The mission of the MRC Tropical Epidemiology Group (TEG) is to help improve health in low- and middle-income countries (LMICs) by conducting research that identifies and evaluates effective interventions
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 low and middle income countries, with a major focus on HIV, tuberculosis, malaria, and emerging and neglected diseases, 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:
- A large-scale stepped wedge trial of seasonal malaria chemoprevention (SMC) in Senegal which established its safety and effectiveness at scale, with administration of ~1 million antimalarial courses
- The ZAMSTAR trial in southern Africa which found that household interventions were associated with a reduction in TB prevalence and transmission
- The REMSTART trial in Tanzania and Zambia which found that screening & pre-emptive treatment for cryptococcal infection in people living with HIV combined with a short period of adherence support substantially reduces mortality
- The HPTN 071 (PopART) trial to evaluate the impact of a universal test-and-treat intervention on population-level HIV incidence in southern Africa which has found substantial increases in the coverage of HIV testing and treatment after just one year of the community-wide intervention
- The Oflotub study of a 4-month gatifloxacin-containing regimen vs. standard 6-month treatment for drug sensitive TB which showed the shorter regimen was safe but failed to demonstrate non-inferiority
- Three randomised controlled trials (RCTs) in India and Zimbabwe which showed that trained lay counsellors can treat depression, anxiety and alcohol use disorders effectively and cost-effectively
- Rapid-response studies of the Ebola virus disease (EVD) outbreak, including a trial to assess the efficacy and safety of convalescent plasma for the treatment of EVD in Guinea
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.
Historical Overview of TEG’s Global Impact and Future Challenges
Since 1972, 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.
- Key collaborating institutes
Mwanza Intervention Trials Unit, Tanzania
We collaborate on statistics with multiple researchers, including the MRC/LSHTM research units in Uganda, The Gambia and the Mwanza Intervention Trials Unit (MITU), in Tanzania. This includes providing expertise on the design and conduct of studies, advising and mentoring locally employed statisticians and epidemiologists, collaborating with Unit researchers, and teaching on Unit training courses in epidemiology, statistics and research methods.
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.
Medical Statistics and Epidemiology
Medical Statistics and Epidemiology
Statistics Research Fellow and Data Specialist
Clinical Research Fellow
Clinical in Senior Lecturer
Data management/analysis at LSHTM
Research degree students
- Studies ongoing
Abdoulie Bojang Christian Bottomley Epidemiology of Staphylococcus aureus transmission, genetic diversity, and mechanisms of antimicrobial resistance Abubaker Lule 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 Aderonke Odutola Christian Bottomley Epidemiology of Staphylococcus aureus disease in rural Gambia Amy Sturt Emily Webb Inflammation and the vaginal microbiota in Zambian Women with Female Genital Schistosomiasis and their potential role in HIV acquisition Andrew Abaasa Stephen Nash Overcoming the uncertainty about effect size when extrapolating observational cohort data to planning efficacy trials: A randomised double blind and placebo controlled trial simulating HIV vaccine efficacy in fishing communities of Lake Victoria Uganda Arthi Vasantharoopan Vicky Simms HIV testing and counselling Cara O'Connor James Lewis Health systems strengthening - HIV medication adherance in the Philippines Chido Dziva Chikwari Vicky Simms Index-linked HIV testing of children and adolescents Elaine Flores Vicky Simms Mental health outcomes and possible resilience strategies associated with El Niño Southern Oscillation (ENSO) in the north coast of Peru Elhadji Ba Paul Milligan Inequalities in child survival in a rural area of Senegal where malaria incidence has declined Gautney Brad Kathy Baisley CRT of HIV paediatric HIV management system to improve retention in care Georgia Gore-Langton Matt Cairns Godfather Kimaro Christian Bottomley Reduction of early mortality among HIV-infected individuals on ART in Tanzania and Zambia Grazia Caleo Helen Weiss Epidemiology and control of Ebola virus disease in Sierra Leone Helen Brotherton Akram Zhan Early initiation of Kangaroo Mother Care for hospitalised preterm infants in a low-income country Henry Surenda Jackie Cook Optimising serological surveillance for malaria transmission in Indonesia Hiam Chemiatally Helen Weiss The epidemiology of HIV infection among sex workers in the Middle East and North Africa 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 Helen Weiss Epidemiology and prevention of HIV in a cohort of women involved in high risk sexual behaviour in Kampala Jacqueline Lim Neal Alexander Assessment of the undocumented burden of dengue in Africa John Hustedt Neal Alexander Implementing integrated vector control to better control dengue transmission Jonathan Lambo Andrea Rehman Insecticide Treated Nets Usage : Implications for Malaria Vector Control in sub-Saharan Africa? Joyce Der Daniel Grint Pathways to tuberculosis diagnosis and treatment in Ghana: identifying the gaps and seeking solutions Lily Telisinghe Richard Hayes Can universal testing and treatment for HIV and community-wide active case finding for tuberculosis control the African tuberculosis epidemic Lindsay Wu Immo Kleinschmidt Measures of malaria transmission to inform the design and evaluation of cluster randomised trials for transmission blocking vaccines Lizzie Chappell Kathy Baisley The cascade of care for children living with HIV in rural South Africa Mandi Tembo Suzanna Francis Margaret Tembo James Lewis Hypertension among the adult population in Lusaka province: prevalence, determinants, awareness and control Monica Kuteesa Emily Webb
