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Evaluation of Social and Population Health Interventions (ESPHI)

Developing disease, behavioural and economic models to assess whether and how to intervene to improve global health

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About

We focus on interventions that bridge social, behavioural and public health action across a range of disease issues.

Team

Health economists, social epidemiologists and disease modellers, we draw on spheres from biology to economics to health systems, to advise on policy and practice.

About
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In the research group Evaluation of Social and Population Health Interventions (ESPHI), health economists, social epidemiologists and disease modellers collaborate to improve global health. We work across a wide variety of diseases issues, including infectious diseases such as visceral leishmaniasis, malaria, tuberculosis and HIV and maternal health. We have a specific interest in evaluating interventions that bridge social, behavioural and health action, such as projects to prevent violence against women and girls, improve the welfare of female sex workers and increase HIV self-testing in southern Africa.

We design and implement evaluations that address the question “whether” to intervene, and “how” to intervene to improve population health and welfare. Our focus is quantitative research methods, particularly those that link social epidemiology, behavioural economics, mathematical modelling and economic evaluation. We are specialists in developing disease, behavioural and economic models that pull in information and processes from a range of spheres from biology and human behaviour to economics and health systems. We emphasise policy impact, and regularly engage in advisory bodies on methods, policy and priority setting in global health.

“My definition of “interventions” includes both the biological (e.g. immune response) and societal action (e.g. immunisation).”

Professor Graham Medley

Team
Team Block

Graham
Medley

Professor

Anna
Vassall

Professor

Ala Alwan

Professor

Linda Amarfio

Project Coordinator

Nikita
Arora

Research Degree Student

Alaa Aziz

David
Bath

Research Fellow

Tara
Beattie

Associate Professor

Fiammetta
Bozzani

Research Fellow

Marc
DElbee

Research Fellow

Natalie Dial

Elizabeth
Fearon

Assistant Professor

Silke
Fernandes

Research Fellow

Anna
Foss

Associate Professor

Mitzy
Gafos

Associate Professor

Hollie Ann
Hatherell

Research Fellow

Pitchaya
Indravudh

Research Fellow

Heather Ingold

Research Degree Student

Yoko Laurence

Emily Nightingale

Research Fellow

Mamtuti
Panneh

Research Degree Student

Catherine
Pitt

Associate Professor

Matthew
Quaife

Assistant Professor

Nuru
Saadi

Project Administrator

Linda
Sande

Research Degree Student

Katherine
Snyman

Research Degree Student

Pooja Shah

Research Degree Student

Sedona
Sweeney

Assistant Professor

Sergio
TorresRueda

Research Fellow

Takuya Yamanaka

Research Degree Student
Projects
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An analytical framework for Test, Trace and Isolate in the UK: optimising and targeting deployment alongside other measures

We will develop a robust analytical framework to guide decisions about the deployment of Test, Trace and Isolate (TTI) to control the SARS CoV2 epidemic over the next 12 months. As the UK eases lockdown and workplaces, leisure venues and schools re-open, refining and targeting TTI is necessary to prevent the return of rapid exponential epidemic growth. This will require quick feedback, assessment and integration with real-time epidemiological, behavioural and operational data. We will develop mathematical models of SARS CoV2 transmission and TTI processes, to assess how TTI could be most effectively refined and targeted in association with other control measures, and to develop metrics to assess TTI performance. We will consider how both the design of the TTI system and environmental factors affect people's behaviour. We will respond to emerging questions but currently prioritise: 1) optimal combinations of TTI, screening and physical distancing measures, both to reduce transmission and to protect vulnerable groups; 2) appraisal of the role of behavioural responses to take up and adhere to TTI policies, including trade-offs and the consequences for how policies are supported; 3) signals to initiate stepped up intervention intensity; 4) assessment of our understanding of transmission patterns

People

ATLAS

The ATLAS programme (2019–21) aims to promote HIV self-testing (HIVST) in Côte d'Ivoire, Mali and Senegal, and to distribute half a million HIVST kits to:

  • key populations (sex workers, men who have sex with men, drug users)
  • partners of people living with HIV (PLHIV)
  • patients with sexually transmitted infections

The distribution of HIVST kits will be carried out through routine care under national AIDS strategies and integrated with existing screening policies.

The research components include a set of observational surveys to describe, analyse and understand the social, health, epidemiological and economic effects of the introduction of HIVST. The research is organised into give work packages:

  • a qualitative study including individual and group interviews with key implementers, members of key population communities and HIVST users
  • an ethnographic study on the integration of HIVST for screening of PLHIV’s partners in HIV care clinics
  • an anonymous telephone survey of HIVST users
  • an economic study of HIVST incremental costs with data collected from HIVST distribution sites and time and motion studies
  • epidemiological modelling of the health and economic impacts of different scenarios for scaled implementation

Outputs

The ATLAS project

People

Dates

2019 – 21

Using Computer Modelling to Optimise the Design of Health System Programmes (COSMIC)

Complexity science methods for optimising payment for performance interventions to strengthen health systems in low-resource settings.

