We focus on interventions that bridge social, behavioural and public health action across a range of disease issues.
Health economists, social epidemiologists and disease modellers, we draw on spheres from biology to economics to health systems, to advise on policy and practice.
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
Research Degree Student
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
2019 – 21
Visit the STAR website to read more about this project.
- 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).
2017 – 20
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.
- 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.
Thomas House, University of Manchester
TRANSFORM Study team:
- Peter Weatherburn (LSHTM)
- Thesla Palanee-Philips (Wits RHIO)
- Joshua Kimani (PHDA, Uni Manitoba)
- Adam Bourne (LaTrobe University)
- Adrian Smith (Uni Oxford)
2018 – 22
- 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
- Maisha Fiti
Please visit the Maisha Fiti website for more information about this project.
- Tara Beattie
Countdown to 2030 Data Analysis Centre for Health Financing
Sergio Torres Rueda
Effectiveness of bi-treated long lasting insecticidal nets and deployment strategy for control of malaria transmitted by pyrethroid resistant vectors
2016 – 20
2017 – 21
Managing COVID-19 epidemics in low- to middle-income and crisis affected settings: Epidemiological and economic evaluation
Sergio Torres Rueda
Neonatal and Maternal Mortality Exemplars in Global Health
OMWaNa: Operational kangaroo Mother care before stabilisation among low birth Weight Neonates in Africa: RCT to examine mortality impact in Uganda
SHARP: Improving experiences of severe stigmatising skin diseases in Ghana and Ethiopia
STOP: Towards the interruption of transmission of soil-tranmitted helminths: Clinical research development of a fixed-dose co-fomulation of invermectin and albendazole
Hollie Ann Hatherell
Sergio Torres Rueda