R4D Health

Variable fate of virus-specific CD4+ T cells during primary HIV-1 infection.

Tue, 10 Nov 2009 17:50:00 GMT

Miscellaneous Oxenius, A.; Fidler, S.; Brady, M.; Dawson, S.J.; Ruth, K.; Easterbrook, P.J.; Weber, J.N.; Phillips, R.E.; Price, D.A. 2001 European Journal of Immunology Volume 31 Issue 12, Pages 3782 - 3788 [doi: 10.1002/1521-4141(200112)31:12<3782::AID-IMMU3782>3.0.CO;2-#] Impairment of CD4+ T lymphocyte responses to human immunodeficiency virus (HIV)-derived antigens is the classic immunological defect observed during the chronic phase of HIV-1 infection. Early intervention with potent antiretroviral therapy (ART) can preserve HIV-specific CD4+ T lymphocyte reactivity, providing indirect evidence that such responses are mounted during primary infection and subsequently lost in the majority of infected individuals. Here, we demonstrate early and dramatic expansions of functional HIV-specific CD4+ T lymphocyte frequencies directly ex vivo. These responses are initially of broad specificity, and can disappear rapidly during the natural course of primary infection. This process of loss is variable, such that the rapidity and extent of functional compromise differs between individuals. Institution of ART during these early phases of HIV-1 infection preserves patterns of functional reactivity within the HIV-specific CD4+ T lymphocyte population. However, there was no evidence for the restoration of deleted responses. These findings indicate that, in some individuals at least, ART must be administered within a narrow window of opportunity during primary HIV-1 infection to effect substantial immune preservation.

Direct ex vivo analysis reveals distinct phenotypic patterns of HIV-specific CD8+ T lymphocyte activation in response to therapeutic manipulation of virus load.

Tue, 10 Nov 2009 17:28:00 GMT

Miscellaneous Oxenius, A.; Günthard, H.F.; Hirschel, B.; Fidler, S.; Weber, J.N.; Easterbrook, P.J.; Bell, J.I.; Phillips, R.E.; Price, D.A. 2001 European Journal of Immunology (2001) Volume 31 Issue 4, Pages 1115 - 1121 [doi:10.1002/1521-4141(200104)31:4<1115::AID-IMMU1115>3.0.CO;2-9] Therapeutic intervention with antiretroviral therapy (ART) enables the modulation of HIV virus load and hence provides a unique opportunity to study the consequences of varying antigen load on the phenotype of virus-specific CD8+ T lymphocytes in a persistent human viral infection. The recent advent of tetrameric peptide / HLA class I complexes has enabled the direct phenotypic characterization of antigen-specific T cell populations ex vivo. Here, we use this technology to examine directly ex vivo the consequences of therapeutic manipulation of HIV virus load on the phenotype of HIV-specific CTL. Our observations using samples from 3 patients show that: (1) distinct sequential activation patterns of CD8+ T cells are associated with increasing virus load; (2) T cell receptor (TCR) down-regulation without apoptosis represents an early event during the generation of a T cell response in a natural infection and precedes the emergence of two distinct antigen-specific CD8+ T cell populations which differ in TCR and CD8 expression levels. Clear differences in surface Annexin V staining were observed between these populations. The observation that CTL activation, demonstrated by TCR and CD8 down-regulation, in response to rising levels of virus load, co-segregates with apoptosis only during later stages of the response indicates that antigen-associated cell death is restricted to distinct subpopulations of CTL.

Simple detection of point mutations associated with HIV-1 drug resistance.

Tue, 10 Nov 2009 16:57:00 GMT

Miscellaneous Frater, A.J.; Chaput, C.C.; Beddows, S.; Weber, J.W.; McClure, M.O. 2001 Journal of Virological Methods (2001) Volume 93, Issues 1-2, Pages 145-156 [doi:10.1016/S0166-0934(01)00266-X] A novel assay is described for the detection of HIV-1 drug resistance that is simple, cheap and sensitive. HIV-1 drug resistance in B and non-B HIV-1 subtypes was investigated using Mutagenically-Separated PCR (MSPCR) a competitive semi-nested PCR which uses mutagenic primers. The assay was assessed for sensitivity, specificity and its ability to detect mutant virus within a mixed mutantwild-type population. Gene sequencing was carried out simultaneously for comparison. MSPCR detected five copies of HIV-1 RNA from laboratory isolates and 50 copies from patient samples. We demonstrate 100% specificity of detection for wild type or mutant virus for clades A, B, C, D and E. For mixed populations of virus, MSPCR can detect at least a 10% mix of wild type:mutant, or vice-versa. When applied to African patient samples MSPCR detected 91.6% of the codons tested. Concordance with sequencing data was 88.8% for protease and 97.2% for RT. MS-PCR is sensitive and specific for the detection of mutations in HIV-1, and can be adapted easily to test for resistance at any codon of interest.