For more information please visit the COSMIC website.

People

Dates

2018-22

DCP3 UHC Country Translation

The Disease Control Priorities 3 (DCP3) UHC Country Translation project is a multi-year project designed to respond to the increasing need of low and middle-income countries (LMICs) for technical guidance and support in priority setting and in accelerating progress towards Universal Health Coverage (UHC). The project is supported by the Bill & Melinda Gates Foundation and aims to enable decision makers in LMICs in allocating often tightly constrained budgets so that health system objectives are maximally achieved.

For more information please visit the DCP3 UHC Country Translation website.

People

HIV Self-Testing Africa (STAR)

Visit the STAR website to read more about this project.

People

Maisha Fiti

Please visit the Maisha Fiti website for more information about this project.

People

PRACTECAL-EE

Current treatment regimens for multi-drug resistant tuberculosis (MDR-TB) are long and poorly tolerated, with poor outcomes. Furthermore, the costs of treating MDR-TB are much greater than those for treating drug-susceptible TB, both the health service and patient-incurred costs. Urgent action is needed to identify short, effective, tolerable and cheaper treatments for people with both quinolone-susceptible and quinolone-resistant MDR-TB. PRACTECAL-EE is a sub-study alongside a clinical trial (TB-PRACTECAL) aiming to assess the costs to patients and providers of new regimens, as well as their cost-effectiveness and impact on participant poverty levels.

Outputs

TUBERCULOSIS: TB PRACTECAL - a cutting-edge clinical trial

People

Skin Health Africa Research Programme (SHARP) – Economic Evaluation

Skin disease is a leading cause of global chronic disease burden and morbidity in low-resource settings. Neglected tropical diseases (NTDs) of the skin, such as Buruli ulcer, cutaneous leishmaniasis, leprosy, and yaws, are often associated with physical disability, psychological distress, social exclusion, and financial hardship. In communities affected by skin NTDs, there is also an enormous burden of other more common skin diseases, which may also be associated with stigma and reduced quality of life and may confound the diagnosis of skin NTDs.

The Skin Health Africa Research Programme (SHARP) aims to identify strategies for improving experiences of severe and stigmatizing skin NTDs through three interlinked research projects. Funded by the National Institute for Health Research, SHARP is a 4-year (2019-2023), multi-disciplinary, multi-institutional collaboration to conduct research in Ghana and Ethiopia.

Economic Evaluation

SHARP comprises three interlinked research projects, each of which includes an economic evaluation: A cost-effectiveness analysis alongside a randomised-controlled trial to compare the effects of a novel wound dressing on the healing of Buruli ulcer in Ghana Analysis of the costs of illness and treatment and health-related quality of life as part of a cohort study of individuals diagnosed with cutaneous leishmaniasis in Ethiopia A cost-effectiveness analysis and contributions to formative research within a project to develop and test integrated case finding and management strategies for skin NTDs in Ghana and Ethiopia. Together, these economic evaluations seek to inform priority setting in Ghana, Ethiopia, and elsewhere regarding the implementation of strategies to improve the lives of people with skin NTDs.

People

Universally Accessible HIV Prevention Technologies for African Girls and Young Women through Knowledge Applied from Behavioural Economics (UPTAKE)

The UPTAKE study seeks to assess the behavioural determinants or uptake of marketed LA contraceptive and existing HIV LA-PrEP products in Kenya and Uganda as part of a package of screening, prophylactic and contraceptive options, to inform the product development of novel LA HIV prevention products and MPTs.

The objectives of the study are (i) to understand facilitators and barriers for uptake and access of future injectable and implantable LA-PrEP and multi-purpose prevention technologies to prevent HIV and unwanted pregnancies, (ii) to measure the strength of preferences for LA-PrEP and how these preferences are segmented by user profiles, (iii) to design interventions, that will be tested for their impact on retention of AGYW and FSWs to long-acting marketed contraceptive products, as models for adherence to LA-PrEP and (iv) to estimate cost and cost-effectiveness of LA-PrEP products and interventions that could be uniquely provided in the context of a suite of self-care sexual and reproductive health products.

This work is being done in partnership with Busara Center for Behavioural Economics, Stichting International AIDS Vaccine Initiative (IAVI), KAVI - Institute of Clinical Research (KAVI - ICR), and MRC/UVRI & LSHTM (MUL) Uganda Research Unit.

