Close
Explore more Centres, Projects and Groups
Welcome
Welcome Banner
MRC Tropical Epidemiology Group

MRC Tropical Epidemiology Group

Improving health in low and middle income countries by conducting epidemiological studies of infectious diseases.

Bottom Content
About

TEG aims to improve health in LMICs by conducting research that identifies and evaluates effective interventions in infectious diseases and selected areas of increasing global public health importance.

About
About MRC Tropical Epidemiology Group 2 columns
About MRC Tropical Epidemiology Group
Paragraph
A number of the Group’s members at our Annual Retreat in September 2015.
A number of the Group’s members at our Annual Retreat in September 2015.

The MRC Tropical Epidemiology Group (TEG) led by Professor Helen Weiss, is based within the Department of Infectious Disease Epidemiology. The Group was established in 1972 and now comprises 34 statisticians and epidemiologists with a research portfolio of over 30 grants.  We conduct studies on the epidemiology and control of major public health problems of developing countries, with a major focus on HIV, tuberculosis, malaria and neglected tropical disease, and a special emphasis on intervention studies. The Group’s research is largely based in Africa and Asia.

Below are a few recent examples of where our work has had a significant impact on health policy and practice:

  • Results from the group’s studies in Tanzania have helped the Tanzanian national HPV vaccination programme to plan and implement HPV vaccination delivery strategies in Tanzania.
  • The World Health Organisation has produced policy recommendations for the management of SMC, based on the review of evidence which included pivotal work performed by members of TEG.
  • Group members helped to develop a new standard treatment regimen for visceral leishmaniasis which was incorporated into national treatment guidelines in Ethiopia, Kenya, Sudan and Uganda.
  • The work of TEG has influenced the World Health Organisation’s new guidelines on antiretroviral therapy with specific reference to task shifting and decentralisation in Africa.

Group members also have an active role in international technical and policy advisory groups to ensure that results from our studies are used to influence global policy, governance and guidelines.

MRC Tropical Epidemiology Group in the press

Lancet Profile   MRC Network article

History

Historical Overview of TEG’s Global Impact and Future Challenges

Over the last 40 years TEG has been involved in state-of-the-art intervention research in developing countries across an expansive range of research areas, including malaria, HIV, TB, vaccine-related diseases, maternal, neonatal and child health, non-communicable diseases, and methodology of cluster RCTs.

40th Anniversary Symposium, March 2012

Intervention research to improve health in developing countries: Progress and future challenges

To mark over 40 years of research on major health problems in developing countries, the Tropical Epidemiology Group hosted a symposium on “Intervention research to improve health in developing countries: Progress and future challenges”. The symposium took place on 29th and 30th March 2012 here at the London School of Hygiene & Tropical Medicine.

A distinguished panel of 30 international researchers spoke at the symposium, with a focus on the current status of interventions against major tropical diseases in the developing world and research priorities going forward.

TEG 40 year symposium programme

Presentations

Photographs

For more information contact us: teg@lshtm.ac.uk

 Left to right: Professor Kevin Decock, Symposium debate session and Professor Laura Rodrigues.

Overseas MRC Sites

Mwanza Intervention Trials Unit, Tanzania

We provide statistical support to researchers in the UK and overseas, and have for many years provided epidemiological and statistical support to the main MRC-funded research centres in Africa including the MRC research units in UgandaThe Gambia and the MRC supported Mwanza Intervention Trials Unit (MITU), in Tanzania. This includes helping with the design and conduct of studies, advising and guiding locally employed statisticians, collaborating with Unit researchers, and teaching on training courses in epidemiology, statistics and research methods (organised at the Units for local scientists).

We have also helped to create a clinical trials data centre at the Kenya Medical Research Institute, Nairobi, competent in GCP-compliant data management systems and electronic data capture.

MRC Field Station Basse, The Gambia and MRC/UVRI Uganda research Unit on AIDS.

