Dr Fiona Cresswell
MBChB BSc MRCP DTMH PGCert Epi
Wellcome Trust Clinical PhD Fellow in Global Health
I am a clinical PhD fellow with a clinical and academic interest in advanced HIV disease, HIV-associated central nervous system infections, transmission of HIV and antiretroviral therapy. I began my clinical PhD in 2017 and am based at the Infectious Diseases Institute in Kampala, Uganda, supervised by Prof Alison Elliott. The focus of my PhD research is improving diagnosis and treatment of HIV-associated TB meningitis, during which I have been conducting a phase II clinical trial investigating the pharmacokinetics and safety of high dose rifampicin for TB meningitis and observing if this intensified treatment has any impact on neurocognitive outcomes and mortality. I have also been evaluating the diagnostics for extrapulmonary TB including Xpert MTB/Rif "Ultra" on cerebrospinal fluid and urine.
As a clinician i do ward rounds on the Infectious Diseases ward at Mulago Hospital and also see outpatients in the Infectious Diseases Institute clinic, which has an HIV cohort of ~10,000 adults.
I have had the pleasure of being a tutor on the East African Diploma in Tropical Medicine and Hygeine since its inception in 2011. I do ward-based teaching with undergraduate medical students from Makerere University, Uganda.
My research projects include:
- Epidemiology: As a member of the steering committee of the Africa Meningitis Trial Network we are describing the epidemiology of central nervous system infections at selected sites in Uganda, Zimbabwe, Botswana, Malawi, Tanzania and South Africa. Secondly, Through a retrospective cohort study I am describing the clinical and laboratory features and outcomes of TB meningitis in Uganda over the last 5-10 years.
- Diagnostics: Myself and the team have evaluated Xpert MTB/Rif Ultra on adults presenting to Mulago and Mbarara Hospitals with (non-cryptococcal) meningitis. We are also evaluating utility of Ultra and LAM on urine for hospitalised adults with suspected meningitis and next generation sequencing technologies in collaboration with University of California San Francisco.
- Supportive care: We are evaluating the feasibility and utility of bed-side ultrasound for the management of patients with meningitis (both for managing fluid balace via vena caval US and monitoring for raised intracranial pressure with optic nerve sheath diameter). I plan to investigate causes of hyponatraemia in HIV-associated TB meningitis in order to produce evidence-based guidance on fluid management.
- Clinical Pharmacology: I beleive TB meningitis should be treated with a higher dose of rifampicin (due to poor blood brain barrier penetration) and am part of an international consortium conducting a phase III trial in Uganda, Indonesia and South Africa.
- Transmission of HIV and STIs: I have been involved in molecular epidemiological studies of gonorrhoea transmission using whole genome sequencing. I am the chair of the writing group of the national HIV post exposure prophylaxis guidelines and more recently conducted a systematic review on HIV transmission of HIV through biting and spitting incidents.