Monitoring the HIV continuum of care in key populations across Europe and Central Asia (May 2018)

In a paper published this week in HIV Medicine, data from 29 countries in Europe and Central Asia reported to the European Centre for Disease Prevention and Control were analysed in relation to a four stage HIV continuum of care for three key populations: men who have sex with men, people who inject drugs, and people born outside of their country of diagnosis. Although few reporting countries could produce a continuum for all three key populations, the analyses presented in the paper help identify specific stages of the HIV continuum of care where further investment is required.

Find the paper here
Co-author Dr Brian Rice – Deputy Director of the MeSH Consortium

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The UK’s breastfeeding problem: a societal issue with an environmental solution?

Laura discusses one aspect of her PhD research in this blog-post on breast-feeding in the UK. She focuses on the importance of studying women’s environmental quality as a predictor for initiating and maintaining breast-feeding, as well as the ‘subtler barriers’ behind the breastfeeding-specific barriers that have recently been brought to attention by organizations such as UNICEF.

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Adrian Root Memorial Fund and London-Paris bike ride

Written by Dr Ian Douglas, Associate Professor and Msc Programme Director for Epidemiology. The Electronic Health Records Group are cycling from London to Paris to raise money for a prize remembering their friend and colleague, Dr Adrian Root. You can visit their JustGiving page to support them: https://www.justgiving.com/fundraising/ehrlshtm 

Our much loved colleague, Adrian Root, tragically died at the end of 2017 after a long illness. Adrian was a GP, an epidemiologist and a proud, self-confessed data geek with a fondness for electronic health records and all the immense opportunities to improve health they bring when using them for research.

In honour of Adrian’s memory, and as a fitting way to inspire a future generations of data geeks, we decided to set up a prize fund, to be awarded annually to the best MSc Epidemiology project analysing data from electronic health records.

To kick start fund raising for the prize, a group of us are planning to cycle from London to Paris in July, travelling along the famous Avenue Verte. Around 10 of us are hoping to complete the full route, and are regularly discussing whether our knees are up to it, which cycle shorts are the best and how to minimise bag weight. Adrian managed to complete the London to Brighton ride on a Brompton, so we’re feeling the pressure!

Please sponsor us! There’s a link here to the JustGiving page, and we’re hoping to raise £10-12,000 to make sure the prize fund will be self sustaining

If you have any questions, or wish to make a donation in a different way (cheque, US tax efficient giving), please contact Victoria Bennett: .

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International Clinical Trials day

May 20th is International Clinical Trials day, and so today we celebrate the work of Sir Austin Bradford Hill – a pioneer in clinical trials.

Sir Austin Bradford Hill is best known for his work with Sir Richard Doll on the carcinogenic effects of smoking and on the use of randomisation in clinical trials of new drugs but he was also the statistician on the Medical Research Council Streptomycin in Tuberculosis Trials Committee. Their study is generally accepted as the first randomised clinical trial.

Sir Austin Bradford Hill

 

His career began as a pilot during WW2 which was cut short when he contracted Tuberculosis while in service at Gallipoli. Following his recovery he initially studied economics but went on to research in epidemiology and statistics. He joined the London School of Hygiene & Tropical Medicine in 1927 and went on to become Reader in Epidemiology and Vital Statistics in 1933. In 1937 he published the first edition of Principles of Medical Statistics, a textbook which has influenced generations of medical statisticians and epidemiologists.

His time at The School included many achievements with the Department of Medical Statistics and Epidemiology ranging from the effectiveness of inoculation procedures in severe polio epidemics to his crowning achievements and developments in pioneering clinical trials. While Bradford Hill was mostly known for the clinical trials of the link between smoking and lung cancer, but his impact on clinical trials in general have impacted the world through clinical trials of new products of the pharmaceutical and chemical industries.