Epidemiology of HIV and substance abuse among young key populations in sub-Saharan Africa
Mzembe Themba Kathy Baisley Incidence of tuberculosis infection among adolescents in rural KwaZulu-Natal, South Africa Ngozi Kalu Melissa Neuman Odutola Aderonke Akram Zhan Epidemiology of Staphylococcus aureus disease in rural Gambia Richard Sanya Emily Webb The effect of helminth infection on insulin resistance and type 2 diabetes in rural and urban Uganda Ruramayi Rukuni Andrea Rehman The IMpact of Vertical HIV infection on child and Adolescent SKeletal development in Harare, Zimbabwe: the IMVASK Study Sonali Nayantara Wijayanandana Neal Alexander Dengue transmission dynamics in Sri Lanka: evaluating spatial heterogeneity, transmission intensity and the effect of population mobility Susannah Woodd Andrea Rehman Burden and Aetiology of Maternal Peripartum Infection Titus Divala Katherine Fielding Community screening for TB
- Studies completed
Alasdair Cook Simon Cousens Strategies to control salmonella infection in pigs 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 Augustine Choko 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 Benson Droti (DrPH) David Ross One month versus three months of ARV refills in Uganda Claudia Hanson Joanna Schellenberg The epidemiology of maternal mortality in Southern Tanzania Cynthia Kahari Andrea Rehman The effect of HIV on trabecular and cortical bone strength, density, geometry and muscle through the life course: a pQCT study David Katende Kathy Baisley Investigating the medium to long term impact and sustainability of an intervention to improve care for hypertension and diabetes within the primary health care setting in Uganda Erin Anastasi (DrPH) Sian Floyd Between women’s use of antenatal care and skilled birth attendance? A case study in Northern Uganda Eugene Ruzagira Heiner Grosskurth Effect of counselling on linkage to HIV care after home-based HIV testing in rural Uganda: An intervention study Ghina Mumtaz Helen Weiss The epidemiology of HIV infection among high-risk populations in the Middle East and North Africa Giorgia Gon Stephen Nash Birth attendants’ hand hygiene in maternity wards in low-resource settings: levels and drivers 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 Intira Collins Shabbar Jaffar Outcomes and cost-effectiveness of anti retroviral treatment in HIV-affected children in Thailand Jennifer Thompson Katherine Fielding Statistical design and analysis of cluster-randomised stepped wedge trials Joel Francis Heiner Grosskurth/Helen Weiss Epidemiology of alcohol use and alcohol use disorders (AUD) among young people in Northern Tanzania 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 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 Kammerle Schneider Matt Cairns The epidemiology of malaria in adolescents in Zambia Karen Myllynen Webb Melissa Neuman Uptake of facility-based delivery and early infant HIV diagnosis in a high HIV-prevalence context 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 Laura Ferguson David Ross Linking women who test HIV-positive in pregnancy-related services to HIV care and treatment services in Kenya: missed opportunities Lawrence Lubyayi Emily Webb Statistical modelling approaches for longitudinal multiple outcome data from immuno-epidemiological studies in Entebbe, Uganda Linda Sande Melissa Neuman Equity analysis in a cluster randomised trial of HIV self-testing in Malawi and Zambia Lori Miller Richard Hayes Measurement of adherence in microbicides effectiveness trials Michael Wallace Simon Cousens Facilitating correction for classical covariate measurement error 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 Peter Horby Neal Alexander Avian, inter-pandemic, and pandemic influenza in Vietnam 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 Princess Ruhama Acheampong Matt Cairns Exploring new approaches to prevent malaria in pregnancy in Ghana- The potential of pre-pregnancy interventions in adolescent girls Rebecca Geary Emily Webb Youth-friendly health services: a critical investigation of provision and young people’s experiences in South 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 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 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 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 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 Geographic access to health facilities and child survival in rural Ethiopia 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
About the scheme
The TEG Training Fellowship Scheme launched in 2005 and forms a key part of TEG’s investment in capacity development strategy. The Scheme enables 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 is highly competitive, with over 1000 applications in 2018. The majority of our fellows are now either working as medical statisticians at research institutions in Africa, or are engaged in PhD studies.
