Talk of trials, TB and surviving your PhD

Titus Divala from Malawi describes his research and shares his advice for a successful first year of PhD study

I am a medical doctor by training, having graduated from medical school in Malawi in 2009. For the past eight years, I have been in clinical practice, six of those working in clinical trials. I have a Master’s in Public Health from the University of Malawi and a Master’s in Epidemiology and Preventative Medicine from the University of Maryland.

The goal of my doctoral training at LSHTM is to strengthen my clinical trials expertise so I can become a fully independent investigator, conducting clinical trials and looking for new interventions for infectious diseases. We have a high burden of infectious diseases in Malawi, the key ones being tuberculosis (TB), malaria and HIV. I registered for my PhD in September 2017 in the Department of Infectious Disease Epidemiology. I am using systematic reviews and a randomised controlled trial (RCT) to establish whether the current practice of using antibiotic treatments as part of the diagnostic algorithms for TB has more benefits than harms. I consider my PhD as one of the global efforts towards averting the impact of TB and antimicrobial resistance (AMR), two major problems of this century.

Titus’s Top 5 Tips:

• Plan well – the goal for your first year should be to have a well-formed plan for your PhD
• Get to know your supervisors and their collaborations – they will be the people supporting you day in, day out
• Look beyond your PhD – see what other special lectures and events are happening at LSHTM, even if they are not directly related to your topic
• Get involved with the Centres – they will be a huge support system for your work
• Socialise with friends – you even get good ideas when you’re in the Pumphandle Bar!

During my first year, I have been working on my systematic reviews, which is what most students start with as a way of developing a broad understanding of the research area; and then the protocol for my RCT, which will be my main research activity. Next, I defended my planned PhD work in the upgrading process, and now I am in the process of obtaining ethical and regulatory clearance for my RCT. The RCT will take about twelve to fifteen months in Malawi, after which I will return to London to analyse the data, publish papers and write my thesis.

My first year has involved a lot of writing! But I think the key is to have a clear timeline. This can be difficult at first as you do not have a clear idea of what you need to achieve. You can have a plan, but your supervisors will keep bringing more ideas, so it’s good to put those in a proper timeline to get a clear picture of what is achievable within the time-frame of the PhD. I try to segment my time as much as possible, focusing on one particular activity at a time. It’s important to allow time for breaks to interact with other PhD students; and I also have many friends from MSc programmes as I have taken optional MSc modules in Clinical Trials and Statistical Methods in Epidemiology. These, along with the transferable skills courses, have been a very good way to build up the specific skills I need for my PhD.

LSHTM is rich in resources for students. Although you have a lot to do for your PhD, you have to get out of your shell and see what else is out there and grab those opportunities

I have had a very good relationship with my supervisors: Professors Liz Corbett and Katherine Fielding. While they give me a lot of independence in decision-making, they do pay attention to my questions, responding rapidly and giving me appropriate advice. I meet them every two weeks. Katherine is based here at LSHTM and Liz is based in Malawi. So when I am here, we sit in Katherine’s office and Liz joins meetings by phone; and when I go to Malawi for fieldwork it will be the other way round. I must say, if a relationship with supervisors is more ideal than this, I would be surprised! Learning from some of the best experts in the world on this subject has been wonderful, and I have been able to tap into their broader network of collaborations here in the UK and in Malawi. So getting to know your supervisors is very important, especially during the first few months.

Another support group you may need is your fellow PhD students. There are three other students under Liz and Katherine’s mentorship who have helped me every step of the way. As they had already been through the upgrading process, they were the first people to see drafts of my reports and presentations, and they helped me polish them.

Titus presents his prize-winning poster

Titus presents his prize-winning poster


LSHTM is rich in resources for students. Although you have a lot to do for your PhD, you have to get out of your shell and see what else is out there and grab those opportunities. There are so many special lectures here, by the likes of Professor Peter Piot or renowned experts from other institutions. They may not be directly related to your topic, but since you are here, you should take advantage of them.

In addition to my studies, I am a member of LSHTM’s TB and AMR Centres. I am a student representative for the TB Centre and recently organised a seminar designed to help MSc students working on TB topics for their summer projects prepare for fieldwork. Being a student representative also means I am part of the Centre’s steering committee, quite an honour for me, as the Centre is one of the top scientific bodies in the world looking at TB. My recent highlight was the opportunity to represent the Centre at a United Nations meeting in New York in preparation for the upcoming UN High Level Meeting on TB to be attended by heads of state.

In terms of other events, I attended the TB Centre retreat where my e-poster earned me a best poster award; and recently at LSHTM’s annual research degree poster day, I won the prize for the best poster by a pre-upgrade student. The abstract for one of my systematic reviews has been accepted for oral presentation at the 49th Union World Conference on Lung Health, which will take place in The Hague.

The biggest piece of advice I can give to a new PhD student is to be flexible

My long-term interest is to do as much as possible to identify solutions for the current high burden of infectious diseases we have in Malawi. So when I complete my PhD, I will remain in research to look at whatever solutions we can find using clinical trials. We are working towards establishing a centre for TB and HIV research within the University of Malawi, so I will be part of that centre for most of my career, while maintaining external collaborations.

The biggest piece of advice I can give to a new PhD student is to be flexible. In the first year, the research topic you have now will undergo metamorphosis to become the eventual project you will defend at upgrade and carry forward. So the best thing you can do in the first few months is to understand your topic and get to the point where you have well-formed research question, then go through a systematic review as early as possible as it will help you develop your main research protocol ready for defending in the upgrading seminar. To arrive at that point, plan your time well, set deadlines with your supervisors and don’t stress yourself too much! Give yourself time to socialise with the people around you and learn from them, and have other things to focus on beyond your PhD, so that when you come back to it, you are fresh. Once you are through the first year, everything should fall into place nicely, but hey, am not there yet!


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