Our main focus is on formative research and trial of community-level HIV/TB interventions, aiming to identify affordable novel strategies that maximise and accelerate gains available through use of existing drugs and diagnostic tools.
- How can screening for undiagnosed TB and HIV be used to maximize health benefits and sustainability, while minimizing harms and costs?
- Can high-risk individuals and groups be engaged to deliver effective and low-cost home-based HIV and TB screening interventions?
- Can TB prevention strategies be more effectively targeted through better understanding of urban social and TB transmission networks?
- What are the harms and survival benefits of intensified antibiotic prophylaxis for adults and adolescents with HIV/TB-related chronic lung disease
- Which bacteriological or host biomarkers best predict treatment outcome? How does this relate to the potential of novel or repurposed TB regimens to shorten TB treatment?
- What sustainable and equitable interventions can mitigate the catastrophic patient costs associated with health care seeking before, during and after a TB diagnosis?
- Both TB and HIV Global Control strategies rely heavily on scaling up early diagnosis and treatment, as a prerequiste for meeting ambitious control targets. Home & community-based screening programmes achieve much greater coverage than facility-based strategies, but need to be effective and affordable. Community-led and patient-delivered interventions, with greater targeting, are among the possible solutions.
- Early mortality soon after diagnosis with HIV and with TB remains extremely high, as does morbidity from ongoing cumulative lung damage. Urine-based TB screening and more intensive use of adjuvant broad-spectrum antibiotic have a strong case for RCTs.
- TB patients shoulder heavy care-seeking costs in relation to their incomes despite provision of services that are free at point of care. For the poorest, costs are frequently catastrophic (>20% of income) and are associated with poor clinical outcomes and unwillingness to engage in contact tracing due to fear of incurring additional costs.
- Shortening and/or simplifying TB treatment remains an important research goal. Activity in clinical trials of treatment for TB has increased in recent years. Our programme of work has established laboratory and statistical capability, and a growing reputation in this field.
- A number of studies and trials investigating uptake, costs and health benefits of different approaches to delivering TB diagnosis, HIV self-testing, and TB case management. This includes 4 cluster randomised trials.
- 3 ongoing RCTs aiming to reduce HIV and TB mortality and morbidity, plus 2 other submitted proposals, with associated mechanistic immunological/micro substudies
- Cross cutting specific objectives include the role of: i) masculinity and ii) extreme poverty and their effects on exposure to TB and willingness/ability to access health care
- To explore the potential of novel biomarkers (vital staining, flow cytometry, RNA/DNA quantification, enhanced culture) to predict individual and trial response
Publications: HIV self-testing publications in JAMA (2014), PLoS Med (2015), BMC Medicine (2016)Postgraduate Research Method Short Courses (highly successful COM/MLW collaborative delivery, meeting essential needs and with very high student ratings).
Fellowships: WT Training Fellowship to Augustine Choko (2015), UNITAID implementation grant with Population Services International (2014)
Invited Oral: 2015 Int AIDS Society Conference (Peter MacPherson)
Networks/Meetings: CoM and MLW initiated formation of the Malawi TB Research Network in 2016 with MoH and KNCV. Led Organising Committee of 1st National TB Research Meeting.