- How to apply
TEG Postgraduate Training Fellowship in Medical Statistics for African Scientists
Three fellowships are available, funded by the UK Medical Research Council (MRC), GSK and LSHTM, respectively, to 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 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 with a background in mathematics, statistics or a related subject
(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 their application through the online portal which can be accessed below:
Please note a curriculum vitae, academic transcript and personal statement must be uploaded as part of the application. The personal statement form can be found below.
Applications for the 2019 TEG Fellowship will close on Friday 26th April.
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.
Further information on the MSc in Medical Statistics can be found on the course page.
Informal enquiries concerning the scholarship can be made to David Macleod.
Informal enquiries concerning the MSc can be made to the Admissions Tutors, Jenny Nicholas and John Gregson.
Further information about visa requirements can be found here.
Current TEG Fellows
Ondijo Ouma, from Kenya
Ondijo is currently completing the MSc in Medical Statistics at LSHTM.
Isaac Sekitoleko, from Uganda
Isaac is currently completing the MSc in Medical Statistics at LSHTM.
2018-2020 TEG Fellowship
Thomas Gachie, from Kenya
Thomas is currently completing his second year placement at Zambart in Zambia.
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 had 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.
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).
Updates on previous fellows’ progress
- Sylvia Kiwuwa Muyingo (2003-2005) successfully completed a PhD in June 2012 and became 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) took a job as a medical statistician in northern Ghana when he finished, and then began studying for a PhD at the University of Cape Town.
- Phellister Nakamya (2006-2008) became a distance learning tutor for LSHTM and Monitoring and Evaluation Specialist for the Uganda Country Coordinating Mechanism.
- Nuredin Ibrahim Mohammed (2008-2010) left to study for a PhD at the University of Birmingham.
- Evans Muchiri (2009-2011) began working with Wits Reproductive Health & HIV Institute in South Africa.
- James Jafali (2010-2012) left to study for a PhD in Bioinformatics in Edinburgh.
- Bernard Chasekwa (2014-2016) became employed as a Senior Biostatistician at Zvitambo Institute of Maternal and Child Health Research in Harare, Zimbabwe. The institute was 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) got a job at the Medical Research Council Unit, The Gambia.
- Sarah Mulwa (2014-2016) accepted a job at Stellenbosch University in South Africa.
Our mission is to conduct research on the epidemiology and control of diseases of major public health importance in low and middle countries. We initiate epidemiological research and provide epidemiological and statistical expertise for research projects in resource-poor settings. We focus primarily on design and analysis, conducting rigorously designed intervention studies, including randomised controlled trials (RCTs) to identify effective interventions against these diseases and (evaluating strategies to implement such interventions. Our research is collaborative, and we have strong links with clinical epidemiologists, social scientists, and health economists.
Global partnerships and projects
We are in the midst of developing an interactive map of our current projects and partnerships. You are welcome to view our last map to see key information about each project. To magnify any given area or project, please hover your mouse over the markers.
For any more information about any of the projects, please email email@example.com.
Main research themes
Our group has an expanding research programme addressing key challenges in malaria control and elimination. This work focuses on malaria prevention through new approaches in vector control, vaccine evaluation and chemoprevention, and on novel approaches for malaria surveillance.
- We are engaged in trials evaluating new generation long lasting insecticidal mosquito nets that meet the challenge of insecticide resistance, and novel malaria vector control tools, such as attractive targeted sugar baits and house improvements through eaves tubes.
- We carry out large scale studies and evaluations of seasonal malaria chemoprevention (SMC), now deployed at scale in the Sahel region of Africa. We also evaluate seasonal use of the RTS,S malaria vaccine as an alternative to or combined with SMC.
