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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

The Evaluation of Social and Population Health Interventions (ESPHI) group is one of six research groups in the Department of Global Health and Development, bringing together health economists, social epidemiologists, mathematical epidemiologists, and social scientists. We draw on spheres from biology to economics to health systems, to advise on policy and practice.

About
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ESPHI in an interdisciplinary research space that brings together health economists, social epidemiologists, mathematical epidemiologists, and social scientists to collaborate and improve global health. We work across a wide variety of diseases issues, including communicable diseases (e.g., HIV, TB, malaria, COVID-19, STIs) including neglected tropical diseases (e.g., visceral leishmaniases), and non-communicable diseases (e.g., diabetes, cardiovascular disease, respiratory disease, cancers), and societal and wellbeing issues (e.g., health systems research, child health, mental health, violence, addiction). We conduct multi-regional global research. Lastly, we use multi-dimensional approaches that bridge structural, social, behavioural and clinical 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

Linda Amarfio

Project Coordinator

Nikita
Arora

Research Fellow

Alaa Aziz

Research Degree Student

David
Bath

Research Fellow

Tara
Beattie

Associate Professor

Alicja Beksinska

Research Fellow

Fiammetta
Bozzani

Assistant Professor

Natalie Dial

Research Fellow

Elizabeth
Fearon

Assistant Professor

Anna
Foss

Associate Professor

Mitzy
Gafos

Professor

Rosalie
Hayes

Research Assistant

Pitchaya
Indravudh

Research Fellow

Heather
Ingold

Research Degree Student

Joseph Kazibwe

Assistant Technical Analyst

Emilie
Koum Besson

Research Fellow

Lebohang Letsela

Research Degree Student

Laura
Lunani

Research Degree Student

Andres Madriz-Montero

Research Assistant

Graham
Medley

Professor

Yolanda Moyo

Research Degree Student

Cassandra
Nemzoff

Research Degree Student

Mwansa
Njelesani

Research Degree Student

Mamtuti
Panneh

Research Degree Student

Catherine
Pitt

Associate Professor

Frances Ruiz

Senior Policy Fellow

Linda
Sande

Research Degree Student

Pooja
Shah

Research Degree Student

Maninder Pal Singh

Research Assistant

Katherine
Snyman

Research Degree Student

Sedona
Sweeney

Assistant Professor

Sergio
TorresRueda

Research Fellow

Jahanzaib Sohail

Research Degree Student

Rossana To

Project Administrator

Anna
Vassall

Professor

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

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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

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Dates

2019 – 21

CBIG-SCREEN

CBIG-SCREEN aims to overcome and reduce any barriers to cervical cancer screening and pilot interventions with strategic outcomes to inform policy making to be updated after the decision is made on the categorisation of vulnerable groups.

The key objectives are to:

  • Make the offer of screening more attractive
  • More accessible
  • More acceptable to vulnerable women
  • And ensure they are not left out in the follow up if necessary

The consortium will work in collaboration with women to identify and develop strategies, programmes and communications and other services to meet individual needs to develop recommendations.

Secondary objectives are:

  • Tackle inequality in cervical cancer screening
  • Create a Europe wide knowledge framework around barriers to CCS
  • Achieving the WHO 2030 target of screening >70% of women for cervical cancer

Project dates

  • Second ‘Meet & Greet’ Meeting 31 May 2022
  • First annual Consortium Meeting 25 March 2022
  • First CBIG-SCREEN annual consortium meeting 09 March 2022
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.

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Dates

2018-22

Countdown to 2030 Data Analysis Centre for Health Financing

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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.

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Health Economics Research Strategy

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Dates

2020-21

HIV +D

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Papers

Dates

2017-21

International Decision Support Initiative (iDSI)

Strengthening and scaling countries' institutional capacities to make better decisions for health.

Background/overview

The International Decision Support Initiative (iDSI) is a network of priority setting institutions that have, since 2013, supported the use of evidence in healthcare decision-making in low- and middle-income countries across the world.

LSHTM became an iDSI core partner in June 2021, leveraging its substantial existing expertise in cost-effectiveness analysis and global health. LSHTM also has extensive experience working with current and past iDSI partners including KEMRI-Wellcome in Kenya, and Thailand’s HITAP. The iDSI-LSHTM team is located within the Department of Global Health and Development.

iDSI responds to demand for government-to-government knowledge sharing to establish and sustain evidence-informed and procedurally fair mechanisms for better priority-setting in health. These include supporting the delivery of:

  • High quality Health Technology Assessments (HTAs) for a variety of interventional types
  • Supporting the use of other evidence-informed methods for priority-setting, including Clinical Guidelines and Quality Standards.

