulnerable communities”). Then, with stakeholders and communities, we shall co-design the VAnguard Community Study, and implement it to investigate in detail which biological and social factors most influence vaccine impact in vulnerable communities.\nData and economic modellers will study the results to identify which factors could usefully be modified, and we shall work with the communities to explore ways in which this could be done. Hence we shall co-develop strategies which national stakeholders may be able to implement straight away, or which can be tested in future studies.\nThe work will be led by young African scientists, supported by local and international experts, to build capacity for African vaccine research. Biological, social, and implementation scientists and experts will work closely together to understand each other’s disciplines, establishing a culture of collaboration that will foster sustainable pathways to the desired impact: healthy communities.. VAnguard’s goal is to identify modifiable structural, social and biological determinants of impaired vaccine impact in vulnerable African communities, and hence to develop integrated strategies to address them and to drive health equity. VAnguard brings together East African leaders in vaccine research, implementation and community engagement, with UK experts in vaccine biology and the social anthropology of vaccine hesitancy. Our specific objectives are, in Uganda and Kenya, to\n\n1. Investigate biological drivers and mechanisms of population differences in vaccine response\n2. Understand how social and biological determinants of vaccine response interrelate to determine vaccine impact\n3. Identify and model integrated strategies to inform development of future interventions to optimise vaccine impact among vulnerable populations\n\nFirst, we shall work with national stakeholders (such as Ministries of Health, and vaccine-related non-governmental organisations), review literature, and work on samples from previous studies, to identify Ugandan and Kenyan communities likely to have most difficulty in getting the best out of vaccination programmes (“vulnerable communities”). Then, with stakeholders and communities co-design the VAnguard Community Study, and implement it to investigate in detail which biological and social factors most influence vaccine impact in vulnerable communities.\n\nBased at the UVRI, VAnguard will initiate a new multidisciplinary Group comprising the London School of Hygiene & Tropical Medicine (LSHTM), East African partners at the forefront of building vaccine research capacity in the region: UVRI and Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme. Additional contributions will be made by the Medical Research Council (MRC)/UVRI and LSHTM Uganda Research Unit (MUL), Makerere University, Uganda Christian University (UCU), the Ugandan and Kenyan Ministries of Health (MoH) and expert collaborators.\n \n ID: GB-GOV-10-GHRG_3_134544\nTitle: NIHR Global Health Research Group Improving Hypertension Control in Rural Sub-Saharan Africa (IHCoR-Africa)\nDescription: Many people live with high blood pressure in Sub-Saharan Africa (SSA), where the rate is amongst the highest in the world. In SSA, high blood pressure occurs at young ages, few people are treated, and high blood pressure causes severe complications and premature deaths. This is a serious health concern particularly in SSA where there is little knowledge of, or treatment for this condition. The causes of the high impact of high blood pressure in rural SSA are multiple including lack of clear symptoms; restricted access to healthcare; and competing demands on time which may prevent people from going to clinics and seeking care. One suggested approach to improve the management of people with high blood pressure in rural SSA is to use a community-centred approach, where care is more actively promoted and brought into the community to remove obstacles in accessing it.\n\nOur proposed NIHR Group will develop and assess a community-based approach to improve the identification and management of high blood pressure in rural SSA (in Kilifi, Kenya and Kiang West,\nthe Gambia).\n\nThe research will be divided into three linked work packages that match the specified objectives. We will adopt a multidisciplinary research approach including document reviews; in-depth interviews, focus groups with patients living with high blood pressure, healthcare workers and other key stakeholders; cross-sectional studies; a co-creation design to develop the intervention; and, a cluster feasibility trial to test it.\n\nThe work is being developed in partnership by the KEMRI-Wellcome Trust Research Programme in Kenya, MRC the Gambia and The London School of Hygiene & Tropical Medicine. Within the core research team, there is a strong expertise in high blood pressure research. There is support from other key stakeholders including existing local community health organisations and the Ministries of Health in Kenya and the Gambia. Community engagement and involvement are key to this work. Existing community health worker organisations and patients have been consulted in the development of this work and will contribute throughout the research as part of interviews, focus groups and the co-creation process.\n\nIn addition to the research, we will provide a training programme in hypertension research in SSA.