- We are involved in studies on the epidemiology, surveillance, and elimination of malaria in low transmission settings, including the development of serological approaches to measure transmission and the evaluation of elimination strategies.
In our work, we collaborate closely with scientists in the UK and malaria endemic countries, with international agencies, national malaria control programmes and other implementing partners.
Cissé B, Ba EH, Sokhna C, JL ND, Gomis JF, Dial Y, Pitt C, Ndiaye M, Cairns M, Faye E, M ND, Lo A, Tine R, Faye S, Faye B, Sy O, Konate L, Kouevijdin E, Flach C, Faye O, Trape JF, Sutherland C, Fall FB, Thior PM, Faye OK, Greenwood B, Gaye O, Milligan P. Effectiveness of seasonal malaria chemoprevention in children under ten years of age in Senegal: A stepped-wedge cluster-randomised trial. PLoS Medicine, 13(11): e1002175.
West PA, Protopopoff N, Wright A, Kivaju Z, Tigererwa R, Mosha F, Kisinza W, Rowland M, Kleinschmidt I. (2014). 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 Medicine, 11(4): e1001630.
Staff working on malaria:
Theme Leaders Immo Kleinschmidt Matthew Cairns
- HIV and sexual health
Our HIV and sexual health research priorities for the next 5 years focus largely on the UNAIDS 90-90-90 targets that, by 2020, 90% of those living with HIV know their status, 90% of known HIV-positive individuals receive sustained ART, and 90% of individuals on ART have durable viral suppression. Our projects include:
- Large-scale intervention studies to improve uptake of HIV testing, and treatment for prevention: We lead the HPTN 071 (PopART) trial in South Africa and Zambia, evaluating the impact on HIV incidence of a combination prevention intervention, and lead the epidemiological research for the UNITAID STAR project – the largest evaluation of HIV self-testing (HIVST) in Africa to date.
- HIV and sexual health among adolescents and young people: Adolescents fare more poorly than adults in achieving the UNAIDS goals. We are evaluating strategies to help increase the proportion of young people who are aware of their status, link to care and achieve viral suppression – for example through structured support home visits by trained lay workers.
- HIV prevention and treatment among key vulnerable populations: Key populations continue to have high HIV and STI prevalence in many settings. We are leading a study looking at the association of hormonal contraception and bacterial vaginosis among women at high risk in Kampala, Uganda, and studies on HIV risk factors among fishing communities on Lake Victoria.
- Improving health care systems to respond to HIV: The sustainability of HIV treatment is increasingly important due to improved ART-related survival. We are expanding our focus on treatment of co-morbidities including integration of care for HIV with NCD and mental health disorders in Zimbabwe, Uganda and Tanzania.
d'Elbée M, Indravudh PP, Mwenge L, Kumwenda MM, Simwinga M, Choko AT, Hensen B, Neuman M, Ong JJ, Sibanda EL, Johnson CC, Hatzold K, Cowan FM, Ayles H, Corbett EL & Terris-Prestholt F. (2018). Preferences for linkage to HIV care services following a reactive self-test: discrete choice experiments in Malawi and Zambia. AIDS 32(14): 20143-2049.
Simms V, Rylance S, Bandason T, Dauya E, McHugh G, Munyati S, Mujuru H, Rowland-Jones SL, Weiss HA & Ferrand RA. CD4+ cell count recovery following initiation of HIV antiretroviral therapy in older childhood and adolescence. AIDS 32(14): 1977-1982.
Kelly H, Faust H, Chikandiwa A, Ngou J, Weiss HA, Sgondy M, Dillner J, Delany-Moretlwe S & Mayaud P. (2018). Human Papillomavirus Serology Among Women Living With HIV: Type-Specific Seroprevalence, Seroconversion, and Risk of Cervical Reinfection. Journal of Infectious Diseases 14, 218(6): 927-936.
Torres-Rueda S, Wambura M, Weiss HA, Plotkin M, Kripke K, Chilongani J, Mahler H, Kuringe E, Makokha M, Hellar A, Schutte C, Kazaura KJ, Simbeye D, Mshana G, Larke N, Lija G, Changalucha J, Vassall A, Hayes R, Grund JM &Terris-Prestholt F. Cost and Cost-Effectiveness of a Demand Creation Intervention to Increase Uptake of Voluntary Medical Male Circumcision in Tanzania: Spending More to Spend Less. Journal of Acquired Immune Deficiency Syndromes 1, 78(3): 291-299.