Members
Members MRC Tropical Epidemiology Group
Neal Alexander

Neal Alexander
Professor in Medical Statistics and Epidemiology

Grey profile block

Philip Ayieko
Assistant Professor in Medical Statistics & Epidemiology

Kathy Baisley

Kathy Baisley
Associate Professor in
Epidemiology and
Medical Statistics

Christian Bottomley
Christian Bottomley
Associate Professor in
Epidemiology
& Medical Statistics
John Bradley
John Bradley
Assistant Professor in Medical Statistics and Epidemiology
Matthew Cairns
Matthew Cairns
Associate Professor in Epidemiology
Jackie Cook

Jackie Cook
Assistant Professor in Malaria Epidemiology

Aoife Doyle

Aoife Doyle
Assistant Professor in Epidemiology

Tansy Edwards

Tansy Edwards
Assistant Professor in Medical Statistics

Katherine Fielding

Katherine Fielding
Professor in Medical Statistics & Epidemiology

Sian Floyd

Sian Floyd
Associate Professor in Epidemiology and Medical Statistics

Suzanna Francis

Suzanna Francis
Assistant Professor in Epidemiology

Kate Greenaway

Kate Greenaway
Research Programme Coordinator

Daniel Grint

Daniel Grint
Assistant Professor in Medical Statistics and Epidemiology

Heiner Grosskurth

Heiner Grosskurth
Professor of Epidemiology and International Health

Grey profile block

Chris Grundy
Assistant Professor in Geographical Information Systems

Christian Hansen

Christian Hansen
Associate Professor in Medical Statistics and Epidemiology

Sarah Harman

Sarah Harman
Research Programme Manager

Richard Hayes

Richard Hayes
Professor of Epidemiology and International Health

Grey profile block

Min Kim
Research Fellow

Immo Kleinschmidt

Immo Kleinschmidt
Professor of Epidemiology

Grey profile block

Artemis Koukounari
Assistant Professor

David MacLeod

David MacLeod
Research Fellow in Medical Statistics

Paul Milligan

Paul Milligan
Professor in Medical Statistics and Epidemiology

Stephen Nash
Stephen Nash
Research Fellow in Medical Statistics
Melissa Neuman
Melissa Neuman
Assistant Professor in Epidemiology
Andrea Rehman
Andrea Rehman
Assistant Professor in Medical Statistics
Kalpana Sabapathy

Kalpana Sabapathy
Clinical Lecturer in Epidemiology

Grey profile block

Steven Saunders
Research Programme Administrator

Joanna Schellenberg

Joanna Schellenberg
Professor of Epidemiology and International Health

Victoria Simms
Victoria Simms
Assistant Professor in Epidemiology
Peter Smith
Peter Smith
Professor of Tropical Epidemiology
Grey profile block
Jennifer Thompson
Research Fellow
Emily Webb

