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      "related_activity_context":"ID: GB-GOV-10-RP_07\nTitle: National Institute for Health and Care Research (NIHR)’s seventh Global Research Professorship call\nDescription: National Institute for Health and Care Research (NIHR)’s seventh Global Research Professorship call. The Global Research Professorships programme funds research leaders, with a track-record of applied health research in low- and middle-income countries (LMICs), to promote effective translation of research and to strengthen research leadership at the highest academic levels. Funding of up to £2m over up to 5 years is awarded to Professors working in close partnership with a research institution in an LMIC.. By the end of the award, NIHR Global Research Professors will be expected to: \n\n1) Have demonstrated research leadership at a national and/or international level.\n2) Have been developed and protected by their institutions, including being relieved of administrative tasks.\n3) Enhance existing and establish new research collaborations in low- and middle-income countries (LMICs).\n4) Have supported training and capacity strengthening/mentorship within LMIC and UK (if applicable) institutions that enhances research capacity for future global health and care research.\n \n ID: GB-GOV-10-RP_07_304257\nTitle: NIHR GHRP: Testing on the frontline: empowering health engagement through ‘rational use’ of diagnostics for infectious and non-communicable disease\nDescription: The NIHR Global Health Research Professorship (GRP) scheme is open to all professions and all Higher Education Institutions (HEI), based in UK and low- and middle-income countries (LMICs), to nominate health researchers and methodologists with an outstanding research record of clinical and applied health research and its effective translation for improved health. Global Research Professors are required to have existing strong collaborations or links with collaborators or partners in institutions in countries on the OECD DAC list and the award should plan to strengthen these/support training and capacity development/mentorship in these partners.\n\nImproving access to diagnosis has the potential to improve lives, particularly in settings where people are exposed to multiple chronic conditions and outbreaks of disease with high numbers of deaths and where health systems are under-resourced and over-burdened. Self-testing was effective in contributing to disease control during the COVID-19 pandemic and there have been global calls for action to improve access to diagnostics. Opportunities for self-care have increased with advances in technology and the private direct to consumer self-testing market is predicted to expand to 13.6 billion USD by 2033. This has potential to lead to unregulated and uncontrolled access through both public and private sources. However, self-testing can lead to equitable transformations in disease management and outcomes if used appropriately, presuming it is aligned to the wider social context and that it reaches marginalised and vulnerable populations who are appropriately informed. Self-testing has the potential to contribute to self-management of chronic conditions such as Human Immunodeficiency Virus (HIV) and non-communicable diseases such as diabetes and has been shown to aid in responsiveness to emergency disease outbreaks such as Ebola. Self-testing is an important element in country-level strategies to increase access to diagnostics but there remains a gap in evidence on how to do this. This project will contribute evidence from user perspectives to address this gap.\n\nI will focus on three examples of self-testing and self monitoring for infectious and non-communicable disease under different social conditions across two countries: Malawi and Uganda. I will establish a team of qualitative researchers across Malawi, Uganda and the UK in collaboration with two in-country institutions: Malawi-Liverpool-Wellcome Trust (Malawi) and the University of Makerere (Uganda). We will use in-depth qualitative methods (social mapping, ethnography, interviews and group discussions) and work directly with communities of users to understand the drivers of use of self-testing and self-monitoring under external conditions of stigma, emergency disease outbreaks and lifestyle and risk management. We will work together to explore how use of self-testing and self monitoring for HIV, diabetes and Ebola impacts on people’s lives and how they engage with care and treatment. We will develop community approaches that can be adopted to communicate appropriate use aligned to the needs of target populations and establish a pathway to advocate for user perspectives as countries develop national strategies for diagnostics. We will work to inform international guidance aimed at inclusive and equitable access to diagnostics that reflects actual use.. The project