London School of Hygiene & Tropical Medicine

Every year we recruit two to three STIRIG student reps to help develop our student community and ensure that student views and experiences are incorporated into our work – championing the next generation of STI and HIV researchers is one of our core objectives. Student reps work closely with our co-directors on the following:

• Identifying key areas of interest for STIRIG seminars and helping to organize
• Suggesting themes and co-producing at least two newsletters
• Developing student specific activities e.g. journal clubs, feedback sessions, blog-writing
• Communicating STIRIG activities to networks and other students

Student reps are recruited at the start of each academic year, and details are available at the student welcome fair and posted on the updates page of our website.

Student representatives

Year 2024-2025

• Kathryn (Katy) Mackey: MRC LID PhD with LSHTM and SGUL in Epidemiology and Population Health
• Rubina Stanford Valodia: MSc Public Health for Development
• Raphaela Berghammer-Böhmer: MSc Reproductive and Sexual Health Research

Year 2023-2024

• Rosie Matthews: MSc Public Health
• Kaja Swenson: MSc Public Health

STIRIG students share their work and tips below

Omar Chidiac

Thesis title
"Epidemiology of Neisseria gonorrhoeae in Europe: A systematic review, meta-analysis, and meta-regression"

Overview
Neisseria gonorrhoeae (NG) is a major cause of serious reproductive health sequelae worldwide. Knowing its prevalence and incidence can help target interventional programs for key populations such as sex workers, men who have sex with men (MSM), and sexual contacts. The overarching aim of this study was to comprehensively characterize the epidemiology of gonorrhea across Europe. This entailed systematically reviewing prevalence and incidence studies of gonorrhoea aimed by estimating pooled mean prevalence by anatomical site, population type, and assay used, and by identifying possible predictors of gonorrhea prevalence and between-study heterogeneity.

Top tip
To start, you must really know what interests you. As you outline your project, it is important to get appropriate guidance from your supervisor and experts in the field. It is very important to write as you go, highlighting key statements you encounter, which will prove to be useful at the end of your project when writing the discussion part.

MSc course
Infectious Diseases (DL)

Year of course
2021

How did you identify your project? (e.g. Did you approach your supervisor with an idea? Did you select it from a list?)
I approached my supervisor with a deep interest to carry out an epidemiological study on sexually transmitted infections (STIs). My supervisor helped me pick a project that I would be able to finish in a one-year timeframe.

What are you doing now?
I am currently working at the Infectious Diseases Epidemiology Group temporarily until I travel to pursue my Ph.D. in Epidemiology with a focus on Infectious Diseases.

How has your project helped your post-MSc life?
My work experience was focused on the genetic and epigenetic aspects of diabetes and its complications. With an aim to transition to a field of research I am passionate about, I enrolled in this MSc Infectious Diseases in 2018. This program allowed me to develop my knowledge in the biology and epidemiology of infectious diseases and prepared me to go for higher education and pursue my Ph.D. in this field.

Motoyuki Tsuboi 

Thesis title
"Prevalence of syphilis among men who have sex with men: a global systematic review and meta-analysis from 2000-20"

Overview
The WHO Global Health Sector Strategy aims to reduce worldwide syphilis incidence by 90% between 2018 and 2030. To achieve this goal, interventions that target high-burden groups, including men who have sex with men (MSM), will be required. However, there are no global prevalence estimates of syphilis among MSM to serve as a baseline for monitoring or modelling disease burden. We therefore aimed to assess the global prevalence of syphilis among MSM using the available literature.

In this global systematic review and meta-analysis, we searched MEDLINE, EMBASE, LILACS, and AIM databases, and Integrated Bio-Behavioral Surveillance (IBBS) reports to identify syphilis point prevalence data between Jan 2000 and Feb 2020 among MSM who were tested by biological assay. We used random-effects models to generate pooled prevalence estimates across the eight regions of the Sustainable Development Goals (SDGs). We calculated risk of study bias based on Appraisal tool for Cross-Sectional Studies, and stratified results based on low versus high risk of bias. This study was registered with PROSPERO (CRD42019144594).

We received 4,339 records, 228 IBBS reports, and 10 articles from other sources. Of these, 345 prevalence data points from 275 studies across 77 countries were included. The global syphilis prevalence among MSM between 2000 and 2020 is 7.5% (95% CI 7.0-8.5), ranging from 1.9% (95% CI 1.0-3.1) in Australia and New Zealand to 10.6% (95% CI 8.5-12.9) in Latin America and the Caribbean.