Emily Webb
Associate Professor in Epidemiology and Medical Statistics

Helen Weiss

Helen Weiss
Head of Group, Professor of Epidemiology

Barbara Willey

Barbara Willey
Assistant Professor in Epidemiology

Research Degree Students

Studies On-going

PhD Student

Supervisor

Dissertation title

Abubaker Lule Neal Alexander Dengue transmission dynamics in Sri Lanka: evaluating spatial heterogeneity, transmission intensity, and the effect of population mobility
Alasdair Cook Simon Cousens Strategies to control salmonella infection in pigs
Augustine Choko Kathy Baisley Incidence of tuberculosis infection among adolescents in rural KwaZulu-Natal, South Africa
Benson Droti (DrPH) David Ross One month versus three months of ARV refills in Uganda
Chido Dziva Chikwari Christian Bottomley Reduction of early mortality among HIV-infected individuals on ART in Tanzania and Zambia
Claudia Hanson Joanna Schellenberg The epidemiology of maternal mortality in Southern Tanzania
Elhadji Ba Paul Milligan Establishing demographical surveillance system for monitoring serious adverse events and mortality in an area where seasonal IPTc is being implemented
Eugene Ruzagira Katherine Fielding Statistical design and analysis of cluster-randomised stepped wedge trials
Ghina Mumtaz Helen Weiss The epidemiology of HIV infection among high-risk populations in the Middle East and North Africa
Godfather Kimaro Katherine Fielding PArtner-provided HIV Self-Testing and Linkage (PASTAL) in antenatal care clinics: methodology and delivery of an adaptive cluster-randomised trial in Blantrye, Malawi
Gregory Kabadi Joanna Schellenberg Towards a new method for evaluating national maternal health programmes in Tanzania: measuring implementation strength of focused antenatal care and emergency obstetric care
Imran Morhasen-Bello Suzanna Francis The epidemiology of and risk factors for oro-genital and anal human papillomavirus infections among sexually active Nigerians: A mixed methods study
Ivan Kasamba Heiner Grosskurth Effect of counselling on linkage to HIV care after home-based HIV testing in rural Uganda: An intervention study
Jennifer Thompson James Lewis Hypertension among the adult population in Lusaka province: prevalence, determinants, awareness and control
Joel Francis Heiner Grosskurth/Helen Weiss Epidemiology of alcohol use disorders and their contribution to STIs and HIV in Tanzania
Kalpana Sabapathy Richard Hayes From Testing to Treatment in PopART/HPTN 071 – Factors associated with the uptake of interventions and the impact on clinical status of patients presenting for care
Kate Sabot (DrPH) Joanna Schellenberg Evaluating factors that determine the effectiveness of national scale-up of community health worker models to reduce maternal and neonatal mortality in sub-Saharan Africa
Lori Miller Richard Hayes Measurement of adherence in microbicides effectiveness trials
Margaret Tembo Victoria Simms Index-linked HIV testing of children and adolescents
Monica Kuteesa Emily Webb The effect of helminth infection on insulin resistance and type 2 diabetes in rural and urban Uganda
Mzembe Themba Emily Webb Investigating the impact of pre-natal, early-life and genetic exposures on blood pressure among Ugandan adolescents, using data from a tropical birth cohort
Pamela Muniina Sian Floyd The impact of adult HIV infection and mortality on household composition, family structure, and household welfare in rural south-west Uganda, 1989-2006
Philippa West Immo Kleinschmidt Investigating the complementary use of two malaria vector control methods: A cluster randomised control trial in Northwest Tanzania
Pierre Martel Simon Cousens Measuring child mortality
Richard Sanya Emily Webb Epidemiology of HIV and substance abuse among young key populations in sub-Saharan Africa
Ronnie Kasirye Heiner Grosskurth/Emily Webb Whether to stop or continue cortimoxazide in HIV affected adults on ART
Sachin Shinde Helen Weiss The role and impact of social capital on risk behaviours and wellbeing in adolescents from secondary schools
Sapna Desai Simon Cousens The effect of community health worker-led group education on women’s health and utilisation of health insurance: A cluster randomised trial in Gujarat, India
Sonali Nayantara Wijayanandana Helen Weiss Epidemiology and prevention of HIV in a cohort of women involved in high risk sexual behaviour in Kampala
Stefanie Dringus David Ross Sports-based HIV prevention programme
Stephen Gichuhi Matthew Burton/Helen Weiss The epidemiology and management of ocular surface squamous neoplasia in Kenya
Yusuke Shimakawa Christian Bottomley Natural history of chronic hepatitis B infection in the Gambia, West Africa
Zachery Kaufman David Ross Sport-based HIV prevention in South African schools: a cluster RCT
Studies Completed

Name

Supervisor

Title

Anatoli Kamali Richard Hayes Research on the epidemiology and prevention of HIV in rural South West Uganda, 1989-2010 (City University, London)
Anita Ramesh Neal Alexander The role of residential proximity to public and private water sources in lymphatic filariasis
Anthony Ngugi Immo Kleinschmidt Prevalence, incidence and mortality of epilepsy in four health and demographic surveillance sites in Sub-Saharan Africa
Erin Anastasi (DrPH) Sian Floyd Between women’s use of antenatal care and skilled birth attendance? A case study in Northern Uganda
Intira Collins Shabbar Jaffar Outcomes and cost-effectiveness of anti retroviral treatment in HIV-affected children in Thailand
Joel Francis Heiner Grosskurth Epidemiology of alcohol use and alcohol use disorders (AUD) among young people in Northern Tanzania
Joel Francis Heiner Grosskurth Effect of cotrimoxazole on malaria in HIV-infected patients on antiretroviral therapy
Joshua Mendelsohn David Ross Is forced displacement a barrier to acceptable treatment outcomes among refugees on antiretroviral therapy? A field study in Malaysia and Kenya
Laura Ferguson David Ross Linking women who test HIV-positive in pregnancy-related services to HIV care and treatment services in Kenya: missed opportunities
Michael Wallace Simon Cousens Facilitating correction for classical covariate measurement error
Peter Horby Neal Alexander Avian, inter-pandemic, and pandemic influenza in Vietnam
Rebecca Geary Emily Webb Geographic access to health facilities and child survival in rural Ethiopia
Ronnie Kasirye Emily Webb Youth-friendly health services: a critical investigation of provision and young people’s experiences in South Africa
Salome Charalambous Katherine Fielding A study to identify clinic-level factors which may determine clinical outcomes on antiretroviral therapy (ART) in patients attending primary health clinics in South Africa
Samuel Biraro Helen Weiss Herpes Simplex Virus type-2: Epidemiological trends and relation with trends in HIV incidence and HIV transmission in south-western Uganda
Stephen Gichuhi Helen Weiss The epidemiology of alcohol use among young people in Tanzania
Susan Mavedzenge-Napierala Helen Weiss The epidemiology of Mycoplasma genitalium and HIV infection
Suzanna Francis Richard Hayes Are intravaginal practices a risk factor for HIV acquisition: An in-depth exploration of highly prevalent behaviours among women at high risk of HIV infection in Tanzania and Uganda (Awarded Cicely Williams Prize)
Yemisrach Okwaraji Helen Weiss
Publications
Publications MRC Tropical 2 columns
Publications MRC Tropical
Paragraph