Sabapathy K, Mulubwa C, Mathema H, Mubekapi-Musadaidzwa C, Schaap A, Hoddinott G, Hargreaves J, Floyd S, Ayles H, Hayes R. & HPTN 071 (PopART) Study Team. (2018). Is home-based HIV testing universally acceptable? Findings from a case-control study nested within the HPTN 071 (PopART) trial. Tropical Medicine & International Health 23(6): 678-690.
Ferrand RA, Simms V, Dauya E, Bandason T, Mchugh G, Mujuru H, Chonzi P, Busza J, Kranzer K, Munyati S, Weiss HA & Hayes RJ. The effect of community-based support for caregivers on the risk of virological failure in children and adolescents with HIV in Harare, Zimbabwe (ZENITH): an open-label, randomised controlled trial. The Lancet Child & Adolescent Health 1(3): 175-183.
Staff working on HIV and sexual health:
Theme Leader Helen Weiss Richard Hayes
- Tuberculosis and pneumococcal disease
The TB research conducted by TEG 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.
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 and pneumococcal disease:
Theme Leader Katherine Fielding
- Emerging and neglected diseases (END)
The Emerging and Neglected Diseases theme encompasses significant research activity on neglected tropical diseases (NTDs), mental health, eye health, and disease outbreaks. Priorities for the next 5 years for each of these research areas are outlined below:
Neglected tropical diseases: Following the WHO roadmap, our focus will be primarily on large-scale intervention studies for NTD control and elimination. These include a dose-ranging trial of praziquantel treatment of schistosomiasis in pre-school aged children in Uganda, and a trial of entomological interventions against dengue fever in Malaysia.
Mental health disorders: Our work in this area focuses in particular on adolescents, and on integration with HIV treatment, evaluating effectiveness of interventions through large-scale trials. TEG is heavily involved in continued evaluation of the “Friendship Bench” (a lay-health worker delivered psychological intervention shown to effectively treat common mental disorders among adults attending primary care). We are also working on the IMPRESS trial, evaluating a community-based model in addition to facility-based for lay-counsellor treatment of depression in India.
Eye health: 80% of visual impairment is avoidable. In TEG, we focus on eye health in relation to both infectious and non-communicable disease agents. Planned work includes evaluation of the impact of a package of interventions on uptake of eye care services among patients with diabetes, and a CRT to evaluate strengthening prospects for trachoma elimination through enhancing Antibiotic, Facial Cleanliness and Environmental Improvement measures. We will also continue to collaborate on studies investigating the implementation of smartphone-guided eye care (PEEK), including a CRT to evaluate effectiveness for screening for visual impairment in schools in Kenya.
Disease outbreaks: During the 2014 Ebola epidemic, TEG demonstrated its capacity, capability and preparedness to respond to a need for scientifically rigorous research during rapidly emerging epidemics with a leading role in treatment and vaccine trials. We will continue to provide rapid-response expertise in future outbreaks with the DFID-funded, LSHTM-based, UK Public Health Rapid Support Team, and are also part of the ZikAlliance and ZikaPLAN Consortia.
Sanya RE, Nkurunungi G, Hoek Spaans R, Nampijja M, O'Hara G, Kizindo R, Oduru G, Kabuubi Nakawungu P, Niwagaba E, Abayo E, Kabagenyi J, Zziwa C, Nakazibwe E, Tumusiime J, Kaweesa J, Muwonge Kakooza F, Akello M, Lubyayi L, Verweij J, Nash S, van Ree R, Mpairwe H, Tukahebwa E, Webb EL, Elliott AM & LaVIISWA trial team. (2018). The impact of intensive versus standard anthelminthic treatment on allergy-related outcomes, helminth infection intensity and helminth-related morbidity in Lake Victoria fishing communities, Uganda: results from the LaVIISWA cluster randomised trial. Clinical Infectious Diseases: doi: 10.1093/cid/ciy761.
Rono HK, Bastawrous A, Macleod D, Waniala E, Di Tanna GL, Weiss HA & Burton MJ. (2018). Smartphone-based screening for visual impairment in Kenyan school children: A cluster randomised controlled trial. The Lancet Global Health, 6(8): e924-932. doi: 10.1016/S2214-109X(18)30244-4.
