Collaborations

WHO Collaborating Centre for Sexually Transmitted Infections

The Department of Clinical Research in ITD is a World Health Organization (WHO) Collaborating Centre for Sexually Transmitted Infections. LSHTM carries out three activities in collaboration with the WHO:

1. Support the STI point of care testing (POCT) initiative (advise on research/validation, support normative work, and training on STI POCTs in LMICs.
    
2. Develop and evaluate new strategies for STI control in key populations.
    
3. Evaluate and promote new strategies to improve the health of women and children particularly in the area of dual elimination of mother to child transmission of HIV and Syphilis (eMTCT) and prevention of cervical cancer.

Read the LSHTM Collaborating Centre Annual Report (5/2017-5/2018) (pdf)

LSHTM investigators

David Mabey; Rosanna Peeling

Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections

The National Institute for Health Research (NIHR) Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections is led by University College London in partnership with Public Health England and LSHTM. The unit aims to conduct state-of-the-art research to improve the health of the population, and to help develop practical policy guidelines for those working in health protection.

The NIHR HPRU has received almost £3.7 million to undertake collaborative research that addresses the key health protection priorities for the prevention and control of STIs and BBVs, notably understanding risk and risk reduction, reducing the burden of under-diagnosis, and improving care and management of those diagnosed with infections.

There are three research themes

• Theme A: Understanding risk and risk reduction for STIs and BBVs
   
• Theme B: Reducing the burden of undiagnosed STIs and BBVs
   
• Theme C: Improving the care and management of people with STIs and BBVs

LSHTM investigators

Tim Rhodes; Peter Wetherburn

SHIP (Sexual Health Improvement Programme)

The Sexual Health Improvement Programme (SHIP) was set up as a Bristol Health Partners Health Integration Team in 2013. It brings together experts from across disciplines to improve the sexual health of people in the region and reduce STIs, supporting the commissioning of evidence-based sexual health services. Our priorities are: increasing uptake of HIV testing; improving STI testing and responding to antimicrobial resistant (AMR) infections; increasing patient and public involvement in sexual health and ending stigma; ending domestic violence; reducing health inequalities; implementing informatics and digital transformation; developing a national network for sexual health improvement. A major focus for the next three years will be evaluating and developing strategies, including vaccination, for combating the development of antimicrobial resistance (AMR) in STIs.

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LSHTM investigator

Emma Harding-Esch

The Applied Diagnostic Research and Evaluation Unit (ADREU)

The Applied Diagnostic Research and Evaluation Unit (ADREU) based at St George’s, University of London (SGUL) is a proven multi-institutional and multi-disciplinary group including experts in clinical medicine, diagnostic evaluations, epidemiology, public health, social science, basic and translational science. ADREU provides a comprehensive service to facilitate the development and evaluation of rapid diagnostics for STIs, other infectious diseases and antimicrobial resistance for both academic institutions and industry. ADREU offers bespoke diagnostic accuracy evaluations, from proof-of-concept projects to late-stage evaluations, providing data for regulatory approval for our collaborating partners in academia and industry. With close links to Public Health England and LSHTM, ADREU combines real word situations with leading academic insight to evaluate novel commercial technologies, providing feedback on the clinical and social impact that STIs and rapid STI diagnostics can have on all aspects of the healthcare system, from patients to healthcare professionals.

LSHTM investigator

Emma Harding-Esch

Applied Diagnostic Research & Evaluation Unit (ADREU)

The Applied Diagnostic Research and Evaluation Unit (ADREU) based at St George’s, University of London (SGUL) is a proven multi-institutional and multi-disciplinary group including experts in clinical medicine, diagnostic evaluations, epidemiology, public health, social science, basic and translational science. ADREU provides a comprehensive service to facilitate the development and evaluation of rapid diagnostics for sexually transmitted infections (STIs), other infectious diseases and antimicrobial resistance (AMR) for both academic institutions and industry. ADREU offers bespoke diagnostic accuracy evaluations, from proof-of-concept projects to late-stage evaluations, providing data for regulatory approval for our collaborating partners in academia and industry. With close links to Public Health England and LSHTM, ADREU combines real word situations with leading academic insight to evaluate novel commercial technologies, providing feedback on the clinical and social impact that STIs and rapid STI diagnostics can have on all aspects of the healthcare system, from patients to healthcare professionals.