TEG’s publications are collected and stored in LSHTM’s online central database Research Online. This database provides direct access to all of TEG’s papers.

Please visit the link below to view TEG’s outputs:

Tropical Epidemiology Group’s publications database

Fellowship Scheme
Fellowship Scheme MRC Tropical Epidemiology Group 2 columns
Fellowship Scheme MRC Tropical Epidemiology Group
Paragraph

About the scheme

We are particularly proud of our TEG Training Fellowship Scheme, launched in 2005, which forms a key part of TEG’s investment in capacity development strategy. The Scheme provides support for promising research students from Sub-Saharan Africa to undertake MSc training in Medical Statistics at LSHTM followed by a year working as a statistician at one of our partner centres in Africa. The fellow continues to receive mentoring, supervision and support for the duration of their fellowship from members of our Group.

The summer project, chosen by the fellow, often provides an introduction to the research topic to be pursued further during the placement year. During the placement year, the fellow is exposed to different aspects of research including study design, data management, analysis and reporting of findings. They are guided by local statisticians and researchers as well as relevant TEG members.

The Scheme has been well received and is now very competitive, with over 100 applications each year. The majority of our fellows are now either working in medical research posts at research institutions in Africa, or are engaged in PhD studies.

How to apply

TEG Postgraduate Training Fellowship in Medical Statistics for African Scientists

Two fellowships, funded by the UK Medical Research Council (MRC) and GSK respectively, provide support for two years training in medical statistics.  For the first year the successful applicants will study for the MSc degree in Medical Statistics at the London School of Hygiene & Tropical Medicine (LSHTM).  This will be followed by a one-year professional attachment at one of the African centres associated with the research programme of the MRC Tropical Epidemiology Group (TEG) at LSHTM.  During the professional attachment, training Fellows will develop their statistical and research skills by working on studies with guidance from TEG scientists.

This support is intended to foster excellence in the field of medical statistics and epidemiology in sub-Saharan Africa.  The fellowship will provide costs for fees, stipend (£16,400 per annum) and return air travel.

To be eligible, candidates must:

(i) be resident in and a national of a country in sub-Saharan Africa
(ii) be in possession of an excellent degree in mathematics or statistics
(iii) have at least 1 year of work experience in medical statistics or epidemiology

Support will not be given as a supplement to other funding, nor to students who have funding from other sources.

How to apply for the Fellowship:

Candidates should complete an application form and provide a curriculum vitae, two references, and an academic transcript.  An application form and referee form can be downloaded below:

Application form      Referee form

Applications received after the closing date will not be considered.  Short-listed candidates will be interviewed by telephone and if successful, may be required to undertake an English language assessment.

Completed application forms, curricula vitae, academic transcripts and references should be emailed to: teg@lshtm.ac.uk.

Please include “TEG Fellowship Application” and your name in the subject line.

Applications for the 2019 TEG Fellowship will open early next year.

Enquiries

Further information on the MSc in Medical Statistics can be found on the course page.
Informal enquiries concerning the scholarship can be made to John Bradley.
Informal enquiries concerning the MSc can be made to the Admissions Tutors, Jenny Nicholas and Amy Mulick.
Further information about visa requirements can be found here.

Current TEG Fellows

 

Thomas Gachie, from Kenya

Thomas is currently completing the Medical Statistics MSc at LSHTM.

2015-2017 TEG Fellowship

 

Miriam Wathuo, from Kenya

Miriam completed the Medical Statistics MSc in 2015/16 and her subsequent placement year at the MRC Unit, The Gambia. Following this, the MRC Unit employed Miriam as a Statistician.