Our findings presented the global syphilis prevalence among MSM between 2000 and 2020 is alarmingly high. Achieving the goal of reducing global syphilis incidence by 90% by 2030 will require sustained commitment to interventions that can accelerate syphilis prevention, screening, and treatment in this population.

Top tip
First of all, clear objectives and feasibility of study plan are the most important because of the limited time for summer project. Since I conducted this study as a team in collaboration with other master students for second review, frequent and regular communications with other students and our supervisor was also essential and valuable to share our visions and clarify any questions with each other. Considering the high burden of systematic review and meta-analyses, I believe a goal of your project is not submission as a summer project. If possible, it should be publication on academic journals which is also meaningful for your career in global health.

MSc course
Tropical Medicine and International Health

Year of course
2018/2019

What are you doing now?
I am now working as a medical officer at National Center for Global Health and Medicine in Tokyo, Japan. Because of my background, infectious disease clinician, I have participated in various sorts of COVID-19 responses including health check-up for charter flight returnee, response to outbreaks on cruise ships, and management of accommodation facilities for COVID-19 patients with mild or no symptoms. What I learned during the master course, such as epidemiology, statistical methods, and infectious disease control, was quite helpful. I am also trying to contribute to global health in the field of infectious diseases consistently.

How has your project helped your post-MSc life?
Through this project, I have learned a lot, including practical methods for systematic review & meta-analysis and many advantages of work in a study team from multiple organisations. Also, I reconfirmed the importance of discussions among different professionals. I believe this wonderful experience helps me grow as a global health specialist.

Sarah Fortna

Thesis title
"Barriers and solutions to the scale-up of curable STI management: Perspectives of pregnant women, healthcare providers, and policymakers in Mwanza, Tanzania"

Overview
Pregnant women and their babies are among those most vulnerable to STI/RTI complications. The goal of this project was to identify barriers and solutions to antenatal care access and participation, especially in regard to STI testing and care. Focus group discussions with pregnant women and in-depth interviews with pregnant women, healthcare providers, and policymakers took place prior to my joining the project. I was lucky to spend time in Mwanza, Tanzania, where I worked to identify trends at the individual, sociocultural, environmental, and health systems levels which contribute to the current state of care and associated recommendations for improvement. My colleague ran a project parallel to this, using the interview responses to identify barriers and solutions to malaria care in pregnancy.

Top tip
Identify a supportive supervisor and a project you are really interested in/passionate about.

MSc course
Control of Infectious Diseases

Year of course
2018

What are you doing now?
I'm a second year medical student in the United States.

How has your project helped your post-MSc life?
I plan to specialise as an infectious diseases physician.

Ellie Clarke

Thesis title
"Online tests for STIs, friend or foe? A scoping review and analysis of providers"

Overview
My project was an analysis of STI tests available to order online, that users complete themselves at home. These are an increasingly popular option, however the standard of tests and the quality of care provided can vary. I conducted a scoping review, to map the literature available for STIs, as well as gathering information on online tests available in the UK. I sent questionnaires to providers, collated information from websites and compared it to national guidelines. The results showed that although there is a lot of literature and providers, care is often substandard and test quality may not be sufficient. This project let me explore an interest in STIs whilst learning skills such as literature reviewing, and I really enjoyed working on such a relevant and important topic.

Top tip
Be open to projects that are outside of your comfort zone – you will learn some really helpful skills. Also, write as you go! Will definitely make it less stressful at the end.

MSc course
Control of Infectious Diseases

Year of course
2019

What are you doing now?
Now I am a vaccine tracking officer with Public Health England collating data on Flu and Covid vaccination uptake.

How has your project helped your post-MSc life?
Although not directly related to my current role, completing my project gave me a wide variety of academic skills and exposure to a new field within public health. Also, I have been able to continue work on the topic after graduating from LSHTM which has been good to bring more attention to the issue and also network with others in the field.