Research Projects

safetxt: A randomised controlled trial of an intervention delivered by mobile phone messaging to reduce STI in young people

The NIHR-funded safetxt Trial is a single blind randomised controlled trial to evaluate the effect of a safer sex intervention delivered by text message on chlamydia and gonorrhoea infection at 12 months. The intervention targets partner notification, condom use and getting tested before unprotected sex with a new partner (1).
Over 5900 participants aged 16-24 have been recruited from 50 GU and Sexual and Reproductive Health services across the UK.
Full recruitment is crucial to provide trials with sufficient power to detect intervention effects, yet only 56% of publicly funded trials in the UK achieve their target sample size.

Mixed methods supported by evidence from behavioural science were used to maximise recruitment including meetings with site staff to enable new services to learn from experienced recruiters, monthly newsletters to highlight major achievements, competitions to develop engagement and motivation and certificates for staff who achieve recruitment milestones.

The questionnaire follow-up of participants is closely monitored and is currently 88.2% at 4 weeks and 77.1% at 1 year. The return of test kits at 1 year is 71.8%. Steps taken to improve follow up rates include: simplified test kit instructions, clear postage instructions, and a prize draw entry for participants who return test kits (2).

The safetxt collaboration between 50 GU and Sexual and Reproductive Health services and the trial management team is on target to recruit 6250 participants on time by December 2018.  The trial is due to report in 2020.

LSHTM investigators

Caroline Free, Ona McCartney, Rebecca French, Kaye Wellings

References

Free C, McCarthy O, French RS, Wellings K, Michie S, Roberts I, et al. Can text messages increase safer sex behaviours in young people? Intervention development and pilot randomised controlled trial. Health Technol Assess 2016;20(57)
McCarthy O, French RS, Roberts I, Free C. Simple steps to develop trial follow-up procedures. Trials. 2016;17:28. doi:10.1186/s13063-016-1155-1

TracVac: A phase I adjuvant Chlamydia trachomatis vaccine

TracVac builds on the results of a phase I clinical trial (NCT02787109) of an adjuvanted Chlamydia trachomatis vaccine (CTH522; Olsen et al 2015, JID PMID2578320) developed by Statens Serum Institut (SSI), Copenhagen. TracVac (www.trachoma-vaccine.org) is a 4 partner (LSHTM, Imperial College London, Commissariat à l’Energie Atomique et aux Energies Alternatives, Paris and SSI) EU sponsored consortium that will expand the C. trachomatis serotype coverage of CTH522 and investigate the immunization regimen required for the optimal induction of protective responses at mucosal surfaces that include the eye.  C. trachomatis infection of the eye causing trachoma remains the leading cause of blindness due to any infection. The immunological routes of C. trachomatis protection and pathogenesis in both the eye and urogenital tract are believed to share common features. There are currently no chlamydial vaccines licenced for human use. We expect that study of trachoma can serve as a useful and translatable model for C. trachomatis vaccine development in addition to the delivery of vaccine that protects against ocular infection. We are using novel Human B cell cloning technologies to select neutralizing and protective epitopes from trachoma ‘resistant’ individuals. We have identified ‘resistant’ individuals from longitudinal cohort studies. The selected epitopes will be incorporated into the next generation recombinant vaccine. Antibody neutralization and cellular responses to the vaccine constituents are being further tested on a wider scale in longitudinal trachoma cohort studies established LSHTM from The Gambia and Tanzania.  By the end of the study we aim to deliver a vaccine that covers both urogenital and ocular C. trachomatis infection for further clinical development in 2020.