Impact of baseline polymorphisms in RT and protease on outcome of highly active antiretroviral therapy in HIV-1-infected African patients

Tue, 10 Nov 2009 16:27:00 GMT

Miscellaneous Frater, A.J.; Beardall, A.; Ariyoshi, K.; Churchill, D.; Galpin, S.; Clarke, J.R.; Weber, J.N.; McClure, M.O. 2001 AIDS (2001) - Volume 15 - Issue 12 - pp 1493-1502. Objective: To assess the therapeutic response and investigate the significance of polymorphic codons in African patients (treated in the UK) receiving highly-active antiretroviral therapy (HAART). Design and methods: African patients were identified from the St Mary's Hospital HIV-1 database. Clinical outcome was assessed by viral load and CD4 cell count. Pre-and post-therapy sequences of RT and protease were analysed. The impact of subtype and individual polymorphic codons on therapeutic outcome was assessed statistically (Fishers exact and χ² tests) and phylogenetically (Jukes and Cantor). Results: Of 79 drug-naive African patients who were prescribed HAART, 60 remained undetectable for 1 year, with no differences detected in the clinical response to nonnucleoside reverse transcriptase inhibitor (NNRTI)- or protease inhibitor (PI)-containing regimes. Country of origin, sex and viral subtype had no impact on outcome of HAART. A total of 133 polymorphisms were identified in pol (37 in protease and 96 in RT), with a mean of 9.0 in protease and 22.3 in RT per patient. There was no significant difference in the overall numbers of polymorphisms per patient, and no single polymorphism had any impact on clinical outcome. Sequences from 'failing' patients experiencing viral rebound produced few mutations known to be associated with drug resistance, suggesting minimal drug pressure. Conclusions: The response of patients infected with African subtypes of HIV-1 to HAART appears to be independent of regime, HIV-1 clade and baseline polymorphisms. Non-B subtypes are fully sensitive to HAART and, accordingly, therapy should not be withheld from African patients for reasons of viral diversity.

A phase I/II study of the safety and activity of a microsphere formulation of KNI-272 in patients with HIV-1 infection.

Tue, 10 Nov 2009 15:44:00 GMT

Miscellaneous Churchill, D.R.; Slade, P.M.; Youle, M.; Gazzard, B.G.; Weber, J.N. 2001 Journal of Antimicrobial Chemotherapy (2001) 47 (3), pp. 353-355. Eighteen patients [in the UK?] with symptomatic HIV disease were enrolled into a phase I/II study of a microsphere formulation of the HIV protease inhibitor KNI-272, with doses escalated up to a maximum dose of 60 mg/kg/day. One patient (only) developed reversible elevation in hepatic transaminase. The plasma half-life of the drug was very short, varying between 0.25 and 1.1 h. No consistent effect on plasma HIV RNA levels or CD4+ lymphocyte counts was seen.

Absence of viral transmission in injecting drug users in Russia

Fri, 06 Nov 2009 17:58:00 GMT

Miscellaneous 2001 The Lancet (2001) Volume 358, Issue 9286 (22 September), Pages 1016-1017 [doi:10.1016/S0140-6736(01)06146-3] The authors draw attention to studies showing that the populations of HIV-1 and HCV subtypes found in injecting drug users (IDUs) in the former Soviet Union differed from those in western Europe (and that human T-cell leukaemia virus type II was common in western European IDUs but not present at all in their Russian counterparts). This indicates that contacts between IDUs in one region and those in the other were limited, and much less pronounced than those within each region.

Serological approaches to subtyping of HIV-1 in injecting drug users in Russia: evidence of subtype homogeneity at the main sites of the epidemic.

Fri, 06 Nov 2009 16:45:00 GMT

Miscellaneous Bobkova, M.R.; Kazennova, E.V.; Selimova, L.M.; Buravtsova, E.V.; Lister, S.; Prilipov, A.G.; Weber, J.N.; Pokrovsky, V.V.; Bobkov, A.F. 2001 International Journal of STD & AIDS (2001) 12 (1), pp. 34-40. The aim of this study was to develop and evaluate a simple V3 peptide-based enzyme immunoassay (PEIA) for large-scale serotyping of HIV-1 specimens derived from injecting drug users (IDUs) in the Russian Federation. Two synthetic peptides were evaluated, named P1 (RKSIHIGPGRAFYATGD) and P2 (RTSVRIGPGQVFYKTGD), in an PEIA, using sera from 63 HIV-1 IDUs (including a few from neighbouring countries) for which genotypes had been determined by heteroduplex mobility assay (HMA) and sequencing. The sensitivities of P1 (subtype B) and P2 (subtype A) were 87% and 75% respectively. Specificity of the assay was 100% for both peptides, with 100% predictive values of a monoreactive positive test for both peptides. Using the PEIA with peptides P1 and P2, we have serotyped 375 of 477 serum samples derived from IDUs in 4 main sites of the HIV-1 epidemic in Russia. The results demonstrated a high level of subtype homogeneity in all regions studied. In 3 of 4 territories, namely Tver (n=345) and Rostov-on-Don (n=61) regions and Krasnodar Kray (n=27), 100% of typable sera were found to belong to env subtype A. On the other hand, all specimens serotyped in the Kaliningrad region (n=38) belonged to env subtype B, and there is strong evidence that the recombinant gagAenvB virus which has caused in this region the largest outbreak of HIV-1 in Russia is common here. At the present time another parental strain with gagBenvB genotype is of minor importance in the IDU HIV-1 epidemic in Russia.