\n\nDissemination: The research team involved in this work includes staff closely linked with the local community and community health workers, collaborators from non-governmental and governmental organisations who will ensure grassroots dissemination and sustained implementation of the findings beyond the research period. We will also pursue traditional dissemination routes including publishing results in academic journals and presenting the results at international conferences.. 1) To understand what is currently done (and what needs to be done) at all levels from patients to the whole healthcare system. To understand how the current healthcare system operates, and what changes need to be made, from patients upwards.\n2) To improve the way community workers can decide whom to treat for high blood pressure.\n3) To co-create, with patients and health workers, and test a new community-based programme for treating high blood pressure.\n \n ID: GB-GOV-10-GHRG_3_134629\nTitle: NIHR Global Health Research Group on Disrupting the cycle of GEndered violence & Poor Mental health among Migrants in precarious Situations (GEMMS)\nDescription: The mental health and psychosocial (MH) consequences of precarity experienced by migrants is widely acknowledged as a global health challenge. Migrants inhabiting and moving across ‘precarious situations’ are at high risk of Gendered Violence (GV), at both the interpersonal and structural level. Combined with the inability to report or access healthcare and other systems of protection, and invisibility in policy and planning results in excess burden and entrapment in a damaging cycle of GV\nand MH. In order to inform the design of appropriate interventions that address these burdens, it is necessary to improve our understanding of the relationship between drivers of risk among migrants in precarious situations. Responding to conceptual, empirical and intervention gaps affecting this global public health crisis, we build on existing interdisciplinary expertise and prior collaborations to establish a Global Health Research Group on GEndered violence & Poor Mental health among Migrants in\nprecarious Situations’ (GEMMS). GEMMS brings together clinical, psychosocial, sociological and public health expertise within the University of Essex with expertise from South Asia and Southern Africa to advance this agenda.\n\nAims:\nWorking in four precarious situations with diverse migrant groups in India, Myanmar, South Africa and Zimbabwe, we aim to create the necessary conceptual and methodological tools and actions that may create solutions to disrupt the damaging cycle of GV and poor MH and improve migrants' wellbeing. WP1: Situational Assessment And Data Appraisal – evaluate existing evidence and service gaps to inform the design of research and intervention tools and conceptual framework to advance other WPs.\nWP2: Lived Experiences – conduct research with migrants, health providers using mixed methods integrated with Participatory Action Research to generate new knowledge about:\n• burden and lived experiences of the intersecting risks of GV and poor MH\n• socio-economic determinants and contextual mechanisms\n• distribution and accessibility of resources that support resilience and well-being.\nWP3: Actions & Interventions - Drawing on WP1 &2, develop a participatory approach to co-design actions and a training and support intervention for healthcare workers and service providers\n \n ID: GB-GOV-10-GHRG_3_134638\nTitle: NIHR Global Health Research Group on sustainable care for anxiety and depression in Indonesia\nDescription: Depression and anxiety are common mental health problems, affecting large numbers of people around the world. Depression and anxiety affect 14 million people in Indonesia, and this country has one of the highest rates of depression in the South-East Asia region. Depression and anxiety can affect how people feel and how communities function. These disorders can worsen physical health conditions and significantly increase healthcare costs. This can challenge sustainable development in low-middle income countries. \nDepression and anxiety are treatable but there is a shortage of trained professionals. Many people in Indonesia, and across the world, are not getting the help they need. Talking treatments can help people with depression and anxiety to recover. These treatments can be delivered by people without a mental health qualification and are recommended by the World Health Organization's for areas where mental health services are limited. Training lay workers to deliver talking treatments is cheaper and more feasible than training a smaller number of highly skilled professionals. It can reduce the stigma of mental health treatment and make treatment more accessible. Similar approaches have been tested in other countries, but the best way to organise and support these services is unknown. This means that we do not know how best to deliver these interventions in Indonesia, how acceptable they will be or what benefits they will have. \n\nOur group will use information from existing national surveys in Indonesia to identify where rates of depression and anxiety are highest and where talking treatments are needed the most. We will find out which groups of people have the greatest difficulties accessing talking treatments and explore what effects this has. We will work directly with patients and professionals to understand their experiences of, and preferences for, receiving and