Sir Austin Bradford Hill lecturing at the London School of Hygiene & Tropical Medicine

 

While at The School it was Bradford Hill who played a pivotal role in the development of studies in occupational health and occupational medicine. Additionally, a working tradition can be traced back to Bradford Hill and his colleague Greenwood for a long lasting collaborating between the MRC and The London School. This was alongside a sense of mutual respect and unqualified cooperation between epidemiologists of whatever persuasion initiated by Greenwood and legitimised ‘Medical Statistics’; but it was firstly developed and co nsolidated under Bradford Hill, ‘who fought the good fight to have his department recognised as pre-clinical rather than non-clinical.’ (Prevention and Cure, p.118.)

Bradford Hill retired in 1961 and was knighted the same year.

The London School of Hygiene & Tropical Medicine holds a memorial lecture: ‘Bradford Hill Memorial Lecture’ held in June, this year’s topic on ‘Statistical Challenges in Infectious Disease Research: From HIV to Dengue’. For more information on the Bradford Hill Memorial Lecture please see https://www.lshtm.ac.uk/bhill2018 and for any archival enquiries please contact

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Short-term Research Fellow position with the MeSH Consortium

Within a broader portfolio of projects to improve the use of routinely collected HIV data in Southern and Eastern Africa, the MeSH Consoritum (http://mesh.lshtm.ac.uk/) is currently conducting three independent but linked pilots on the use of assays for recent HIV infection in routine settings in Kenya and Zimbabwe.

As these projects are coming to a close, the MeSH Consortium will be recruiting a RF with good analytical skills to assist with data analysis and write up. The appointment will be made for 5 or 6 months starting in July or August.

Please contact Brian Rice () for more information on this position.

 

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Have you got data on follow-up of children after Group B Streptococcus infection?

By Professor Joy Lawn,  LSHTM

What data do we have regarding GBS?

Group B Streptococcus (GBS; Streptococcus agalactiae) is a leading cause of infant sepsis and meningitis. First systematic estimates of the worldwide GBS burden (presented in a recent publication series in Clinical Infectious Diseases 2017 Vol 65) have identified priority data gaps. Such gaps concern particularly long-term outcomes especially after early/late onset GBS invasive disease (sepsis or meningitis). Data from low, and middle-income countries (LMIC) where the burden is highest are also crucial.

Why is this important?

Reliable estimates are critical to inform public health interventions particularly the development of GBS vaccines suitable for maternal immunization in pregnancy and use in LMIC.

 What data do we need?

The London School of Tropical Medicine in collaboration with the World Health Organization currently requests for data to address the gap in information on long-term sequelae of infant GBS infections. The economic impact for individuals (such as earning potential and costs to families), are essential in order to more accurately assess health (e.g. Disability Adjusted Life Years) and economic burden

Expected existing data types lending themselves to addressing the need may include the following;

  • Large (eg national) datasets in which data contributors can cross-link exposure data with long term outcomes (eg child development and/or education) in cases and controls
  • Observational designs such as cohorts, following up infants after GBS sepsis or meningitis
  • Cross-sectional studies with known GBS sepsis and/or meningitis. Such studies may not currently have follow-up but could have the potential to re-enrol participants to capture information on long term outcomes and economic data. 

How could this benefit you? 

If you contribute such data and they are included in analyses you will be invited as co-authors on relevant papers from this work in scientific journals. Data from each individual study could be also published by your team as a separate paper. Some seed funding might be available for re-enrolment of cohorts with high quality exposure data in LMIC contexts, especially Africa and South Asia. We are also planning an investigators meeting to discuss results, which we invite all investigators to attend.


Please click on the link here for further details of this call for data. We very much appreciate your contribution and hope to hear from you soon.

7 – 13 May 2018

Peter Piot provides comment to Scientific American on why Ebola continues to re-emerge in DR Congo following the outbreak of the disease in the country: “Due to its huge swathes of forest, the DRC is a reservoir for the virus, making the country particularly susceptible to outbreaks of Ebola.”

Jimmy Whitworth was interviewed by BBC Radio 4’s World at One programme (from 36mins) providing insight into the DRC Ebola outbreak. Jimmy is also quoted by Thomson Reuters.