aims to focus on understanding the potential and actual, intended and unintended harms and benefits and ‘rational use’ of self-testing for Human Immunodeficiency Virus (HIV), Ebola and Type 1 and Type 2 diabetes. I will situate this through the lived experiences of individuals, families, communities and frontline health workers and the impact on management of health and well-being at home and through interactions with the primary health system. The aims of this work are to: \n\n1. Define and document social and structural drivers of ‘rational use’ under conditions of stigma, emergency disease outbreaks and lifestyle and risk management. unpack the dynamic between empowerment through self-testing and engagement with public and private health services. \n2. Explore uncertainty, trust and risk influencing decisions, embedded within complex socio ecological environments and impact on intended and unintended, beneficial and potentially harmful health and social consequences. \n3. Co-produce toolkits for ‘rational use’ of frontline diagnostics. \n4. Promote health equity across mainstream and marginalised groups through ‘rational use’ of self-testing and monitoring that reflects direct to consumer markets. \n \n ID: GB-GOV-10-RP_07_304266\nTitle: NIHR GHRP: MILK-Centre: Maternal and Infant Lactation Pharmacokinetics: Centre of Excellence for Lactation Therapeutics Research and Engagement\nDescription: The NIHR Global Health Research Professorship (GRP) scheme is open to all professions and all Higher Education Institutions (HEI), based in UK and low- and middle-income countries (LMICs), to nominate health researchers and methodologists with an outstanding research record of clinical and applied health research and its effective translation for improved health. Global Research Professors are required to have existing strong collaborations or links with collaborators or partners in institutions in countries on the OECD DAC list and the award should plan to strengthen these/support training and capacity development/mentorship in these partners.\n\nExclusive breastfeeding is recommended by the World Health Organisation (WHO) for the first six months of life, because of benefits to the mother and child. However, globally around half of all women require treatment with some form of medication during breastfeeding. For all mothers, their first concern will be about potential consequences to the infant. A woman may stop breastfeeding before she wishes, or not take medication because of these concerns. This risks harm to both the mother and child. For decades, there has been recognition that everybody deserves access to the information they need to make an informed choice about their healthcare. But frequently, when a breastfeeding mother requires treatment with a medicine, that evidence simply does not exist. Studying drug safety and effectiveness in breastfeeding, so-called ‘lactation pharmacology’, is complicated. It requires breastfeeding mothers to trust the research team, and for the research team to have the skills and equipment to perform research that keeps the number of participants and biological sampling points to a minimum whilst maximising the information gained. Once the research is complete, the research team must also engage with policy makers to make sure that the results change healthcare practice.\n\nWe aim to meet the critical need for better understanding of which drugs are safe for mother and infant during breastfeeding by establishing a centre of excellence for lactation pharmacology at the Infectious Diseases Institute in Uganda. \n\nThis work builds on community priorities established in Uganda. Peer mothers and a public engagement officer will ensure community participation in research, including Citizens Juries, using street theatre to create messages and other approaches established during my previous work. Strategic partnership with the Oxford Centre for Research Equity will enable knowledge exchange, mentorship and training in equity in engagement. \n\nThrough strategic partnership with the WHO and the South African Healthcare Products Regulatory Agency, my group will ensure rapid sharing of findings at policy level. We will also share results through presentations and publications, community-facing events, social media channels, stakeholder newsletters and posting on the webpages of the Uganda Chapter of Pharmacometrics Africa. . This project will create a special research centre in Uganda focused on understanding which medications are safe for mothers and babies during breastfeeding. There are 5 key objectives: \n\n1.\tTo work with communities and decision-makers to understand which drugs we should study first.\n2.\tDevelop ethical and safe ways to include breastfeeding mothers in our studies, especially those who might be in more vulnerable situations, such as young mothers (14-17), those with mental health challenges, or mothers breastfeeding during an infectious disease outbreak.