delivering treatments and the types of challenges they face. \nOnce we understand the problem, we will work with patients, lay workers, professionals and policy makers to culturally adapt talking treatments, produce locally relevant delivery plans and provide workforce training. We will explore the impact of our intervention on individuals, communities and health service use. We will talk to patients and professionals about their experiences of our intervention and identify any other needs. \nWe will measure the cost of delivering our intervention and identify the geographical areas and patient groups that should be prioritised for treatment roll out. We will compare and contrast findings from different regions within Indonesia to help us understand how best to support treatment availability and uptake in the longer term and deliver new learning to help us enhance the delivery of talking treatments in other global settings. \nWe will hold collaborative, faceto-face engagement events to engage individuals, families and communities in our programme and deliver applied health services research training programs to Indonesian health researchers and public representatives to enable further high quality work. We will work with government, academic and public representatives to tell patients, professionals and policy makers what we find.\n\nWhere is it being done? Java, Indonesia (South-East Asia)\n\nWhen is it being done? August 2022-July 2026\n\nWho is doing it? \nOur research team represents an international partnership between mental health professionals and health researchers at the Universities of Manchester and Manchester Metropolitan University, UK and The University of Indonesia, The Indonesian Research and Innovation Agency within the Ministry of Health and non-governmental organisations in Indonesia.. 1. Explore nationally representative and publicly available datasets to assess the distribution, determinants and socio-economic consequences of depression and anxiety for adults in Indonesia, providing a robust evidence base for the development and evaluation of primary care and community mental health services in this country.\n2. Understand, through interviews with health professionals and decision makers, the different contexts in which psychological interventions may be used in Indonesia, and culturally-adapt a low intensity psychological intervention (Guided Self-Help) to treat depression and anxiety in Indonesian adults.\n3. Work with local community and clinical partners to develop local strategies for intervention implementation, including culturally sensitive workforce training programmes. \n4. Deliver and evaluate, through a mixed method research, the costs, reach and health impacts of our low-intensity psychological intervention. \n5. Combine and disseminate our findings to inform policy and support sustainable service scale-up.\n6. Work in partnership with national and local governmental, non-governmental and public stakeholders to engage communities, promote mental health advocacy and stimulate demand for effective, efficient mental healthcare. \n7. Build equitable research partnerships and strengthen research capacity, research management and public and community involvement in mental health research in Indonesia.\n \n ID: GB-GOV-10-GHRG_3_134663\nTitle: NIHR Global Health Research Group on Community Food, Nutrition and Planetary Health in Island States\nDescription: In small island countries of the Caribbean, South East Asia and the Pacific, around two thirds of the food consumed is imported. Most of the imported food is of low nutritional value. At the same time, local food production has been steadily declining, made worse by increasingly frequent extreme weather events associated with climate change. All of these countries have high burdens of nutrition related ill-health, including non-communicable diseases associated with overweight and obesity and deficiencies of some micronutrients, especially iron.\n\nWe are public health, agricultural and social scientists and civil society stakeholders who aim to improve the nutrition, health, social and economic well-being of populations in low- and middle- income small island countries by applying approaches that develop healthy, resilient and environmentally sustainable community-based food production. We come from the Universities of the West Indies, South Pacific, Western Philippines, Exeter (UK), Cambridge (UK), McGill (Canada), and the Danish Technical University. We include scientists from the James Hutton Institute (UK) and community engagement and development specialists from the Foundation for Rural Integrated Enterprises and Development (FRIEND) in Fiji.\n\nWe will work in island countries and settings in the Caribbean, Pacific and Philippines to provide evidence on how to improve human and ecosystem health for better nutrition. The work will be guided by the UN Food and Agriculture Organization’s 10 elements of agroecology. We will work with local communities to assess their needs and develop ‘living labs’ to work together to increase local food production and improve household nutrition. The project will inform national and regional policy goals of developing sustainable and healthy food systems. The project is organised into four work packages (WP), which are summarised below.. 