LSHTM research is featured in an online documentary by BBC Newsbeat on ME/CFS (Chronic Fatigue Syndrome) that explored what it is like to live with the illness. The documentary includes interviews with Luis Nacul and Caroline Kingdon from LSHTM’s CureME project.

Following the documentary, Eliana Lacerda was interviewed by BBC Breakfast and Luis Nacul was interviewed by BBC Radio 5 Live’s Drive programme. The work of the project is also highlighted in an article published by The Sun.

Graham Medley provides comment to SciDev.net on the discovery of a new strain of the leishmaniasis parasite: “We do not have a good animal model for visceral leishmaniasis, so it’s always going to be unclear how the genetic and metabolic differences translate into pathogenicity, drug susceptibility and other key processes determining transmission and disease.”

Lucinda Hiam is quoted by the Daily Telegraph on an editorial she co-authors that health chiefs are failing to investigate the 10,000 reported ‘excess deaths’ in the first few weeks of 2018. Lucinda said: “The figures for this year make the case for an investigation both stronger and more urgent with each passing day.”

‘Now is the time’ for adolescent health: an interview with former MARCH adolescent theme student liaison

By Nisso Nurova, A-theme student Liaison (MSc Public Health)

Constance Mackworth-Young Previous A-Theme liaison at the MARCH Centre LSHTM.

You may have seen Constance’s name featured in our Theme-A February newsletter, as a first author of a research publication ‘“My mother told me that I should not”: a qualitative study exploring the restrictions placed on adolescent girls living with HIV in Zambia’. But Constance Mackworth-Young’s relationship with the MARCH Centre began two years ago when she served as the MARCH A-Theme liaison at the LSHTM.

Today, she is in Zambia, conducting her PhD with LSHTM and working with Zambart, a Zambian research organisation focused on HIV and TB research. Constance’s research focuses on adolescent health, specifically with adolescent girls living with HIV in Lusaka, Zambia.

We spoke to Constance about her experiences working in the adolescent health sphere after graduating from LSHTM to learn more about her work in Zambia.

Can you share a bit about your background, and area of interest in adolescent health?

My background was initially in anthropology, both biological and social anthropology. I started working in public health first in policy, doing an internship at the WHO in Geneva and then at a UK based global think tank Meteos, working on access to medicine. After three years of working in public health policy, I wanted to work in a more connected way with people who were affected by the public health issues and policies that we were working on. I moved to Zambia to work with a Zambian research organisation called Zambart. I worked together with the Zambart social science team, led by Dr. Virginia Bond, who is also based in LSHTM.

This is where my interest in adolescent health really developed. I started working on a qualitative study with adolescent girls living with HIV and I really enjoyed hearing their stories of incredible resilience while dealing with various challenges that they faced. After working in Zambia for a while, I wanted a more active role in my research and so I undertook a Masters’ at the LSHTM. After that I started a PhD at LSHTM, funded by ESRC, that has led on from our initial research with adolescents living with HIV.

“HIV will not stop me from achieving my dreams; it will not stand in my way for anything that I do”

Can you share a little bit more about the stories of resilience and challenges by these adolescents?

A lot of research often focuses on the challenges adolescents face. Our research has also looked at these issues, including around treatment and disclosure. One of the key findings was that many participants have never opened up to a single person about their HIV status, which comes with other challenges around keeping treatment hidden from people.

But to me, one of the things that I loved and that I find really exciting about my work is hearing more about the stories of resilience, hopes and aspirations. One of my favourite quotes from a participant is:“HIV will not stop me from achieving my dreams; it will not stand in my way for anything that I do”. That level of resilience and desire that HIV will not stand in their way is something that I think is really important to highlight.

Young women participating in a icebreaker during the project. (Copyright: Constance Mackworth-Young)

Are there any themes you witnessed in your research on how adolescents came to dealing with disclosure, coping with their status and becoming more confident as young women?

The participants that I am now conducting ethnographic research with were recruited almost 4 years ago. They have gone through about 1 year of doing research with us at Zambart, and then they had 1 year of participating in support groups that we ran after the research, before taking part in a follow-up ethnographic study.