Nadkarni A, Weobong B, Weiss HA, McCambridge J, Bhat B, Katti B, Murthy P, King M, McDaid D, Park AL, Wilson GT, Kirkwood B, Fairburn CG, Velleman R & Patel V. (2017). Counselling for Alcohol Problems (CAP), a lay counsellor-delivered brief psychological treatment for harmful drinking in men, in primary care in India: a randomised controlled trial. The Lancet: 389(10065):186-195.
van Griensven J, Edwards T, de Lamballerie X, Semple MG, Gallian P, Baize S, Horby PW, Raoul H, Magassouba N, Antierens A, Lomas C, Faye O, Sall AA, Fransen K, Buyze J, Ravinetto R, Tiberghien P, Claeys Y, De Crop M, Lynen L, Bah EI, Smith PG, Delamou A, De Weggheleire A, Haba N & Ebola-Tx Consortium. (2016). Evaluation of Convalescent Plasma for Ebola Virus Disease in Guinea. New England Journal of Medicine: 7,374(1):33-42. doi: 10.1056/NEJMoa1511812.
Staff working on END:
Theme Leader Emily Webb Tansy Edwards
- Adolescent health
The number of adolescents and young people is at an all-time high globally and is projected to increase in the coming decades, especially in sub-Saharan Africa. The age group 10-24 years is a transitional period of critical importance for several of our disease themes - including HIV where over 1/3 of new infections are in adolescents and young people, and mental health, as over half of mental health problems begin during adolescents. The Group is now expanding to work on broader issues of adolescent health, including improvement of menstrual management, evaluation of interventions to increase uptake of modern contraceptives in adolescent girls, and strategies to improve detection and counselling for behaviours that impact on future health (such as alcohol, smoking and sexual behaviour).
- Non-communicable diseases
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.
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:
Community health worker waits for rapid diagnostic test results on baby in Takorasi, Ghana. © LSHTM.
One of this theme'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.
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
Courses available at LSHTM
TEG members teach on several Masters courses at LSHTM. More information on these courses, including distance learning options, can be found on LSHTM’s central website through the following links:
TEG is involved in the organisation and teaching of several overseas training courses in epidemiology, statistics and research methods for local scientists. These courses are organised in collaboration with our affiliated units across Africa.
TEG Director Prof Helen Weiss features on the Feminem podcast discussing careers in epidemiology, gender equity in leadership and why there aren't more women populating the highest leadership positions in public health.
Ending period poverty by 2030: From research to impact
Thursday 4 July
This meeting, held by the GCRF East and Southern Africa Menstrual Hygiene Research Network will bring together researchers, funders, policy makers and practitioners to discuss how we can use existing evidence to develop and deliver effective menstrual health policies and programmes globally and in the UK to end period poverty by 2030.
Parts of the day will be recorded and a link posted here after the meeting. We’ll be tweeting highlights of the meeting throughout the day using the hashtag #MHMResearch2Impact from our Twitter account @MRCTEG_LSHTM.
Celebrating International Clinical Trials Day 2019 and the PopART Trial
The Clinical Trials Programme by Distance Learning, and the PopART Trial team, at the London School of Hygiene and Tropical Medicine has produced a resource to celebrate International Clinical Trials Day. You can learn about an important trial carried out in Sub-Saharan Africa which “tested the theory that HIV incidence could be dramatically reduced if everyone in a community knows their HIV status, and those positive are effectively treated”.
Through the words of the trial team, and through their inspirational photographs from the field, you can engage with the need for the trial, the methods used in the research, and gain insights into the value and importance of a rigorously conducted trial in changing the evidence base for care.
Field Trials of Health Interventions: a Toolbox - 3rd Edition
The third edition of 'Field Trials of Health Interventions: a Toolbox' can now be accessed online here
Seminar: Impact of universal test-and-treat on HIV incidence in Zambia and South Africa: Results of the HPTN 071 (PopART) trial
PopART was a cluster-randomised trial carried out in 21 communities in Zambia and the Western Cape of South Africa, and the largest HIV prevention trial ever undertaken. Richard Hayes, who led the trial, will present the primary results of the trial, and discuss the implications of the findings in the context of other trials of universal test-and-treat.
Professor Richard Hayes has been working at the School since 1978, and for much of this period he has headed the MRC Tropical Epidemiology Group whose mission is to develop and apply statistical methods in tropical epidemiology and to carry out research on major public health problems of developing countries.