\n3.\tMeasure the transfer of specific medications, like antidepressants and antibiotics, into breast milk and, consequently, to the infant.\n4.\tCreate computer models that predict how likely certain drugs transfer into breast milk.\n5.\tBe prepared to quickly study the safety and breast milk transfer of new drugs during a virus outbreak.\n \n ID: GB-GOV-10-RP_07_304286\nTitle: NIHR GHRP: Angioedema in Africa study\nDescription: The NIHR Global Health Research Professorship (GHRP) scheme is open to all professions and all Higher Education Institutions (HEI), based in UK and low- and-middle-income-countries (LMICs), to nominate health researchers and methodologists with an outstanding research record of clinical and applied health research and its effective translation for improved health. Global Health Research Professors are required to have existing strong collaborations or links with collaborators or partners in institutions in countries on the OECD DAC list and the award should plan to strengthen these/support training and capacity development/mentorship in these partners.\n\nThe main goal of this research is to understand, prevent and manage angioedema more effectively in sub-Saharan Africa (SSA). Angioedema is sudden swelling, often around the face and throat, which can be life-threatening if not treated quickly and correctly.\n\nIn many African countries, while everyone is aware of diseases like HIV and malaria, not many know about angioedema. This condition, although less common, is becoming more frequent. Angioedemas have different causes with specific treatments, and most doctors are not equipped to diagnose and manage angioedemas. Angiotensin-converting enzyme inhibitors (ACEI) used to treat blood pressure are the commonest cause, and this side effect may be more common in African populations.\n\nThere are no tools to predict or diagnosis ACEI-angioedema. Hereditary angioedemas, requiring targeted treatments, are under-diagnosed in SSA. The role of food-additives in damaging the gut barrier and causing angioedemas in an African context is unknown. This research aims to address these important gaps.\n\nOur research design and method is divided into three parts:\n\n1. Developing a simple test for ACEI-angioedema - We are working on a test that could be used in clinics to identify people at risk of getting angioedema from their blood pressure medication. This test looks for specific proteins in urine samples. In this project we will validate the accuracy of these urinary proteins in diverse groups across SSA. We will also develop a prototype, low-cost lateral flow test that could be scaled for use in resource poor settings.\n2. Improving how angioedema is managed and finding hereditary angioedema cases - Through engagement with healthcare workers, patients and communities we will form a strategy of targeted healthcare worker trainings, telemedicine allergy-specialist support and community-level advocacy with awareness campaigns that improve the management of acute angioedemas and diagnose new hereditary angioedema families across underserved SSA.\n3. Studying the role of food additives in damaging the gut barrier and causing recurrent angioedema - Food additives may make angioedema worse by damaging the gut barrier. We will conduct a detailed study of patients with recurrent angioedema to understand the contributions of food additives and gut infections in causing angioedema. Patient engagement work will examine knowledge and barriers to low food-additive diets, and using this we will design a randomised controlled trial to see if a low-food-additive diet can heal the gut barrier and resolve angioedema.\n\nThis research is important because angioedema can be life-threatening if not treated correctly, and currently ACEI-angioedema is the key safety issue that limits use of this life-saving medication across diverse African countries. We can save lives and valuable resources by improving angioedema diagnosis and management, and developing a low-cost predictive tool for ACEI-angieodema. Understanding food additives in gut barrier damage and angioedema, and the healing benefits of low additive diets would mean affordable, effective treatment, and data for advocacy around improve food additives regulations in SSA. This research has the potential to change lives, not just in Africa but in other parts of the world too.