Should people on TB treatment be given nutritional supplements?

Fri, 06 Nov 2009 14:59:00 GMT

Miscellaneous 2009 Evidence Update, Tuberculosis Series. Effective Health Care Research Programme Consortium, Liverpool School of Tropical Medicine, Liverpool, UK, 2 pp. Each Evidence Update is a 2-page summary of a Cochrane Review of healthcare interventions relevant to people in low-income and middle-income countries.

This Evidence Update is adapted from Abba K, Sudarsanam TD, Grobler L, Volmink J. Nutritional supplements for people being treated for active tuberculosis. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006086. DOI: 10.1002/14651858.CD006086.pub2.

Data on the effects of food or micronutrients on illness recovery are limited in patients with TB.

Do corticosteroids prevent death and improve respiratory function in people with tuberculous pleurisy?

Fri, 06 Nov 2009 14:54:00 GMT

Miscellaneous 2009 Evidence Update, Tuberculosis Series. Effective Health Care Research Programme Consortium, Liverpool School of Tropical Medicine, Liverpool, UK, 2 pp. Each Evidence Update is a 2-page summary of a Cochrane Review of healthcare interventions relevant to people in low-income and middle-income countries.

This Evidence Update is adapted from Engel ME, Matchaba PT, Volmink J. Corticosteroids for tuberculous pleurisy. Cochrane Database of Systematic Reviews 2007, Issue 4.

There is insufficient evidence to determine whether corticosteroids benefit people with tuberculous pleurisy.

Antibiotic therapy for Shigella dysentery

Fri, 06 Nov 2009 14:17:00 GMT

Miscellaneous P. R. H. Christopher, K. V. David, S. M. John, V. Sankarapandian 2009 Christopher PRH, David KV, John SM, Sankarapandian V. Antibiotic therapy for Shigella dysentery. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006784. DOI: 10.1002/14651858.CD006784.pub2 Shigellosis is a bacterial infection of the colon that can cause diarrhoea, dysentery (diarrhoea with blood and/or mucus) and may lead to death. It occurs mainly in low- and middle-income countries where overcrowding and poor sanitation exist, and may lead to around 1.1 million deaths per year globally, mostly in children under five years.

The intention of giving antibiotics in shigellosis is to speed recovery, reduce the seriousness of the disease, and reduce the length of time patients are infective. However, some antibiotics can have serious side effects while others may not be effective against the Shigella bacteria.

The review examined both the effectiveness and the safety of antibiotics in treating Shigella dysentery. While antibiotics tested here appeared safe and effective, there was insufficient evidence to suggest which antibiotics were superior. More well designed trials will help inform decision making.

African Insect Science for Food and Health (ICIPE)

Tue, 03 Nov 2009 13:58:00 GMT

Current

ICIPE has specific objectives in each of the 4-H research areas of human, animal, plant and environmental health. icipe develops, introduces and adapts new tools and strategies for arthropod management that are environmentally safe, affordable, appropriate, socially acceptable and applicable by the target end-users, with full community participation. In addition, there are centre-wide goals that span all programme areas:

Create knowledge: ICIPE aims to serve as the regional focus for bioscience and technology information and knowledge, and to develop and adapt improved arthropod management technologies.
Build capacity: ICIPE will continue to build the capacity of individual researchers and institutions in the tropics to initiate original research activities as new problems arise; to empower women and harness the youth; and to build capacity to use, transfer and teach icipe's technologies.
Develop policy: ICIPE contributes to policy development in areas relevant to its work by cooperating and working closely with African governments and institutions at the local level, and with other policy-making organisations at regional and international levels.
Reduce poverty: The ultimate goals of ICIPE research are to reduce the impact of arthropod pests that have a direct bearing on poverty, food production and well-being; create sustainable livelihoods for rural communities and entrepreneurs through agrobased food, fibre and health products enterprise development; and promote use of beneficial insects.

ICIPE's mission is to help alleviate poverty, ensure food security and improve the overall health status of peoples of the tropics by developing and extending management tools and strategies for harmful and useful insects, while preserving the natural resource base through research and capacity building.