2014-2016 TEG Fellowship

 

Sarah Mulwa, from Kenya

Completed the Medical Statistics MSc at LSHTM and subsequent placement at MRC Unit, The Gambia.

Abdul Muhammad, from The Gambia

Completed the Medical Statistics MSc at LSHTM and subsequent placement at Mwanza Intervention Trials Unit, Tanzania.

Bernard Chasekwa, from Zimbabwe

 Was awarded a one year Fellowship and completed the Medical Statistics MSc at LSHTM.

For the TEG funded Fellowship round for 2014-2016 we were able to support three fellows rather than the usual one, thanks to additional support from the School’s Faculty of Epidemiology and Population Health and the Medical Statistics Department. The Faculty provided funding for Abdul’s fellowship and the Medical Statistics Department provided funding for Bernard. We extend our thanks to both the Faculty and the Department for this additional support.

EDCTP Fellowships 2014/15

TEG were awarded 3 Master’s Fellowships in Epidemiology and Medical Statistics funded by a call from the European & Developing Countries Clinical Trials Partnership (EDCTP).

Joseph Musaazi, from Uganda

Completed the Medical Statistics MSc at LSHTM and currently completing placement at Infectious Diseases Institute (IDI), Uganda.

Sungai Chabata, from Zimbabwe

Completed the Medical Statistics MSc at LSHTM and currently completing placement at Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Zimbabwe.

Patience Nyakato, from Uganda

Completed the Medical Statistics MSc at LSHTM and currently completing placement at Infectious Diseases Institute (IDI), Uganda.

Previous TEG Fellows at the Group’s 40th Symposium (from left to right: Nakua Emmanuel Kweku, Phellister Nakamya and Tim Awine).

Previous TEG Fellows at the Group’s 40th Symposium (from left to right: Nakua Emmanuel Kweku, Phellister Nakamya and Tim Awine).

Updates on previous fellows’ progress

  • Sylvia Kiwuwa Muyingo (2003-2005) successfully completed a PhD in June 2012 and is now working as a statistician at the MRC/UVRI Unit, Uganda.
  • Emmanuel Kweku Nakua (2004-2006) is a lecturer in Biostatistics based in Ghana and started a doctoral degree in Sept 2013.
  • Tim Awine (2005-2007) is currently working as a medical statistician in Northern Ghana.
  • Phellister Nakamya (2006-2008) is now a distance learning tutor for LSHTM and Monitoring and Evaluation Specialist for the Uganda Country Coordinating Mechanism.
  • Nuredin Ibrahim Mohammed (2008-2010) is currently studying for a PhD at the University of Birmingham.
  • Evans Muchiri (2009-2011) is working with Wits Reproductive Health & HIV Institute in South Africa.
  • James Jafali (2010-2012)  is studying for a PhD in Bioinformatics in Edinburgh.
  • Bernard Chasekwa (2014-2016) is employed as a Senior Biostatistician at Zvitambo Institute of Maternal and Child Health Research in Harare, Zimbabwe. The institute is currently conducting Sanitation Hygiene and Nutrition Efficacy (SHINE) trial. This community-based cluster randomized trial in two rural districts of Zimbabwe. Details of this trial can be found here
  • Abdul Muhammad (2014-2016) is currently working at the Medical Research Council Unit, The Gambia.
  • Sarah Mulwa (2014-2016) has recently accepted a job at Stellenbosch University in South Africa.
Research
Research MRC Tropical Epidemiology Group 2 columns
Research MRC Tropical Epidemiology Group
Paragraph
Household survey team, Morogoro District, Tanzania, (c) Patrick Kachur, CDC

The MRC-funded Tropical Epidemiology Group (TEG) initiates epidemiological research and provides epidemiological and statistical expertise for research projects in resource-poor settings. The mission of the Group has remained the same over the past 40 years – to conduct research on the epidemiology and control of diseases of major public health importance in developing countries.  We focus primarily on statistics and epidemiology with an emphasis on conducting rigorously designed intervention studies, including i) randomised controlled trials (RCTs) to identify effective interventions against these diseases and (ii) research strategies to implement such interventions. Our expertise is constantly evolving and we have established expertise in mathematical modelling, data management, and public health. In addition we have good links with social scientists and health economists which adds a further dimension to our work.