People

Dates

2020-23

Use of dynamic network models to explore the role of social media use in HIV transmission and health promotion among gay men and other MSM

This project, conducted through a Medical Research Council Skills Development Fellowship, explores the feasibility and value of data-driven dynamic sexual partnership network models of HIV transmission applied to intervention design, particularly to investigate the role of social media, in the context of men who have sex with men (MSM) in sub-Saharan Africa.

The majority of HIV transmission takes place between individuals via sexual contacts. At a population level, these partnerships can be viewed as connected into a dynamic sexual partnership network, whose structural and compositional characteristics influence, and are influenced by, the HIV epidemic. Although this is well understood, lack of data and a framework for utilising sampled network data and strategies for translating simulation findings into health promotion strategies has prevented the use of data-driven dynamic network mathematical models to inform the design of interventions in specific settings.

The way that individuals seek and form sexual partnerships is changing in many settings, and so plausibly are the characteristics of the sexual partnership network. A rapid rise in the use of online social media is occurring not only in high income settings, but also in sub-Saharan Africa. It is now both critical and feasible to develop a framework for data-driven dynamic partnership network models of HIV transmission, to understand the intersection of HIV acquisition and transmission risk with online socialising and partner-seeking, and to ensure that HIV prevention and engagement in care interventions can be most effectively designed and targeted.

A key group affected by HIV across the world is men who have sex with men (MSM), including in sub-Saharan Africa (SSA). Studies of MSM in SSA have found high HIV prevalence and incidence, alongside widespread experience of social stigma, violence, harassment and poor access to sexual health services. The incentives for MSM to socialise and seek partners online are high, and correspondingly, there is great potential to use online social media venues to provide information or referrals for in-person HIV prevention, testing and care services.

This project uses data from the TRANSFORM study on sexual partnerships, online and offline-initiated, HIV status and engagement in care, and social media use from representative samples of MSM from Nairobi and Johannesburg to develop dynamic network models of HIV transmission, explore the potential role of social media use in HIV transmission, and bring networks-based insight to improve targeting of health promotion and inform intervention development and future research to reduce HIV incidence.

People

TRANSFORM Study team:

  • Peter Weatherburn, LSHTM
  • Thesla Palanee-Philips, Wits RHIO
  • Joshua Kimani, PHDA, Uni Manitoba)
  • Adam Bourne, LaTrobe University
  • Adrian Smith, Uni Oxford

Project dates 

2018 – 22

Value TB

There is a dearth of tuberculosis (TB) cost data for specific countries and interventions to enable policy decisions. Data scarcity means that a number of resource allocation models developed in the past do not provide sound estimates of the cost-effectiveness of TB investments. This prevents both National TB Programmes and global organisations like the Global Fund for AIDS, TB and Malaria from allocating their resources in an efficient and fair way.

The overall aim of this project is to generate unit cost data TB diagnosis, treatment and prevention from five settings. The specific objectives are to:

  • estimate the resource requirements of TB programmes through collection and analysis of consistent and comparable data
  • make these data available to modellers, policy-makers, and other stakeholders to enable policy decisions and modelling of country costs

This work supplements the work by the Global Health Cost Consortium (GHCC) and the TB Modelling Consortium (TB-MAC).

People

Dates

2017 – 20

Studies

Countdown to 2030 Data Analysis Centre for Health Financing

Catherine Pitt

Effectiveness of bi-treated long lasting insecticidal nets and deployment strategy for control of malaria transmitted by pyrethroid resistant vectors

Catherine Pitt

FLACSAM

Yoko Laurence
2016 – 20

HIV+D

Yoko Laurence
2017 – 21

Managing COVID-19 epidemics in low- to middle-income and crisis affected settings: Epidemiological and economic evaluation

Fiammetta Bozzani
Nuru Saadi
Sergio Torres Rueda
Anna Vassall

Neonatal and Maternal Mortality Exemplars in Global Health

Catherine Pitt

Operational kangaroo Mother care before stabilisation among low birth Weight Neonates in Africa: RCT to examine mortality impact in Uganda (OMWaNa)

Catherine Pitt

NTD Modelling Consortium

Graham Medley

Setting the Post-Elimination Agenda for Kala-Azar in India (SPEAK)

Emily Nightingale
Graham Medley

Towards the interruption of transmission of soil-tranmitted helminths: Clinical research development of a fixed-dose co-fomulation of invermectin and albendazole (STOP)

Hollie Ann Hatherell
Graham Medley
Catherine Pitt

What Works

Sergio Torres Rueda
Anna Vassall