New information on disease epidemics (partly as a result of climate change) permits to re-identify target sites for disease control by using bio-rational pesticide compounds, attractants and repellents detrimental to disease vectors identified.
The epidemiology, transmission and diagnosis of malaria, Human Africa Trypanosomosis (HAT) and leishmaniasis is elucidated (results published and widely recognized).
Modules and monitoring tools for predicting emergence and re-emergence of infectious diseases developed.
For emerging infectious diseases such as Rift Valley Fever and Dengue Fever, Integrated Vector Management (IVM) strategies for use in different ecological settings are developed and disseminated.
Education of African vector control specialists undertaken, activities expanded into other regions and research capacity strengthened.
New icipe tsetse repellent technology optimised and validated in at least 3 different agro-pastoral locations.
New artificial baits (both visual and olfactory) for riverine tsetse developed for monitoring and suppressing fly populations effectively.
Knowledge on the biology, behaviour and ecology of vectors responsible for emerging infectious diseases such as blue-tongue and lumpy skin disease is generated and adequately communicated.
Existing and new vector management techniques are systematically integrated in training programs of icipe and of network partners.
The economics of pest management through IPM strategies, biological control (BC) as well as pesticides and the interaction with human and environmental health is assessed in at least 3 specific studies.
The factors that in- or decrease the risk of aflatoxin contamination of maize grain identified and IPM-programs designed to combat mycotoxin-producing fungi in East and Southern African.
Predictive experimental models to determine possible effects of climate change on invasive and indigenous pests of selected target crops developed.
Improved bio- and chemo-pesticide formulations screened and refined for large-scale field validation in locust control. Visible icipe contribution to a catalogue of African arthropod biodiversity.
Minimum 3 new insect-based enterprises (sericulture, apiculture and butterfly farming) exist in buffer zones adjacent to rich biodiversity habitats, creating income opportunities especially for women. The experience is documented.
Altitudinal shifts in arthropod distributions in response to climate change are monitored to provide indicators of the effects of global warming; and changes in rainfall distribution on arthropod populations are understood and documented for at least 4 model species (pests and beneficials).
200 mid-level practitioners and extension workers from 30 national systems trained for enhanced technology uptake and out-scaling.
Institutional strengthening capacity initiatives for national collaborators and African Universities developed.
Research and capacity building in bio-prospecting for useful products from biodiversity undertaken.

Highlights include:
Community-based management and comprehensive farmer training programmes implemented on:

Deployment of ICIPE's NGU tsetse traps (e.g. in Kenya, Ethiopia and Uganda), reducing fly numbers by up to 99.9% without chemical pollution;
Adaptation of IPM systems for vegetables for semi-arid zones by communities in several parts of Kenya;
Adoption of commercial insects farming in improved apiculture (beekeeping) and domestic and wild silkmoth rearing (sericulture), by over 10,000 farmers and extensionists in 24 African countries;
Introduction of community production and processing facilities for medicinal and insect-repelling plants adjacent to biodiversity-threatened areas.

New Crosscutting Disability with Poverty Research Programme

Mon, 02 Nov 2009 01:00:00 GMT

A new DFID-funded research programme seeks to provide evidence on how disability interacts with other factors influencing poverty.

The research of the Medicines for Malaria Venture (MMV) will feature at the forthcoming 5th MIM Pan-African Malaria Conference

Fri, 30 Oct 2009 01:00:00 GMT

MMV will be co-hosting symposia and making oral and poster presentations at the 5th Multilateral Initiative on Malaria (MIM) Pan-African Malaria Conference in Nairobi, Kenya, 2-6 November 2009

Ten years of 'war against poverty': what have we learned since 2000 and what should we do 2010-2020?

Thu, 29 Oct 2009 01:00:00 GMT

The Chronic Poverty Research Centre (CPRC) is calling for papers on poverty research for presentation at an international conference in Manchester, 8-10 September 2010

Straight Talking to combat HIV among young African women

Wed, 28 Oct 2009 01:00:00 GMT

A project in Uganda is helping young women, often disempowered in an environment of gender inequality, to talk about their lives with a view to developing a more gendered HIV prevention approach.

This is Open Access Week

Mon, 19 Oct 2009 01:00:00 GMT

This week, 19-23 October 2009, is the first International Open Access Week, which aims to broaden awareness and understanding of Open Access.

Hunger and gender inequality go hand-in-hand

Thu, 15 Oct 2009 01:00:00 GMT

The 2009 Global Hunger Index just released by IFPRI draws attention to the link between hunger and gender inequalities

Democratizing Brazil's Indigenous Health System

Mon, 12 Oct 2009 01:00:00 GMT

Researchers from the DFID-funded Development Research Centre on Citizenship, Participation and Accountability have helped to reform Brazil's indigenous health system

Multiple-use water services could advance all Millennium Development Goals

Fri, 18 Sep 2009 01:00:00 GMT

Research conducted by the DFID-funded RiPPLE (Research Inspired Policy and Practice Learning in Ethiopia and the Nile Region) programme shows that adapting water systems for multiple-use could address all the Millennium Development Goals.

Why isn't India's economic growth improving its shocking levels of child malnutrition?