The mission

iDSI’s mission emphasizes the importance of developing capacity for robust technical analyses in the context of procedurally fair governance mechanisms in order to optimise resource allocation. It also stresses the need to develop adequate implementation strategies for any evidence informed outputs (e.g., linked changes to provider payment, education and regulation) to ensure impact of the priority setting process.

It aims to achieve this through:

(a) practical support (hands-on process support and institution strengthening)

(b) knowledge products (high quality, policy-relevant research) and

(c) fit-for-purpose capacity building and awareness raising.

iDSIplus (2018-2023) aims to build upon the achievements of iDSI by working with policymaker counterparts to embed evidence and good governance into domestic investment decisions at national and subnational levels in a number of countries including Kenya, Ghana, India and Rwanda. 

iDSIplus seeks to help countries to develop sustainable mechanisms for effective, evidence-informed priority-setting, and will involve mobilising a wide range of capacities among country stakeholders including the technical capacity to “do” research in economic evaluations.

Team

  • Anna Vassall – Professor
  • Francis Ruiz – Senior Policy Fellow
  • Joseph Kazibwe – Assistant Technical Analyst
  • Sergio Torres Rueda – Research Fellow
  • Andres Madriz Montero – Research Assistant
  • Linda Amarfio – Project Coordinator
  • Rossana To – Project Administrator
  • Cassie Nemzoff – PhD student

Publications

The COVID HTA blogs with CGD; Yang’s pre-print looking at the cost-effectiveness of Covid vaccination across the African Union

Maybe some select iDSI relevant publications

  • Chi, Y. L., Blecher, M., Chalkidou, K., Culyer, A., Claxton, K., Edoka, I., Glassman, A., Kreif, N., Jones, I., Mirelman, A. J., Nadjib, M., Morton, A., Norheim, O. F., Ochalek, J., Prinja, S., Ruiz, F., Teerawattananon, Y., Vassall, A., & Winch, A. (2020). What next after GDP-based cost-effectiveness thresholds?. Gates open research4, 176. https://doi.org/10.12688/gatesopenres.13201.1
  • Saadi, N., Chi, Y. L., Ghosh, S., Eggo, R. M., McCarthy, C. V., Quaife, M., Dawa, J., Jit, M., & Vassall, A. (2021). Models of COVID-19 vaccine prioritisation: a systematic literature search and narrative review. BMC medicine19(1), 318. https://doi.org/10.1186/s12916-021-02190-3
  • Hollingworth, S., Fenny, A. P., Yu, S. Y., Ruiz, F., & Chalkidou, K. (2021). Health technology assessment in sub-Saharan Africa: a descriptive analysis and narrative synthesis. Cost effectiveness and resource allocation : C/E19(1), 39. https://doi.org/10.1186/s12962-021-00293-5
  • Nemzoff, C., Ruiz, F., Chalkidou, K., Mehndiratta, A., Guinness, L., Cluzeau, F., & Shah, H. (2021). Adaptive health technology assessment to facilitate priority setting in low- and middle-income countries. BMJ global health6(4), e004549. https://doi.org/10.1136/bmjgh-2020-004549
Maisha Fiti

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

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

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Neonatal and Maternal Mortality Exemplars in Global Health

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

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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

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PrEP delivery to PWID in Myanmar

LSHTM are working with UNAIDS and Myanmar’s Ministry of Health and Sport (MoHS) to provide evidence-based technical support for the development of an Operational Protocol on PrEP implementation among people who inject drugs (PWID) in Myanmar. The main purpose of the project is to:

  • Develop an operational protocol and evaluation framework for PrEP implementation among people who inject drugs in Myanmar.  
  • Develop training materials for the selected implementer(s) on the operational and evaluation designs in Waingmaw Township in Kachin State and Lashio Township in Shan State. 
  • Provide off-site technical support for the set-up of the operational protocol and evaluation framework. 
  • Provide remote technical input to make necessary adjustments during the implementation phase and evaluation of results

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Sustainable Development Goal: Health and Wellbeing (SDG-HaW) Research Consortium

Please visit the SDG-HaW website for more information about this project.

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

Please visit the SPEAK website for more information about this project.

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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.

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

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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.

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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.

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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

What Works

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Completed projects 

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).

Resources and papers

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Dates

  • 2017 - 20