Hester Allen

Thesis title
"Analysis of the link between antiretroviral therapy and syphilis in MSM in England 2008-2017"

Overview
The aim of my project was to explore the hypothesis that there was an immunological link between the use of antiretroviral therapy (ARV) for HIV and the incidence of syphilis among men who have sex with men (MSM), following a resurgence in syphilis in the UK among MSM in the last two decades. Considerable emphasis has also been put on antiretroviral (ARV) therapy causing changes in sexual behaviour amongst MSM, particularly increasing risky sexual behaviour. To explore this, I obtained an honorary contract with the HIV/STI teams at Public Health England (PHE) and carried out an analysis of STI and HIV surveillance data held by PHE. Using matched HIV and STI data to identify STI diagnoses among MSM diagnosed with HIV, I carried out a multivariable random effects poisson model to look at the incidence of syphilis compared to gonorrhoea and chlamydia during periods when individuals were on and off ARV treatment, adjusting for demographic factors and a proxy measure for high risk sexual behaviour. The results showed that  there was no evidence of an increased risk of syphilis in MSM receiving ART and high-risk sexual behaviour markers were the main risk factors for syphilis. This project let me learn more about syphilis and STIs in general, which have always interested me and to understand how surveillance data is collected and can be used and this is an area I still work in. I really enjoyed working on such a relevant and important topic.
https://sti.bmj.com/content/early/2020/11/10/sextrans-2020-054603

Top tip
Be open to projects that involve skills that you don’t feel you are very strong at – I had very little STATA and analytical experience before this project and really enjoyed learning these skills while carrying it out. Keep regular communication with your supervisor throughout and persevere with writing the project up for publication once you have finished.

MSc course
Public Health general stream

Year of course
2017

Here is a presentation of my summer project findings I gave at the joint British association of HIV and STI and British HIV association annual conference 2018 in Edinburgh.

What are you doing now?
After my MSc I joined the HIV/STI team at Public Health England as a scientist working on the surveillance of antimicrobial resistant gonorrhoea and STI outbreak investigation. I now work as a Principal Epidemiological scientist in the PHE COVID-19 Epidemiology cell, part of the National COVID-19 Response Centre where I work on the surveillance of COVID-19 associated mortality and post-acute outcomes of COVID-19.

How has your project helped your post-MSc life?
My project has helped my career immensely, it gave me hands on experience of working with national surveillance data and gave me the opportunity to carry out novel epidemiological analysis independently. It also gave me the opportunity to experience working within a public health body and understand more about the work that goes on in these organisations.

Ajay Rangara 

Thesis title
"Evaluation of VIA, HPV DNA, careHPV and Cervical Cytology as primary screening methods for HPV detection & prevention of cervical cancer in Ghana: which is more cost-effective?"

Overview
The study was a primary ingredients-based cost analysis and cost effectiveness evaluation of different HPV-DNA testing technologies that could be used as a primary screening test to screen for high-risk HPV infections. It compared VIA, PAP smear, care-HPV, Gene Xpert and Quantitative DNA sequencing tests. A decision tree was constructed in TreeAge Pro Healthcare software that modelled the implementation pathway of different tests in the Ghanaian health system. The costs that informed the analysis was collected from five health sites in Ghana, including a tertiary care hospital, primary care center and mobile health clinic. Key probabilities were obtained from a targeted literature review search and several stakeholder interviews were conducted to obtain specific insights into challenges in Ghana. The modelling exercise identified GeneXpert as a potential future candidate for primary screening, although VIA is very cheap it has unacceptably low sensitivity and variability, which is widely used in many LMICs.

Top tip
Setting out clear objectives with your supervisor, making sure you and them share the same vision and think how the outcome of your thesis will affect your career in the future; and that it is important to take calculated risks – such as travelling to a country to conduct a study – which will give you tremendous insights that you would lose out on if you were doing a systematic review or secondary data analysis. But ultimately, the decision rests with how you see your thesis shaping the start of your career in public health.

Bronwyn Neufeld

Thesis title

Investigating the Relationship between Female Genital Schistosomiasis and Sexually Transmitted Infections in Zambian Women Using Field-Applicable Diagnostic Assays.