This session will be live-streamed/recorded - accessible only to internal audience.
Professor Richard Hayes (LSHTM)
Open to all, seats available on first come, first served basis.
Contact: Richard Hayes
LSHTM, Keppel Street
John Snow A Lecture Theatre
Thursday 9 May 2019
12:30 - 13:30
Realizing the potential of HIV self‐testing for Africa: lessons learned from the STAR project
A special issue Open Access edition of the Journal of the International AIDS Society on HIV self-testing, including TEG authored articles.
Field Trials of Health Interventions: A Toolbox – new 3rd edition now available to download
Abstract: Before new interventions are released into disease control programmes, it is essential that they are carefully evaluated in `field trials'. These may be complex and expensive undertakings, requiring the follow-up of hundreds, or thousands, of individuals, often for long periods. Descriptions of the detailed procedures and methods used in the trials that have been conducted have rarely been published.
A consequence of this, individuals planning such trials have few guidelines available and little access to knowledge accumulated previously, other than their own. In this open-access online guide, practical issues in trial design and conduct are discussed fully and in sufficient detail. It has been compiled by an international group of over 30 authors with direct experience in the design, conduct, and analysis of field trials in low and middle income countries and is based on their accumulated knowledge and experience.
UK patient 'free' of HIV after stem cell treatment - BBC World Service
TEG member Kalpana Sabapathy speaks on BBC World Service about the 'London patient', HIV remission and the HPTN 071 (PopART) trial.
2019 TEG Fellowship
We are now accepting applications for the 2019 TEG Fellowship. Please visit the Fellowship page for information about how to apply. Applications should be made via the online portal.
Closing date for applications: Friday 26 April
Short Course in Design & Analysis of Cluster Randomised and Stepped Wedge Trials
8 – 12 July 2019
Cluster randomised trials and stepped wedge trials are increasingly used to evaluate health and social interventions. These trial designs require specific methods of statistical analysis. This course will provide attendees with a clear understanding of the design and analysis of cluster randomised trials and stepped wedge trials.
This includes the rationale for using these designs, specific design issues, the randomisation process, sample size calculations, analytical methods, ethical considerations, and trial reporting and interpretation. We will include case studies from low-, middle- and high-income settings. Participants will gain practical experience of data analysis using the computer package Stata.
Introductory Course in Epidemiology & Medical Statistics
24 June – 12 July 2019
Our Introductory Course in Epidemiology & Medical Statistics is now open for applications for 2019. The course covers the design and analysis of epidemiological studies, statistical methods in epidemiology, data analysis using Stata software and epidemiological principles of research. Further details here
How a bench and a team of grandmothers can tackle depression - BBC Future
18 October 2018
"Zimbabwe is pioneering a groundbreaking mental health programme with stunning results – and the rest of the world is taking note..."
Dixon Chibanda is director of the African Mental Health Research Initiative and an associate professor of psychiatry at the University of Zimbabwe and the London School of Hygiene and Tropical Medicine. He is one of just 12 psychiatrists practising in Zimbabwe – a country of over 16 million. Together with TEG director Helen Weiss and member Vicky Simms, co-authored a paper on tackling depression in Zimbabwe with grandmothers and benches.
Sequential Trials Symposium
18 September 2018
The Centre for Statistical Methodology and the Tropical Epidemiology Group of the London School of Hygiene and Tropical Medicine (LSHTM) held a half day symposium on sequential trials on 26 September 2018. Presentations highlighted recent research and application of these methods, and speakers included Sue Todd (University of Reading), Dominic Magirr (AstraZeneca), Babak Choodari-Oskooei (MRC Clinical Trials Unit at UCL), and Neal Alexander (LSHTM).
Sequential designs are intended to rapidly assess new interventions, particularly when the outcome is rare, and have arguably been under-used in medical research. For example, sequential trials were proposed as a way of ‘getting an answer sooner and cheaper’ for neglected tropical diseases. This meeting concentrated on ‘fully sequential’ trials but group sequential designs were also addressed. In the former, the data are analysed after each patient’s results become available, and the trial is stopped after a pre-specified objective is reached. Hence, the sample size is not fixed in advance. In the group-sequential approach, the sample size is determined conventionally, but the trial may be stopped at one of a small number of interim analyses.
This symposium took place at Birkbeck College in central London. This may be of interest to statisticians and others involved in the design or analysis of trials, whether or not they have previous experience of such.