\n. The overall focus of this research professorship is angioedemas in Africa. This project has 3 distinct, but interconnected objectives:\n\n1. Develop an early prototype low-cost lateral flow urine test to identify patients at high-risk for Angiotensin-Converting Enzyme Inhibitors - AngioEdema (ACEI-AE). \n2. Enhance the management of angioedema in sub-Saharan Africa (SSA), and diagnoses of hereditary angioedemas through a comprehensive, integrated approach combining community engagement, healthcare provider education, telemedicine-specialist support, and strategic partnerships with local and international organisations. \n3. Determine the role and synergy between food additives, chronic gastrointestinal tract infections and altered gastrointestinal permeability in recurrent angioedemas and the impact and barriers to low-food-additive diets. \n \n ID: GB-GOV-10-RP_07_304295\nTitle: NIHR GHRP: Enhanced Virus Surveillance and Intervention Strategies for Health Preparedness in Uganda\nDescription: The NIHR Global Health Research Professorship (GHRP) scheme is open to all professions and all Higher Education Institutions (HEI), based in UK and low-and-middle-income-countries (LMICs), to nominate health researchers and methodologists with an outstanding research record of clinical and applied health research and its effective translation for improved health. Global Research Professors are required to have existing strong collaborations or links with collaborators or partners in institutions in countries on the OECD DAC list and the award should plan to strengthen these/support training and capacity development/mentorship in these partners.\n\nEast Africa, known for its many different types of plants and animals (biodiversity), is a key place for studying viruses that can pass from animals to humans (zoonoses). Uganda is a leader in finding new viruses but has been hit hard by diseases that come from animals, including more than 50 serious outbreaks in the last ten years of some of the most dangerous viruses, including Ebola virus, Sudan virus, Marburg virus, Rift Valley fever, yellow fever, and Crimean-Congo hemorrhagic fever. Other viruses spread by insects, like Zika, Semliki Forest virus, chikungunya, O'Nyong Nyong, and West Nile virus, are also common in this area. Many of these viruses were discovered in East Africa (at the Uganda Virus Research Institute) for the first time.\n\nEven with these issues, Uganda has shown it can handle serious health problems, perhaps best illustrated by how it dealt with HIV (human immunodeficiency virus) after its emergence in the 1980s. Today, there are challenges with other viral diseases. The risk of spread of such infections is higher in the context of our heating planet and the climate emergency.\n\nDiagnosing viruses is limited at the moment because the tests we have are not always available, accurate, or specific, leading to wrong diagnoses and the unchecked spread of viruses. New more advanced DNA sequencing methods offer a modern solution to this problem.\n\nIn sub-Saharan Africa, people often come to the doctor with fever, usually thought to be malaria. However, in the majority of cases, such fevers are actually caused by viruses, something that's often missed because of outdated testing methods. These viruses may be very dangerous, for example in the case of Ebola virus which has previously been detected many times in Uganda. This issue not only makes it hard to treat people properly and creates a public health risk but also hurts the local economy.\n\nThere's a real need for better, more unbiased ways to diagnose these diseases. This research project is about using new DNA sequencing methods to better detect and manage viral infections in Uganda. These methods, which look for virus DNA (or RNA) or how the body reacts to viruses, could change how we understand and respond to virus outbreaks, making the world safer.\n\nThe goal of this research is to use these new tests in important global locations, starting with Uganda, to have \"eyes-on\" viruses emerging in the human population. The research will check if these Next-Generation Sequencing (NGS) tests (Metagenomic-NGS, Target-Enrichment NGS and PhipSeq NGS) are better than current tests, if they can be used to detect more cases of disease, if they can be used to find out what risks certain healthcare workers and farmers in Uganda face, and if they can find viruses in sewage in transport hubs, schools and hospitals.\n\nThe project has several goals: to see how effective the new DNA tests are compared to current tests, to use these tests to find infections in important health sites, to use such testing to find risk factors in people carrying out certain high-risk jobs, and to start using these tests to check sewage in Uganda. This thorough approach aims to find viruses in the community, improving our ability to deal with virus outbreaks and keep the world healthy.\n. Diagnosing viruses is limited at the moment because the tests we have are not always available, accurate, or specific, leading to wrong diagnoses and the unchecked spread of viruses. New more advanced DNA sequencing methods offer a modern solution to this problem. \n\nThis project has 4 objectives:\n\n1. To check if Next Generation Sequencing (NGS) tests are more sensitive and specific than current tests. Specifically, we will compare Metagenomic-NGS (M-NGS) and Target-Enrichment NGS (TE-NGS) to standard tests.