Malaria

Girl collecting mosquito nets, central Africa.  Copyright Peter Vowles, DfID

The Group has an expanding research programme in malaria. In 2011-12, this ranged from trials of malaria vaccines, malaria vector control tools, seasonal malaria chemoprevention, delivery systems for effective treatment drugs and long-lasting insecticidal nets, to studies on the impact of insecticide resistance on malaria vector control, the evaluation of programmatic interventions, and the epidemiology of malaria elimination. We collaborate closely with scientists in the UK and malaria endemic countries, with international agencies and with national malaria control programmes and other local implementing partners.

Key Publications

Rehman AM, Mann AG, Schwabe C, Reddy MR, Roncon Gomes I, Slotman MA, Yellott L, Matias A, Caccone A, Nseng Nchama G, Kleinschmidt I (2013) Five years of malaria control in the continental region, Equatorial Guinea.Malaria Journal 12:154. doi: 10.1186/1475-2875-12-154.

West PA, Protopopoff N, Wright A, Kivaju Z, Tigererwa R, Mosha F, Kisinza W, Rowland M, Kleinschmidt I. Indoor residual house spraying in combination with insecticide treated nets compared to insecticide treated nets alone for protection against malaria: Results of a cluster randomised trial in Tanzania. PLoS Med 2014; 11(4): e1001630.

Staff working on malaria:

Theme Leader
Dr Immo Kleinschmidt


Neal Alexander
Paul Milligan
Emily Webb
John Bradley
Andrea Rehman
Barbara Willey
Matthew Cairns
Joanna Schellenberg
Clare Flach
Peter Smith

HIV and other Sexually Transmitted Infections

HIV/AIDS prevention projects in Mozambique. Copyright Sarah Bandali, LSHTM

We are involved in a number of studies which seek to better understand the dynamics of the HIV epidemic and its drivers as well as various randomised trials to evaluate HIV prevention and treatment strategies. The main aim of the Group’s work on HIV research is to evaluate prevention and treatment strategies. We continue our long-standing collaborations with the MRC/UVRI Unit in Uganda and MITU/NIMR in Tanzania, for example through the cohort of women at high risk in Kampala, which highlight the need for interventions to treat sexually transmitted infections (STIs), and to address alcohol use disorders in these vulnerable populations. There is increasing emphasis on the need for combination HIV prevention strategies, and the role of treatment as prevention. Mathematical models have predicted that test-and-treat interventions, in which the entire community is encouraged to access voluntary HIV testing with immediate onset of antiretroviral therapy (ART) for those infected (irrespective of CD4 count) may lead to steep reductions in HIV incidence. TEG has secured a major grant for the PopART trial, a three-arm cluster RCT in Zambia and South Africa that will evaluate the effectiveness of offering household-based HIV testing and offering immediate ART to all those testing positive.

Key Publications

Baisley K, Baeten JM, Hughes JP, Donnell DJ, Wang J, Hayes R, Jones DW, Celum C (2013) Summary Measures of Adherence Using Pill Counts in Two HIV Prevention Trials: The Need for Standardisation in Reporting. AIDS Behav. 17(9):3108-19. doi: 10.1007/s10461-013-0542-9.

Pathai S, Lawn SD, Gilbert CE, McGuinness D, McGlynn L, Weiss HA, Port J, Christ T, Barclay K, Wood R, Bekker LG, Shiels PG (2013) Accelerated biological aging in HIV-infected individuals in South Africa: a case-control study. AIDS. 27(15):2375-84. doi: 10.1097/QAD.0b013e328363bf7f.

Staff working on HIV & STIs:

Theme Leader
Professor Helen Weiss

Kathy Baisley
Sian Floyd
James Lewis
Emily Webb
John Bradley
Suzanna Francis
Andrea Rehman
Aoife Doyle
Heiner Grosskurth
Kalpana Sabapathy
Katherine Fielding
Richard Hayes
Victoria Simms