Thu, 17 Sep 2009 01:00:00 GMT

A new report, funded by DFID, suggests a failure in governance is responsible for India's high levels of malnutrition and warns that new funding alone cannot prevent another lost generation

Rewarding Achievements in International Development

Wed, 16 Sep 2009 01:00:00 GMT

DFID, in partnership with Marie Stopes International (MSI) and the Guardian, has unveiled the five finalists of the Guardian Achievements in International Development Award.

New TB Regimens: What Countries Want

Tue, 15 Sep 2009 01:00:00 GMT

A new report from the TB Alliance based on interviews with over 200 key stakeholders explores

How will climate change affect insect-borne diseases?

Mon, 14 Sep 2009 01:00:00 GMT

The latest SciDev.Net spotlight looks at how climate change might impact the spread of insect-borne diseases such as malaria, and how countries can prepare for these changes.

Helping vulnerable South African teenagers cope with the impact of AIDS

Tue, 08 Sep 2009 01:00:00 GMT

Research from the he DFID-funded ABBA project (Addressing the Balance of Burden in AIDS) shows how programmes that give young people the skills to improve their education and manage family finances can address some of the costs associated with the AIDS pandemic in South Africa

Improving equity in Indian health care

Wed, 19 Aug 2009 01:00:00 GMT

Health problems and poverty are linked in India. There is therefore a need for health policy to improve equity of health care. Research in West Bengal is generating evidence which can be used to influence policy for targeting the poor.

Activism and aid combine to fight HIV/AIDS in South Africa

Tue, 28 Jul 2009 01:00:00 GMT

A local AIDS advocacy group has teamed up with international aid agency Médecins Sans Frontiéres to both mobilize people living with HIV and AIDS and to provide the medicine and care that patients need. DFID research is helping to document and understand this blending of activism and aid in South Africa.

Kenyan shopkeepers join fight against malaria

Fri, 17 Apr 2009 01:00:00 GMT

DFID-funded research on the effectiveness of training retailers to advise on the home use of shop-bought antimalarial drugs for fevers in coastal areas of Kenya has shown that shopkeeper training can lead to much quicker treatment of malaria

Essential healthcare for newborn babies in Nepal

Wed, 04 Feb 2009 01:00:00 GMT

Refresher training of primary care workers in Makwanpur district Nepal has helped transform care for mothers and their newborn infants

Dire Consequences of Smoking Waterpipes

Mon, 02 Feb 2009 01:00:00 GMT

New research on the effects of waterpipe smoke and the health consequences of this form of smoking have shown that smoking tobacco in hookah pipes can be as harmful as cigarettes

Proposal to conceptually integrate social determinants of health research and capabilities approach to development and social justice.

Fri, 23 Jan 2009 09:36:00 GMT

Current Access to healthcare is necessary but not sufficient to alleviate health inequalities in poor countries. For a person to avoid or mitigate impairments and live a normal length of lifespan depends on the combined result of interactions between her biology, surrounding social and material conditions, choices and abilities to transform these conditions to her advantage, and luck. Yet, health policies almost exclusively focus on distributing limited healthcare resources more effectively or efficiently across the population. The significant gap between the breadth of determinants of longevity and impairments for each individual and the health sector's narrow focus on distributing healthcare may greatly explain the persistence of acute and endemic premature mortality and avoidable morbidity in many poor countries. The gap also points to the significant constraints of the science of epidemiology which underlies the focus on health care and operating parameters of the health sector. An epidemiological model which only recognizes individual-level causal factors such as biology, behaviour, and exposure to material substances will point to clinical care and not to changes in social conditions. However, social epidemiologists are revolutionizing epidemiology by identifying the effects of social phenomenon on psycho-biological pathways to chronic diseases dominant in rich countries. This expansion of epidemiology's scope to include social determinants also presents an important opportunity to develop a more effective and ethical approach to identifying, evaluating, and lessening health inequalities in poor countries. 1) Move towards creating a theory of health causation and distribution that spans rich and poor countries and one that takes account of biology, material conditions, and social conditions. Such a theory should have comprehensive explanatory power and prescriptive power for ethical social response to health inequalities within and across countries.

2) Make use of epidemiology's expanding scope to capture social determinants as an opportunity to develop a better approach to identify, evaluate and alleviate health inequalities in poor countries. This should be achieved through world class theoretical research taking advantage of multi-disciplinary research environment in public health and epidemiology department.

3) Integrate the Capabilities Approach to development and social justice with social determinants of health research in three areas and produce six academic articles publishable in internationally respected peer-review journals. The three areas of research should:
a) Show how Marmot's articulation of the social determinants of health overlaps with the conceptual descriptive device of a capability in the Capabilities Approach. Articulate how the analysis of the social determinants of biological functionings is similar to an analysis of the capability to be healthy.
b) Show how the argument for the moral entitlement to the capability to be healthy overlaps with or is same as the entitlment to the social determinants/ social basis of health functionings. Defend an entitlement to the social basis of a capability to be healthy against alternative conceptions of health entitlements, particularly the narrow focus on distribution of healthcare goods and services.
c) Offer a defence against the critique that epidemiology that capatures social phenomenon is no longer an objective, value free science. Identfy the role of epistemic and social values in the practice of "classic epidemiology" to show that all science is a social endeavor, and social epidemiology is an instrumental science which recognizes a greater role of philosophical and ethical reflection.