\n2. To use M-NGS and TE-NGS to find infections in clinics to see if they improve virus detection for community tracking.\n3. To use NGS blood tests to find risk factors in certain jobs. Specifically, we'll see if Phage immunoprecipitation sequencing (PhipSeq) can identify risks in these groups.\n4. To use M-NGS and TE-NGS to monitor wastewater in Uganda to see if they can systematically identify viruses in the community.\n\n \n ID: GB-GOV-10-RP_07_304306\nTitle: NIHR GHRP: Disentangling the intersections between epilepsy, stroke & dementia in older Zimbabwean populations\nDescription: The NIHR Global Health Research Professorship (GHRP) scheme is open to all professions and all Higher Education Institutions (HEI), based in UK and low- and middle-income countries (LMICs), to nominate health researchers and methodologists with an outstanding research record of clinical and applied health research and its effective translation for improved health. Global Research Professors are required to have existing strong collaborations or links with collaborators or partners in institutions in countries on the OECD DAC list and the award should plan to strengthen these/support training and capacity development/mentorship in these partners.\n\nWith advances in healthcare, more of us are living longer. It is also essential that we live well. Disorders of the mind and brain become much more common as we get older. Increased rates of memory difficulties, strokes and seizures are all seen after the age of 50 years. We know that stroke is the most common cause for seizures in older people and that people who are initially from Africa have a higher risk of stroke. But this information is from studies done in America or Europe, and therefore we must study mindbrain health within Africa itself. \n\nIn this project, I will investigate how memory problems, stroke and seizures may be connected in African populations. I will base my work in Zimbabwe, where there has been a sharp rise in the number of older people. In Zimbabwe, the rates of HIV have been very high and HIV-associated complications are now being seen in later life. The infrastructure to cope with this immense need in older people is, however, extremely limited. \n\nI will work closely with my colleagues in Zimbabwe, whom I have known for over seven years. Together, we have delivered a lot of research into epilepsy. In this project, I will take advantage of seizures being a gateway into many neurological disorders to improve our broader understanding of mind-brain health. In Africa, seizures and epilepsy (which is when seizures can happen more than once) are deeply stigmatised, especially among older people. This research will work to understand why. . This project has 6 key objectives: \n\n1.\tAccelerate knowledge about brain disorders at all levels, from community through to Ministers of Health. We will start by holding community-led workshops and focus groups. We will take oral histories from a large number of older people with lived experience of epilepsy, stroke and dementia. These three conditions inter-connect very closely together, especially in older populations. We will speak with affected individuals, their principal carers and family members.\n\n2.\tDestigmatise brain health disorders: we will explore the stigma that can surround brain disorders, including impacts on relationships, employment, personal well-being and mental health.\n\n3.\tBetter diagnose brain health disorders: we will work with older Zimbabweans to create solutions to these difficulties and engage interested individuals to shape the rest of the project.\n\n4.\tRefine technologies to enable longitudinal deep phenotyping of people with later onset epilepsy and stroke. We will recruit and monitor a large group of Zimbabweans who have had a stroke to work out what makes a seizure more likely in this population. We will track people with epilepsy that starts after the age of 50 years to identify what happens to their memory and find out if they may be at increased risk of stroke.  We will improve the technologies that we have developed to help people with epilepsy in Africa. We will test markers that may stratify people according to their risk of brain health difficulties.\n\n5.\tDevelop tailored guidelines around scalable interventions that align with the World Health Organisation Intersectoral Global Action Plan (WHO IGAP). Once we have better understood the risk factors contributing to brain disorders in older Zimbabweans, we will test whether specific treatments can reduce these risks and improve health outcomes. We will work with the WHO and local Ministers of Health to improve healthcare systems.\n\n6.\tCreate a Zimbabwean Centre of brain health.