Overview

Female genital schistosomiasis (FGS) is a neglected parasitic disease resulting from infection with Schistosoma haematobium. Women with FGS have been found to be at greater risk of STIs including HIV, HPV and Trichomonas vaginalis (TV), though little is understood about precise interactions. Data on coinfection of FGS and STIs is limited in Zambia, and therefore there is a need for larger scale prevalence surveys using field appropriate diagnostic tools. My project was nested in the Zipime Weka Schista study in Zambia (https://www.lshtm.ac.uk/research/centres-projects-groups/zipime-weka-schista) and involved using field-applicable diagnostic assays to determine the prevalence of FGS and seroprevalence of Schistosoma across two communities in Zambia, as well as investigating any associations with STIs (HIV, HPV and TV). Findings included a higher observed prevalence of high-risk HPV in women with FGS compared to those without, though this association was not found to be statistically significant, demonstrating a need for larger scale longitudinal studies. This project allowed me to combine my interests in parasitology and sexual and reproductive health and gain further experience in both laboratory work and data analysis.

Top tip

You get out of what you put into the summer project – use this time to gain new skills in areas you may not be familiar with, and really dive into your interests. Don’t be afraid to approach potential supervisors who work in your areas of interest with your own ideas rather than selecting a project from a list.

MSc course

Medical Parasitology

Year of course

2021-2022

Me in the lab performing serological testing for Schistosoma.

Example of completed serological test (ELISA) where yellow colour change indicates seropositivity.

Recruitment set up in the field for sample collection.

How did you identify your project? (e.g. Did you approach your supervisor with an idea? Did you select it from a list?)

I approached my supervisor as I was aware of her previous work on FGS, and was hoping to find a project that combined both parasitology and STIs.

What are you doing now?

I am currently working as a technician for the Public Health Agency of Canada at the JC Wilt Infectious Diseases Research Centre, on various sexually transmitted and blood borne infection (STBBI) related projects.

How has your project helped your post-MSc life?

I think my project has helped me immensely in my post-MSc life. On a skills level, I use a lot of the laboratory skills I gained during the project in my current job. I also feel conducting my project allowed me to gain valuable insight into what kind of work I’d like to be engaged in, and feel much more confident in the direction I want my future career to take.

Marie Williamson

Thesis title

Association between phone ownership and STI treatment uptake in youth in Zimbabwe in a community prevalence survey: secondary data analysis of the endline survey of a cluster randomised trial

Overview

My thesis analysed youth diagnosed with STIs using laboratory-based testing from a household-delivered survey of an endline survey of a trial looking at the impact of community-based STI testing and treatment on population STI prevalence in youth in Zimbabwe. Molecular STI testing has the potential to reduce undiagnosed and untreated STIs in low-resource settings where syndromic STI management is standard practice. However, results feedback can be very challenging, particularly in settings without routine follow-up. I analysed the proportion of participants who received treatment and whether mobile phone ownership influenced the outcome using logistic regression and adjusted for potential confounders.  

Top tip

Start writing and getting feedback from your supervisor early, particularly the discussion for which the content can be anticipated earlier than you think!

MSc course

Public Health – general stream

Year of course

2021-2022

How did you identify your project? (e.g. Did you approach your supervisor with an idea? Did you select it from a list?)

The project came from the MARCH list and was adapted based on the logistical challenges of laboratory STI diagnostics and data available.

What are you doing now?

I’m back to my day job as a registrar in sexual health and HIV medicine in East London, hopefully bringing fresh energy and new perspectives on sexual health.  Alongside clinical work, I am working on a project collaborating with Positive East an HIV NGO to promote holistic care of people living with HIV.

How has your project helped your post-MSc life?

This project helped me grasp epidemiological and statistical concepts that are hard to understand without using real world data that you care about and are interested in!  I look at research for treatment decisions and journal clubs with a different eye now.  The MSc has given me research skills with which to develop my interest in promoting health equity in marginalised populations in sexual health and HIV.

Kevin Martin

Thesis title

Knowledge, attitudes, and practices of youth towards sexually transmitted infections and STI testing in Harare, Zimbabwe

Overview

Sexually transmitted infections (STIs) such as chlamydia, gonorrhoea, trichomoniasis and syphilis can lead to infertility, pre-term delivery, still birth and an increased risk of transmission of HIV. STIs disproportionately affect those in low income countries, such as Zimbabwe. In settings with limited resources, the World Health Organization recommends “syndromic management” for the management of STIs. This entails providing treatment for most infections that may be the cause of the symptoms or signs that a patient has. However, in addition to treating for infections that may not be present, thus contributing to antimicrobial resistance, this method will also miss individuals with asymptomatic infections. As the majority of STIs are asymptomatic, this is very problematic and contributes to ongoing STI transmission. As a result, there is increasing interest in the use of diagnostic STI tests in these settings.