4) Begin to develop how this theoretical framework can be used to guide health policies in developing country settings. Test the usefulness of the framework to critique exisiting approaches to healthcare priority setting and broader health policies. Begin to identify possible ways to incorporate the theoretical ideas into social determinants research studies.

5) Initiate and engender muturally illuminating colloboration among team of multidisciplinary team of researchers in department through open and respectful dialogue, colloborative writing, seminars, and lectures.

6) Engender greater interest in policy implications of the intersection between social epidemiology and political philosophy among health and development policy makers, established academics, and students through organizing open seminars, guest lectures, disseminating publishings, academic networks, teaching, and issue specific advocacy.

7) Continue the professional development of the researcher through opportunities to give guidance to other researchers and students, participation in academic conferences, and continue developing lectures and curriculum on global health.

Poverty and maternal health in Ghana: A spatial analysis of exclusion from care

Thu, 22 Jan 2009 12:06:00 GMT

Current Improving maternal health has been established as a key development priority and is associated, through the Millennium Development Goals (MDGs), with the eradication of poverty. Ghana is a country with a high level of maternal mortality that is currently undergoing substantial efforts to scale up the provision of maternal health services. Exclusion from maternal health services in Ghana represents a serious constraint to the attainment of both better maternal health and lower infant mortality and is known to be driven in part by poor availability and physical inaccessibility of these services. The overall aim of this project is to quantify the spatial links between poverty and poor utilisation of maternal health services in Ghana. This project builds on previous work in a range of African countries which showed that individual and community characteristics alone do not go far towards explaining service use at childbirth, especially in West African countries. However, previous analyses did not use poverty map estimations of local deprivation, nor did they control for varying geographical accessibility to services via facility mapping and analysis of realistic ground distances using modern geographical information system (GIS) techniques. The specific aim of this project is, therefore, to establish whether there is a relationship between the level of deprivation within communities and the use of health services during pregnancy, childbirth and the postpartum period after controlling for other factors such as the type and quality of services available, physical access, and characteristics of the woman herself. By investigating factors related to both physical accessibility and availability of health services, the research will facilitate an understanding of the effect of poverty on patterns of spatial variation in service use. The results will, for the first time, provide policymakers with spatially explicit explanations for exclusion from care throughout Ghana through nationwide maps of causative factors. 1) To prepare spatial data on use of maternal health services, poverty and physical accessibility at various levels of aggregation by:
*creating maternal health service utilisation maps derived from Demographic and Health Survey data (2003) at individual and district levels for pregnancy, childbirth and postpartum services in Ghana.
*creating a district level welfare poverty map of Ghana using census data and the Ghana Living Standards Survey 2003
*estimating the distance to services based on digital facility maps which include information on maternity provision in health centres and hospitals throughout the country.

2. To identify, by linking all three data sources listed above spatially in a regression analyses, the key factors determining service exclusion throughout Ghana.

3. To provide a more precise understanding of maternal health service utilisation in three case study districts of Ghana.

4. To interpret the findings of regression analyses and case studies based on local and national understandings of using maternal health services in Ghana / by interviewing national and district level health service managers, health facility staff and women who are pregnant or have recently given birth. The project also seeks to establish a methodological approach to producing linked poverty, health access and physical availability maps which can be applied in other data-rich contexts.

Impact Evaluation of Performance-based Contracting for General Health and HIV/AIDS Services in Rwanda

Thu, 15 Jan 2009 11:39:00 GMT

Current The global shortage of human resources for health care delivery is reaching crisis conditions in the poorest countries, adversely affecting the lives of millions and preventing achievement of the Millennium Development Goals (Chen 2004, World Bank 2005). The deficit of well trained and highly motivated health care workers in developing countries is a reflection of the high levels of absenteeism (Chaudhury et al forthcoming) and worker emigration to richer countries (Stilwell et al 2004). This research will provide some of the first rigorous empirical evidence on whether Performance Based Contracting (PBC) for health services is a feasible method for improving quality of care, increasing access to quality health care services, and significantly increasing health outcomes. It will also be the first study of PBC in the African context. This work is especially timely since the human resources crisis, lack of progress towards the MDGs, and health needs of the poor (esp. HIV/AIDS and malaria) are the greatest in Africa. The knowledge generated by this research will not only fundamentally serve the Rwandan government, World Bank and other donor agencies as they prepare for expansion of PBC for health services within Rwanda, but also the international community as it searches for more effective means for addressing the human resource crisis in health care. We propose to evaluate the impact of a new performance-based contracting (PBC) scheme for health care services being implemented by the government of Rwanda for basic preventive and curative health care services and HIV/AIDS treatment. Specifically, the objectives of this research are to identify the impact of performance based contracting on provider behavior, patient utilization and health outcomes. We will observe how incentive-based payment affects behavior, while also studying health care utilization for both preventative and curative care among poor, rural populations. The obstacles facing the Ministry of Health in Rwanda are those which face the majority of poor, developing countries. The objective of this research is to determine the viability of performance-based contracting in health services as a means for overcoming these obstacles in health care. Through extensive data collection and analysis at the facility and household level, our research will provide invaluable evidence on how PBC impacts provider behavior, patient utilization and, ultimately, health outcomes.