1. To critically appraise and synthesize published evidence on diet, nutrition, their health impacts, and on community-based food production in small island countries, with a specific focus on the project islands in the Caribbean, Pacific and Philippines.\n2.Guided by the findings from objective 1 and in consultation with local communities and stakeholders, to select geographically and ecologically defined settings within each project island, and as needed undertake new data collection on:\n3.To create ‘communities of practice’ and ‘living labs’ for the design of interventions in the project settings. These will bring together community food producers, other stakeholders across the food value chain, consumers, policy makers and researchers in order to:\n4.To undertake qualitative (non-mathematical) and quantitative (mathematical) modelling to assess, compared to business as usual, the potential human and ecosystem health impacts if the interventions designed as part of objective 3 are more widely adopted: \nThe objectives related to the continuation of the programme are: \n5.To develop a web-based resource and repository of materials, case studies and guidance to support dissemination and further applied research to support the further development of sustainable community-based food production and human nutrition.\n6.To build the breadth and depth of research capacity across and within the project settings to maintain and further develop this programme of work\n \n ID: GB-GOV-10-GHRG_3_134694\nTitle: NIHR Global Health Research Group on Digital Diagnostics for African Health Systems\nDescription: We are developing new “digital” diagnostic tests for infectious diseases. Our approach uses a handheld electronic device where the test is performed on a microchip. The tests have similar accuracy to large laboratory machines, but are rapid, low cost, and portable. The test results are immediately linked to a smartphone which enables data transmission, so that we can monitor the detection of different diseases in different locations. \nThis project is being undertaken by more than 40 researchers from African institutions, the UK, and the Netherlands. The researchers have a wide range of expertise, from electronic and design engineering, through to clinical medicine and health systems research. We will recruit 10 African PhD students to receive training and undertake research on digital diagnostics. Projects will be based in Burkina Faso, The Gambia, Ghana, Kenya, Sudan, and Zambia, with some technology development in the UK. \nThe project will run between 1st August 2022 and 31st July 2026.\nThe project addresses the unmet need for access to accurate diagnostics in low and middle income countries. At present, less than half of the population of Africa have access to essential diagnostics. Without accurate diagnostics, the correct treatments cannot be given, and public health interventions cannot be targeted to where they are most needed. We will evaluate the potential of digital diagnostic technology to tackle common problems including malaria and other childhood infections. . Our overall aim is to generate evidence to support the development and implementation of new “digital diagnostic” tests to tackle infectious diseases in Africa. The digital diagnostics are hand-held analysers, using a microchip to detect different organisms causing infection, connected to a smart phone to provide instantaneous data transfer for disease surveillance. The specific objectives underpinning the project are:\n1. Evaluate the perceptions of users and stakeholders about the new diagnostic technology, including community members, patients, clinical staff, healthcare managers, and policy makers in different African countries\n2. Evaluate the usability and diagnostic performance of digital diagnostic tests for the detection of malaria parasites, and detection of mutations in the parasites which make them resistant to current treatments \n3. Evaluate the usability and diagnostic performance of digital diagnostic tests to determine the cause of illness in unwell children with suspected infection\n4. Evaluate the usability and diagnostic performance of digital diagnostic tests to detect contamination of water or food with organisms which can cause illness in humans \n5. Develop a user-friendly interface for the digital diagnostic tests by working with the people who would use the new diagnostic tests\n6. Understand the conditions necessary for these new diagnostic tests to bring greatest impact to healthcare systems, at local, national, and international levels\n7. Train a network of researchers, including a cohort of 10 African PhD Fellows, to be future leaders in the development, evaluation, and implementation of digital diagnostic technology \n \n ID: GB-GOV-10-GHRG_3_134717\nTitle: NIHR Global Health Research Group on Establishing Regional Hubs for Genomic Surveillance in West Africa, at the Wellcome Sanger Institute\nDescription: National malaria control programmes (NMCPs) need effective tools to monitor resistance to control measures and to provide early warning that their interventions are causing resistance to rise to unacceptable levels so they can change strategy. Advances in genome surveillance revolutionised the UK response to the COVID pandemic and demonstrated the power of this tool across the world. Proof-of-concept work being carried out as part of this programme of research at the University of Ghana (UG) and the MRC Unit in The Gambia at the London School of Hygiene and Tropical Medicine (MRCG) of malaria genetic surveillance in West Africa has included engagement with NMCPs.