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Programme 2: Transmission reduction in infectious diseases

HIV, TB and malaria are major causes of morbidity and mortality in Malawi and this programme brings together disease-specific research groups that use common approaches to address important questions about transmission and control.

Utilising well characterised urban/peri-urban (Blantyre) and rural (Chikwawa) populations, we take a multidisciplinary approach to answering important research questions that will inform public health policy. We have led the international community in HIV self-testing, showing that this technology will transform the approach to HIV diagnosis and access to care across the region. Our expertise in social science, geospatial mapping and geospatial statistics underpin the study of malaria and TB incidence, community interaction, migration and the effectiveness of control strategies to interrupt transmission of infectious diseases. Building on these platforms, we are using similar approaches to investigate typhoid, non-typhoidal Salmonella infections.

Specific Objectives

This Programme will utilise original methodology, carefully mapped populations, community based interventions and innovative technology to understand and interrupt transmission of infectious diseases in Malawi. The platforms established in HIV, TB and malaria logically extend to include work on enteric and respiratory infections, and also to multi-country studies with regional collaborators. As in Programme 1, strategic choices for active research have been made on the basis of scientific importance, excellent opportunities in the Programme and translational potential. Certain areas of past success have been deprioritised using the same criteria.

Programme 2 track record of excellence (blue rectangles) and prioritised research areas (yellow lozenges).Programme 2 track record of excellence (blue rectangles) and prioritised research areas (yellow lozenges).

 

Programme 2 Key Deliverables HIV & TB

  • Determine the impact of HIV self-testing (HIV-ST)
    • Effect of HIV-ST on behaviour, transmission and undiagnosed HIV infection (Funded UNITAID)
    • Defining international policy & practice for use of HIV-ST (Funded UNITAID,)
  • Immunology
    • Understanding pathogenic mechanisms and in particular the role of small macrophages in pulmonary virus persistence (Funded Wellcome)
    • Long-term effects of HIV and ART on host immune response to lower respiratory tract infections, particularly TB (Funded BMGF and NIH)
  • Community intervention leading to measureable reduction in TB transmission
    • Community education intervention (Funded Wellcome Senior Fellowship)
    • Diagnostic (digital radiography and laboratory) intervention (Macpherson; Wellcome CRCDF application)

Malaria

  • Determine viable regional approaches to malaria control
    • fine-scale methods to map and predict malaria heterogeneity (Funded Liberty Wildlife)
    • targeted malaria intervention packages: transmission & disease reduction (Terlouw; seeking funding)

Transmission related vaccine studies

  • Phylo-geographic and transmission reservoir descriptions of typhoid and iNTS (Funded BMGF)
  • National safety and efficacy RCT of malaria RTS,S vaccine (French, Terlouw; funding application EDCTP)