I think the support groups have been really valuable for many of the participants. Mostly, I think meeting other people through support groups who are similar ages and coping with similar challenges is so valuable to understand that they are not alone in going through these challenges. With the incredibly limited disclosure that we saw, most adolescents had never openly spoken with or met with other people their own age living with HIV. We are now piloting a support group curriculum in two clinics to see if that is feasible and if it can impact young peoples’ aspirations, self-confidence and self-stigma.

what would really support us is meeting other people like us and being able to talk about issues

Thank you so much for sharing that. How do you feel like this research would have a longer-term impact on the local communities?

I think this is a really good question and something we should always be asking when doing research.  From the qualitative research, we saw the participants were actively asking for a support group and saying ‘what would really support us is meeting other people like us and being able to talk about issues’. At the moment in Zambia there are support groups in some of the clinics but often there isn’t continuity or consistent funding to be able to ensure they are ongoing. The support group curriculum that we are piloting was developed based on recommendations from adolescent girls living with HIV. I think that is a really powerful way that can have an impact.

Globally, it is becoming increasingly recognised that adolescents, and specifically those living with HIV, have in the past been left behind and this increased focus means there’s real potential for improvement in adolescent health. But I think that in order for that potential to be realised, one needs to have in-depth understanding of what adolescents living with HIV really need and how they can best be supported. I see doing more in-depth, qualitative and ethnographic work as providing valuable evidence of the every-day life of adolescents living with HIV to ensure that investments in adolescents living with HIV support their real needs.

Creative collages created by Zambian young women (Copyright: Constance Mackworth-Young)

Do you see any challenges in your day to day work, and trying to communicate your research and impact in the local communities?

One of the things I am focusing on specifically is about research ethics in doing research with adolescents. Partly, I am interested in it because it is something I come across every single day in doing data collection and working with participants, and I do think it is something that we need to think actively about.

One of the aspects that I have been thinking about is how to actively involve adolescents in the production of knowledge, research, data collection and even in the analysis and presentation of results. I have been working with colleagues at Zambart to develop different research methods that are as inclusive as possible of young people.

One of the methods that we have been developing is using art-based collages, where participants cut out magazines, write words and draw pictures on cards to involve young people in creating their own representation of themselves. I have really enjoyed using this method I think that the participants really enjoy it too, as well as acknowledging that the collages present meaningful representations of themselves.

Find something that really makes you excited and interested, and that you think is important to change.

During your time with the LSHTM you were also engaged with the MARCH Centre. Can you talk a little bit on what your experience working with the Centre was?

I think that the MARCH Centre does a really excellent job in bringing together a wide variety of people who work in similar fields at the London School and beyond. For me being a student liaison was a really exciting opportunity to connect with other researchers in different disciplines but focused on a specific topic of adolescent health.

I think that the global health scene is really on the cusp of having this amazing focus on adolescent health and I think that the MARCH Centre has an important role in shaping how people at LSHTM and beyond build on, and influence the direction of this opportunity.

Do you have any final thoughts or advice you would give to students at LSHTM and those interested in adolescent health?

A depiction of future aspirations by a Zambia young woman. (Copyright: Constance Mackworth-Young)

My advice around the field of adolescent health is that now is the time! Now is the time that people are really having so much excitement and huge focus around adolescent health, and there is the potential for real impact. My advice more broadly to students is to find a field that you are really passionate about. Find something that really makes you excited and interested, and that you think is important to change. Once you found that, feel really free to search out and contact people that work in that field.

I think that particularly in the London School most people are very happy to meet with someone that has a passion in that field and a free pair of hands to help with a literature review, data collection or just to talk about their research in the field. For me finding an area of adolescent health that got me really excited and made my heart sing was a really important thing in order to then build an area of research that interested me, and that I felt was important.

I would like to say thank you to Constance for taking the time to discuss with me about her important work in adolescent health and providing inspiring words of encouragement to current and future MSc students at the LSHTM.  

For more resources related to Constance’s work, please view this short dissemination brief ‘Transitioning to a Healthy Adulthood Lessons Learned from Adolescent Girls Living with HIV in Urban Zambia’