Tuberculosis

Sputum smear reading for the OFLOTUB project, Conakry, Guinea

The TB research conducted by the Group consists of a broad range of studies including large-scale trials of treatment strategies for patients co-infected with TB and HIV to reduce mortality, studies to assess how new TB diagnostics can improve outcomes among TB suspects and patients, and the effect of earlier initiation of antiretroviral therapy (ART) in HIV-positive individuals on the incidence and prevalence of TB. Through its role as the Biostatistics Core of the Bill and Melinda Gates Foundation-funded Consortium to Respond Effectively to the AIDS and TB Epidemics (CREATE) programme, TEG was pivotal to the recent successful completion of two major cluster RCTs of interventions to control TB in HIV endemic settings. Results of these trials, the ZAMSTAR and Thibela TB studies, were presented at international meetings in 2011 and 2012 and published in peer-reviewed journals. We presented the findings of the OFLOTUB study, a Phase III study of a TB treatment-shortening regimen for drug sensitive TB, at an international meeting in late 2013, which is currently being written up for publication.  The Group’s work on the RAFA project has been extended into 2014 and we hope to have initial results available in early 2015. The work of the Group continues to expand with a new 6-year cluster RCT  soon to start in Lima, Peru. This is a socioeconomic intervention aiming to reduce further TB and mortality in TB-affected households.

Key Publications

Churchyard GJ, Fielding KL, Lewis JJ, Coetzee L, Corbett EL, Godfrey-Faussett P, Hayes RJ, Chaisson RE, Grant AD, Thibela TB Study Team (2014) A trial of mass isoniazid preventive therapy for tuberculosis control. The New England Journal of Medicine, 370(4): 301-10. ISSN 0028-4793 DOI: 10.1056/NEJMoa1214289

Ayles H, Muyoyeta M, Du Toit E, Schaap A, Floyd S, Simwinga M, Shanaube K, Chishinga N, Bond V, Dunbar R, De Haas P, James A, Gey van Pittius NC, Claassens M, Fielding K, Fenty J, Sismanidis C, Hayes RJ, Beyers N, Godfrey-Faussett P; ZAMSTAR team (2013) Effect of household and community interventions on the burden of tuberculosis in southern Africa: the ZAMSTAR community-randomised trial.  Lancet 382(9899):1183-94. doi: 10.1016/S0140-6736(13)61131-9.

Staff working on Tuberculosis:

Theme Leader
Katherine Fielding

Sian Floyd
Victoria Simms
Richard Hayes
Emily Webb
James Lewis

Neglected Tropical Diseases (NTDs)

Community lay workers at home with participants in the MANAS trial, (c) Vikram Patel

The Group has significant research activity on neglected tropical diseases, with ongoing research projects on trachoma, visceral leishmaniasis, helminth infections, and epilepsy. Several important studies were completed in 2011-12, including innovative trials of the management of trachomatous trichiasis in Ethiopia, a trial of short course combination treatment for visceral leishmaniasis, now incorporated into treatment guidelines for East Africa and completion of a 5-year follow-up of the Entebbe Mother and Baby Study, which found no association between helminth infections and their treatment on incidence of other infectious diseases and eczema.

Key Publications:

Edwards T, Smith J, Sturrock HJ, Kur LW, Sabasio A, Finn TP, Lado M, Haddad D, Kolaczinski JH (2012) Prevalence of trachoma in Unity State, South Sudan: results from a large-scale population-based survey and potential implications for further surveys.PLoS Negl Trop Dis, 6(4):e1585. doi: 10.1371/journal.pntd.0001585.

Musa A, Khalil E, Hailu A, Olobo J, Balasegaram M, Omollo R, Edwards T, Rashid J, Mbui J, Musa B, Abuzaid AA, Ahmed O, Fadlalla A, El-Hassan A, Mueller M, Mucee G, Njoroge S, Manduku V, Mutuma G, Apadet L, Lodenyo H, Mutea D, Kirigi G, Yifru S, Mengistu G, Hurissa Z, Hailu W, Weldegebreal T, Tafes H, Mekonnen Y, Makonnen E, Ndegwa S, Sagaki P, Kimutai R, Kesusu J, Owiti R, Ellis S, Wasunna M (2012) Sodium stibogluconate (SSG) & paromomycin combination compared to SSG for visceral leishmaniasis in East Africa: a randomised controlled trial. PLoS Negl Trop Dis 6(6):e1674. doi: 10.1371/journal.pntd.0001674.

Staff working on NTDs:

Theme Leader
Professor Peter Smith

Neal Alexander
Emily Webb
Christian Bottomley
Helen Weiss
Tansy Edwards

Non-communicable Diseases and Mental Health

Late breakfast in Lilongwe, Milawi

Non-communicable diseases, including mental health disorders, are responsible for an increasing burden of disease in Africa and other low-resource settings. Our work focuses largely on defining the burden of these conditions and evaluating programmatic interventions such as task-shifting, to improve diagnosis and treatment.