\n\nKnowledge of genetics, genetic markers and genetic epidemiology is outside the domain of expertise of most NMCPs. Therefore, subject matter experts need to work with NMCPs to bridge the gap and support implementation. Discrete but connected hubs can support NMCP managed activities in different countries and integrate data generated into regional analyses. Hub leaders also serve as advocates to connect these data to a global data sharing network by forging strong relationships in both directions and acting as stakeholder representatives.\n\nBringing malaria genetic surveillance data across the world benefits public health. If a new form of parasite drug resistance or mosquito insecticide resistance emerges elsewhere in the world, it will greatly help an NMCP to monitor and manage the problem if the global genomic data for malaria surveillance is continually updated to incorporate the most useful genetic markers, which are likely to have been discovered elsewhere. However, those new to sharing data openly benefit from working closely with subject matter experts who are knowledgeable and sensitive to cultural, operational and technical challenges in achieving this. \n\nRapid advances building on malaria genomic surveillance in West Africa have the potential to catalyse relationships and advancement in malaria. For example, building on capacity for malaria genetic surveillance, scientists at the University of Ghana utilised capacity built for malaria surveillance to develop sequencing tools to analyse the SARS-CoV-2 virus from confirmed cases in Ghana. Combined with local leadership, genomic surveillance tools can be applied to pathogens and viruses for both endemic and pandemic infectious disease. \n\nFollowing the implementation of genomic surveillance of malaria using Amplicon sequencing, the teams at UG and MRCG will strengthen their own discrete but complementary regional networks. The Wellcome Sanger Institute will support UG and MRCG in building capacity for managing multi-partner collaborations and scaling up sequencing operations. Hub leaders will work with their collaborators to provide training from sample collection through to the translation of genomic data into actionable knowledge. By the end of this project, we aim to be integrating these systems into the routine working practices of NMCPs in countries that are part of the regional networks of Ghana and The Gambia, and to provide a working example of how such systems could be deployed at other locations in Africa.. 1. Implement amplicon sequencing tools to address specific use cases in malaria control.\n2. Enable the regional sequencing hubs to achieve reliable production of genomic surveillance data.\n3. Establish a sampling framework for genomic surveillance of parasites and vectors in selected locations.\n4. Start to integrate genomic surveillance into national and regional malaria control initiatives.\n \n ID: GB-GOV-10-GHRG_3_134781\nTitle: NIHR Global Health Research Group Safe Motherhood Research Programme\nDescription: Most maternal deaths occur in Sub-Saharan Africa. Nearly all are preventable with good quality maternal healthcare. Both Malawi and Zambia are committed to improving maternal\nand neonatal health outcomes but are not making fast enough progress. The aim of the NIHR Safe Motherhood Research Programme is to improve maternity outcomes in Malawi\nand Zambia by improving the quality of care. The senior leadership of the research team are all based in Malawi and Zambia, hosted by the Malawi-Liverpool-Wellcome Research\nProgramme in Blantyre, Malawi.\n\nThe four-year (August 2022 – July 2026) programme of work described here builds upon previous work of the NIHR DIPLOMATIC research group in Zambia and Malawi. We will\nleverage the team research strengths and network, and initiate new work to ensure meaningful impact on maternal and neonatal health outcomes. The NIHR Safe Motherhood\ngroup’s aim will be delivered through 4 themes, which operate alongside the cross-cutting domains of capacity building in institutions in both countries, communicating widely across professional and public settings for impact, and community engagement and involvement. We will ensure the research is centred on the needs of users and their families, and focusseson sustainable improvements that can be implemented within resource constrained health systems.. 1. Data driven improvement – we will report key maternal and neonatal health data to improve the quality of pregnancy care in Zambia and Malawi\n2. Placing users at the centre of change – we will use qualitative methods to understand the experience of vulnerable service users, in particular adolescents and women with mental health problems\n3. Prioritisation and co-design – we will engage stakeholders in prioritisation and train health professionals in methods for co-designing interventions\n4. Implementing and evaluating change – we will implement the behaviour change interventions co-designed with stakeholders in Zambia and Malawi, starting with management of sexually transmitted infections during pregnancy\n5. Capacity building and communicating for impact – all programme activities aim to improve the knowledge and skills of health professionals in Zambia and Malawi, including effective communication of findings for policy impact\n", "_version_":1863490241046773760 }] } }