Health Research Capacity Strengthening Initiative (HRCSI) in Malawi and Learning Project Component

Fri, 19 Dec 2008 15:08:00 GMT

Current HRCS will build local capacity to commission, do and use high-quality research that addresses the health needs of Malawi.

Provide enhanced institutional capacity for high-quality multidisciplinary health-related research (e.g. grants for research training as well as district based operational research).
Ensure that national health policies and programmes are formulated utilising research findings (e.g. support for formulation of national research agendas).
Ensure that scientific knowledge is more effectively shared across international organisations and knowledge networks (e.g. support for research collaborations, training in communication skills).
Improve the regulation and coordination of the national research environment (e.g. support for national bioethical review processes).
Share organizational learning relevant to wider work on research capacity development.

Malawi although only up and running since October 2008 LATH and NRCM have made good ground in such a short space of time e.g. Health research Guidelines drafted, TA's interviewed & in post, and the first calls for grants expected soon. The National Research Council of Malawi now (wef May 2009) under the auspices of the National Commission for Science & Technology.

Anti-retroviral treatment of HIV/AIDS patients in Africa is better delivered in health centres

Wed, 10 Dec 2008 01:00:00 GMT

A new study by the DFID and Elton John Aids Foundation-funded COMDIS programme has shown the value of local care in treating HIV/AIDS patients

The camera never lies: children's views of health in their communities

Tue, 02 Sep 2008 01:00:00 GMT

Young Lives children hosted a photo exhibition in Addis Ababa for the Day of the African Child

Health Research Capacity Strengthening Initiative: Kenya and Learning Project Components

Fri, 15 Aug 2008 12:32:00 GMT

Current HRCS will build local capacity to commission, do and use high-quality research that addresses the health needs of Kenya and:

enhance the quality of health interventions in Kenya through the formulation and use of evidence-based policies.
strengthen institutional capacity to conduct and coordinate health research and to improve its use in evidence-based policy formulation, decision-making and healthcare delivery.

The Kenya initiative has been running through IDRC since Feb 2008. Progress, particularly on spending, has been very slow. The initial ground work has now been laid and the project is now beginning to move. It's now a case of getting into mechanics of what and what's not required. CNHR are now fully manned and being supported by the Incubation team/IDRC.

The Mental Health and Poverty Project: Mental health policy development and implementation in four African countries.

Tue, 25 Mar 2008 11:27:00 GMT

Current The research programme consortium aims to provide new knowledge regarding comprehensive multi-sectoral approaches to breaking the negative cycle of poverty and mental ill-health. The programme will undertake an analysis of existing mental health policies in African countries, provide interventions to assist in the development and implementation of mental health policies in those countries, and evaluate the policy implementation over a 5-year period. 1. Conducted the first large-scale situation analysis of mental health systems in 4 African countries: Ghana, South Africa, Uganda and Zambia. These studies highlighted the neglect of mental health in current policies, the meagre resources available for mental health, lack of data for mental health service provision and widespread stigma against the mentally ill.

2. Established partnerships between research teams and Ministries of Health in all four countries and built capacity for mental health research and policy development through training workshops, exchanges and supervision.

3. Currently conducting and evaluating interventions that are having a significant impact on policy and practice in the four countries, including:

Ghana: reform of mental health legislation and establishment of mental health information systems for routine service monitoring.
South Africa: development of a strategic plan for mental health in the Northern Cape and development of mental health information systems in Northern Cape and KwaZulu-Natal.
Uganda: development of a national mental health policy, national strategic plan and reform of mental health legislation.
Zambia: reform of the mental health legislation.

4. Establishing models of best practice for the integration of mental health into primary health care, through demonstration projects in all 4 countries.

5. Conducted the first systematic literature review of the relationship between mental health and poverty in low and middle income countries. From this process and our engagement in the four African countries we have identified a range of interventions that have the potential to address the vicious cycle of poverty and mental ill-health.

Research and capacity building in reproductive and sexual health and HIV/AIDS in developing countries

Thu, 24 Jan 2008 14:40:00 GMT

Current Reversal of the spread of HIV/AIDS is one of the Millennium Development Goals (MDGs). Failure to achieve this goal will jeopardise other MDGs on poverty eradication, education, and maternal and child health. Success depends critically on improving access to effective interventions for those who are particularly vulnerable to infection (e.g. the poor). Access may be improved and protective behaviour increased through a number of strategies: e.g. mass communication of safe sex messages, together with social marketing of products such as condoms and STI diagnostic tests; provision of integrated SRH and HIV services which decrease stigma and thereby increase uptake; and provision of more effective biomedical interventions which can bring improved diagnostics and preventive technologies to all sections of society. Consortium partners have a long history of working in each of these areas. To support a research programme that will strengthen the evidence base to enable policy makers to identify and prioritise interventions that will improve reproductive and sexual health and reduce HIV incidence among economically poor populations in Africa and Asia. Strategies for behaviour change.