Current studies that TEG are involved in include i) a programme of health systems research on the control of non-communicable diseases in Tanzania and Uganda, ii) collaboration with the Malawi Epidemiology and Intervention Research Unit (MEIRU) to examine the prevalence of, and risk factors for, hypertension, diabetes and hyperlipidaemia in rural and urban Malawi; and iii) a series of randomised controlled trials evaluating psychological interventions delivered by lay health workers in India and Pakistan.

Key Publications

Nyirenda MJ, Amberbir A, Jaffar S. Understanding local Determinants of non-communicable diseases in sub-Sahara Africa. BMC Medicine (2014) in press.

Chatterjee S, Naik S, John S, Dabholkar H, Balaji M, Koschorke M, Varghese M, Thara R, Weiss HA, Williams P, Patel V, Thornicroft G. Effectiveness of a community-based intervention for people with schizophrenia and their caregivers in India: the COPSI randomized controlled trial. Lancet (2014) in press.

Jaffar S, Amberbir A, Kayuni N, Musicha C, Nyirenda M. Scaling up testing services for non-communicable diseases in Africa: priorities for implementation research. Trop Med Int Health. (2013) Sep 4. doi: 10.1111/tmi.12180 (viewpoint).

Atun R, Jaffar S, Nishtar S, Knaul FM, Barreto ML, Nyirenda M, Banatvala N, Piot P. Improving responsiveness of health systems to non-communicable diseases. Lancet. (2013);381:690-7.

Ebrahim S, Pearce N, Smeeth L, Casas JP, Jaffar S, Piot P. Tackling non-communicable diseases in low- and middle-income countries: is the evidence from high-income countries all we need? PLoS Med. (2013);10(1):e1001377. doi: 10.1371/journal.pmed.1001377.

Staff working on Non-communicable Diseases and Mental Health:

Theme Leader
Professor Shabbar Jaffar

Kathy Baisley
Heiner Grosskurth
Fiona Ewings
Helen Weiss

Methodology

Community health worker waits for rapid diagnostic test results on baby in Ghanian village of Takorasi. Copyright, LSHTM.

One of the Group’s objectives is to develop novel study designs and statistical and epidemiological methods, to facilitate interventions against within out priority diseases. Our ideas are motivated by problems we have found on the ground, and facilitated by the many and varied datasets we have helped generate. The major activity is mathematical modelling of HIV/AIDS, malaria, TB and pneumococcal pneumonia. These studies are designed to supplement the empirical data and increase our understanding of the determinants of disease, explore the effects of alternative interventions in different population settings and raise future research hypotheses.

We publish methodological papers in three main areas:

1. Randomised trial and other study designs, including endpoint selection, with emphasis on parasitological and entomological outcomes.

2. Causal inference, which seeks to estimate the strengths of relationships based on models of dependence.

3. Survey design and behavioural measurement, motivated by studies of HIV and other STIs.

Key Publications

Wolbers M, Kleinschmidt I, Simmons CP, Donnelly CA (2012) Considerations in the design of clinical trials to test novel entomological approaches to dengue control. PLoS Negl Trop Dis 6(11):e1937. doi: 10.1371/journal.pntd.0001937.

Alexander N (2012) Analysis of parasite and other skewed counts. Trop Med Int Health 17:684-693. doi: 10.1111/j.1365-3156.2012.02987

Daniel RM, Kenward MG, Cousens SN, De Stavola BL (2012) Using causal diagrams to guide analysis in missing data problems. Stat Meth Med Res 21(3):243-56. doi: 10.1177/0962280210394469.

McCreesh N, Frost SD, Seeley J, Katongole J, Tarsh MN, Ndunguse R, Jichi F, Lunel NL,  Maher D, Johnston LG, Sonnenberg P, Copas AJ, Hayes RJ, White RG (2012) Evaluation of respondent-driven sampling. Epidemiology 23(1):138-47. doi: 10.1097/EDE.0b013e31823ac17c

Staff working on methodology:

Theme Leader
Dr Neal Alexander

Christian Bottomley
Peter Smith
Richard Hayes

TEG’s Global Partnerships and Projects

Access our interactive map that represents all of TEGs global projects and partnerships. You can hover your mouse over a marker to see key information about each project. To magnify any given area, please hover you mouse over any overlapping project markers.

For any more information about any of the projects represented on this map please e-mail teg@lshtm.ac.uk.