\n \n ID: GB-GOV-10-RP_07_304311\nTitle: NIHR GHRP: Transforming diagnosis of tuberculosis through adaptive artificial intelligence imaging\nDescription: The NIHR Global Health Research Professorship (GHRP) scheme is open to all professions and all Higher Education Institutions (HEI), based in UK and low- and-middle-income-countries (LMICs), to nominate health researchers and methodologists with an outstanding research record of clinical and applied health research and its effective translation for improved health. Global Health Research Professors are required to have existing strong collaborations or links with collaborators or partners in institutions in countries on the OECD DAC list and the award should plan to strengthen these/support training and capacity development/mentorship in these partners.\n\nTuberculosis (TB) is now the leading infectious killer globally, with unacceptably slow progress being made towards elimination targets. Southern Africa has been the centre of the global TB pandemic for the last 30 years, driven by generalised HIV (human immunodeficiency virus) epidemics. In 2022, more than one third of people with TB were not diagnosed or treated, resulting in sustained ongoing transmission, and a high risk of severe illness and death.\n\nA major barrier to efforts to control TB is the suboptimal diagnostic tests available. The most-commonly used test is sputum examination by microscopy, culture, or molecular testing. But many people with TB are not able to produce sputum because of severe illness or weakness. Also, the importance of subclinical TB (where sputum tests are positive, but the patient has no symptoms) has recently been recognised. People with subclinical TB have lung changes on chest X-ray, meaning it is possible to detect disease earlier; however, doctors able to interpret chest X-rays for TB are very limited in most high TB-burden countries.\n\nRecently we have shown in a randomised trial in Malawi that highly-accurate computer-aided detection of TB by portable and affordable digital chest X-ray using artificial intelligence software (DCXR-CAD) can increase the number of people diagnosed with TB and speed up diagnosis from a median of 11 days to 1 day. DCXR-CAD uses deep-learning algorithms trained on hundreds-of-thousands of X-rays to identify abnormality patterns consistent with TB. A positive DCXR-CAD needs to be confirmed with a sputum test before treatment is started, with sputum testing being by far the largest cost component of this approach.\n\nHowever, we have recently shown that setting a single DCXR-CAD abnormality threshold for all patients is likely to be highly inefficient, resulting in considerable over-referral for sputum testing. This is because individual patient characteristics – including older age, severity of symptoms, HIV status, and history of previous TB – are strongly associated with the presence of TB. I hypothesise that by setting “adaptive thresholds” accounting for these characteristics, we could dramatically reduce the number of confirmatory sputum tests that are required to diagnose TB, without impacting detection or accuracy. If correct, this would have massive implications for cost-saving for public health programmes in the Global South now rolling-out DCXR-CAD.\n\nThrough knowledge exchange with a high TB/HIV prevalence country in southern Africa (Malawi), we will firstly undertake an individual participant meta-analysis and epidemiological modelling of existing datasets identified through systematic review to identify optimal adaptive thresholds based on patient characteristics, and their potential impact and cost-benefit on TB diagnosis. Subsequently, we will undertake a trial, randomising adults to receive sputum TB testing based on either the fixed DCXRCAD threshold, or the adaptive threshold, with the main outcome being the number of sputum tests required to confirm one TB case. We will embed community needs and voices throughout the project, and work with national, regional, and global policymakers and DCXR-CAD software developers to direct policy and guidelines to include adaptive chest X-ray screening for TB.\n. The key objectives in this project are to:\n1. Use past research and data to figure out the costs and health benefits of a new adaptive Digital Chest X-ray with Computer-Aided Detection (DCXR-CAD) algorithms and follow-up sputum tests. This will help us find the best ways to screen for Tuberculosis (TB) in high burden countries. \n2. Test how well this new artificial intellegence-powered X-ray and follow-up testing works in real life in Malawi, looking at how accurate, fast, and affordable it is. We'll do this with adults who have TB symptoms at local primary care clinics in a randomised controlled trial. \n3. Work with affected communities, national, regional, and global policymakers and software developers to direct policy and guidelines to include adaptive artificial intellegence chest X-ray screening for TB (Policy and knowledge translation).\n\n",
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