Integration of SRH and HIV services.

New biomedical tools.

Two large community randomised trials measuring the effectiveness of school-based and peer-led adolescent SRH interventions in Tanzania (Mema kwa Vijana study) and Zimbabwe (Regai Dzive Shiri study) have shown that young peoples knowledge about how to prevent HIV increased, and that these effects were sustained for at least 5 years. However, the interventions did not lead to a reduction in HIV, other STIs or unplanned pregnancies. These results will be important in guiding the future direction of HIV prevention activities for young people. The two studies communicated their results simultaneously in several fora including with national and international policy makers and researchers and have proven very influential in shaping the WHO Adolescent and Child Health Departments strategies for curbing HIV incidence in young populations.
A study commissioned by the National AIDS Control Programme in Pakistan, funded by DFID Pakistan and conducted by LSHTM researchers and collaborators from Pakistan shed much-needed light on the health and behaviour of populations often neglected or persecuted, in South Asia and elsewhere. The research has shown that violence, abuse and discrimination are commonly experienced by sex workers and injecting drug users, and can increase the likelihood of HIV and sexually transmitted infections. A future HIV epidemic is likely to be concentrated in those with highest levels of STIs and the highest levels of abuse transgender sex workers. Our research has also shown that policy recommendations targeted at transgender sex workers will have little support among society, and will be difficult for the government and public sector to implement, but they could be implemented successfully by NGOs, with donor funding and support.
As a result of our published evaluations which showed that the new point-of-care (POC) diagnostic dipstick tests for syphilis perform well in screening programmes for pregnant women, these tests were made available at discounted prices through the WHO bulk procurement programme. In 2009, a decision was made to use them for antenatal screening in Ghana, and they will now being rolled out nationally to all antenatal clinics in the country. In Tanzania, our results encouraged the government to agree to introduce one of POC test as a demonstration project, which we will evaluate. The Brazilian government has also decided to use them for screening hard-to-access populations in the Amazonas Region, following several evaluations which we conducted in the region.

Influence of international social, health and environmental policy objectives and trade agreements on the livelihoods of livestock-dependent people in developing countries.(SHE-LEAD)

Tue, 20 Nov 2007 00:00:00 GMT

Completed Human population growth, increasing urbanisation, and rising incomes have fuelled an unprecedented demand for livestock products in the developing world. This should present opportunities for poor people who rear, process or market livestock to enhance their livelihoods. However, numbers of large-scale, intensive (industrialised) forms of poultry, pig and dairy production are rising to meet supply of livestock products. The proliferation of industrial enterprises is assisted by favourable economies of scale created by distorted market conditions and low transaction costs at both input and product-supply level. It is anticipated that poor people will find it increasingly difficult to compete with the industrial sector and thus risk losing a significant means of livelihood. International policies and institutions that confer comparative advantage on industrial livestock production in developing countries have been in flux over the past few decades, and are likely to continue in this state as trade distortions and non-trade (social, health and environmental (SHE)) concerns are raised more explicitly in WTO negotiations, for example. The implications of past and future changes in international trade agreements and non-trade concerns (manifested in multilateral agreements, externalities of western governments' policies and responsible corporate behaviour) on domestic policies and markets that affect the livestock sector are far from being properly understood. This project examines the international factors influencing domestic policies and market structures and how this has affected the social and economic structure of the livestock sector in India, Brazil, Thailand and the Philippines - developing countries with dynamic sector expansion, and where large-scale and small-scale production co-exist. This understanding is a prerequisite to formulating livestock policies that attain outcomes with higher SHE values in developing countries. Improved understanding of how international agreements, trade/SHE (social, health and environmental) policies, consumer behaviour in powerful economies and corporate social responsibility shape domestic policies and social and market structures in the livestock sector of developing countries. Characterisation and quantification of social and structural changes in the livestock sector.

Understanding the mechanisms through which international agreements, trade policies and domestic policies influence change in the livestock sector.

Scenarios for how internal and external changes will affect the structure of the livestock sub-sector in each country case over the next decade.

Identification of specific domains in need of policy reform and the policy instruments to address SHE objectives.

HEALTH CARE SEEKING BY POOR HOUSEHOLDS IN TRANSITIONAL ECONOMIES: THE VIETNAM CASE

Tue, 20 Nov 2007 00:00:00 GMT

Completed By analysing existing data, the project will relate socio-economic characteristics of households in poor rural communities to family health care seeking. The project will focus on simple means of identifying households at risk of illness related costs hindering access to health care or resulting in serious economic shocks for the family.