Project dates

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LSHTM investigators

Martin Holland; Harry Pickering

iGugu: Prevalence of STIs among young people in South Africa: A nested survey in a health and demographic surveillance site

iGugu means precious, and is short for Ukuvikela impilo yetho yokuzalana eyigugu, Zulu for “protecting our precious reproductive health.”

Adolescents and young adults are particularly vulnerable to sexually transmitted infections (STIs). The first strategic direction of the WHO Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021 is to collect information on STI prevalence and incidence across representative populations. There is also evidence that bacterial vaginosis (BV) is a risk factor for poor birth outcomes and STIs including HIV. The collection of BV prevalence may therefore also be important. However, developing new cohorts for dedicated STI/BV prevalence studies may not be realistic, particularly in sub-Saharan Africa, where the impact of STIs/BV and their consequences may be greatest. Therefore, nesting STI/BV surveys within networks of health and demographic surveillance sites (HDSSs) could be an efficient way of providing data to better understand STI epidemiology among adolescents and young people in high HIV prevalence settings.

We carried out a nested STI/BV survey among 1,342 adolescent and young people in an HDSS in KwaZulu-Natal, South Africa, between October 2016 and January 2017. Potential participants were contacted at home and invited to participate. Participants were interviewed, and samples were collected for STI/BV testing.

We showed that this study was feasible within the 3.5-month time period: 1,171/1,342 (87%) individuals had ≥1 attempted home visit, of whom 790 (67%) were successfully contacted (1).

The study was acceptable: among those contacted and eligible, 447/645 (69%) enrolled. Both men and women reported few problems with sample collection. We report a high burden of STIs/BV in this population, particularly of chlamydia (5% in men and 11% in women), herpes simplex virus type 2 (17% in men and 29% in women), and BV (42% in women).

Nested STI/BV surveys in HDSSs can be feasible and acceptable; however, more survey time is needed to ensure that all potential participants are visited and contacted.  These studies should be carried out in conjunction with studies to measure STI/BV prevalence in high-risk populations (e.g., female sex workers) to provide robust prevalence estimates.

These data are essential to advocate, fund, plan, implement, and evaluate interventions for STI prevention and control among adolescents and young people. Strategies for the prevention and control of chlamydia, herpes simplex virus type 2, and BV are needed in this population.

LSHTM Investigators

Suzanna Francis; Kathy Baisley

References

Francis SC, Mthiyane TN, Baisley K, Mchunu SL, Ferguson J, Smit T, Gareta D, Dlamini S, Mutevedzi T, Seeley J, Pillay D, McGrath N, Shahmanesh M. Prevalence of Sexually Transmitted Infections among Young People in South Africa: A Nested Survey in a Health and Demographic Surveillance Site. PLOS Medicine, 2018; 15(2):e1002512

Systematic Review: Novel testing technologies, strategies and approaches for testing populations at high risk of STIs in EU/EEA countries

In 2012, the European Centre for Disease Prevention and Control (ECDC) published the technical report “Novel approaches to testing for sexually transmitted infections, including HIV and hepatitis B and C in Europe”. This report was a comprehensive review of testing technologies and strategies across Europe. Almost six years later, there have been a number of developments in the field, and an updated review is required.

We are carrying out a critical appraisal via a systematic literature review of novel STI testing technologies, strategies and approaches for detecting Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, Mycoplasma genitalium, and Trichomonas vaginalis, in at-risk populations. The objectives are to: describe novel (since 2011) STI testing strategies and approaches and determine how they impact on access to testing, testing coverage, and linkage to care; describe what testing technologies are used in these novel strategies and approaches; describe the impact of novel testing technologies, approaches and strategies on reporting to public health surveillance programmes; highlight quality assurance needs and risks; and highlight their feasibility and acceptability. Gaps in knowledge and data availability will also be identified to highlight future research needs.

LSHTM Investigators

Emma Harding-Esch; Suzanna Francis