Of note, young people are particularly susceptible to STIs. In Zimbabwe, youth aged between 15 and 24 comprise 18.9% of the population. Those under 15 make up a further 40.3%. Therefore, failure to appropriately address adolescent health now will lead to significant problems in the future.

I was based in Harare for six weeks, performing a sub-study within the CHIEDZA Trial. CHIEDZA is a cluster randomised trial, aiming to determine the impact of an integrated community-based package of HIV services, sexual and reproductive health services and general health counselling for 16 to 24 year olds. STI testing for chlamydia and gonorrhoea infections were offered as part of this package of services. My aim was to explore the facilitators and barriers to accepting STI testing among Zimbabwean youth. Hopefully, this information will be helpful when STI testing is implemented more widely in the future.

To do this, I conducted interviews and questionnaires across four different sites in Harare. I was made to feel incredibly welcome by the CHIEDZA team, all of whom were extremely committed to providing healthcare to youth. I heard from young people about the challenges they face in accessing sexual health care. This included the associated stigma, costs and frequent lack of knowledge about STIs, which granted me an insight into the likely future barriers to providing STI testing.

I really enjoyed my time in Zimbabwe. In addition to visiting a spectacular country, it enabled me to use the skills I had developed throughout my masters programme. I believe this experience has helped me become a more well-rounded researcher, and I feel better equipped to work in similar settings in the future.

Top tip

Try and build on your thesis, with other outputs like presentations and publications. You will already have put in a lot of work into your thesis, and so you should try and make the most of it! This is especially important if planning a career in academia. Furthermore, if you enjoyed working with your supervisors and want to keep working with them, let them know and see if you can build further on your work.

MSc course

Tropical Medicine & International Health

Year of course

2018/2019

How did you identify your project? (e.g. Did you approach your supervisor with an idea? Did you select it from a list?)

I approached my TMIH MSc group tutor Dr Michael Marks for advice about projects related to STIs. He suggested contacting Professor Rashida Ferrand, who was leading the CHIEDZA trial and which was about to start incorporating STI testing into the intervention. I then developed my project with Dr Marks, Professor Ferrand, and Professor Katharina Kranzer, as my supervisors.

What are you doing now?

I am back in Zimbabwe doing a PhD that builds on my MSc thesis, with the same three supervisors. Between my MSc and my PhD, I continued to work with colleagues in Zimbabwe, to develop further groundwork for my PhD proposal. The aim of my PhD project is to evaluate a strategy of point-of-care testing for STIs including chlamydia, gonorrhoea, trichomoniasis, syphilis, and Hepatitis B with comprehensive case management including partner notification in antenatal settings in Harare Province, Zimbabwe. This will include a mixed methods process evaluation and cost-effectiveness evaluation, to understand acceptability, feasibility, and cost-effectiveness of the testing strategy.

How has your project helped your post-MSc life?

My project has had a huge impact on my post-MSc career and life trajectory. In addition to helping me develop as a researcher, it also introduced me to an incredible team at The Health Research Unit Zimbabwe (THRU ZIM). As a result, I have been able to use my project as a springboard into further research projects and a PhD.

Lauren Hall

Surveillance is a critical component of effective disease control programmes, and during my summer research project I was able to participate in a study evaluating syphilis control and surveillance programming in South-Western Uganda. Undiagnosed and untreated Treponema pallidum infection (the cause of syphilis) during pregnancy risks being transmitted from the mother to her baby resulting in fetal loss, stillbirth and other adverse pregnancy outcomes, such as the baby being born with organ abnormalities known as congenital syphilis. Syphilis is the second leading cause of preventable infant mortality worldwide, despite global recommendations for universal screening programs during pregnancy. Under the stewardship of the World Health Organization (WHO), effective elimination of mother to child transmission (eMTCT) of syphilis (and HIV and hepatitis B) programmes include achieving indicators of 95% syphilis testing at first antenatal visit and 95% of women with positive tests effectively treated with penicillin, so as to bring down the rate of congenital syphilis to less than 50 cases/100,000 live births.

Lauren at the Lukaya Health Centre III, Kalungu District, South West Uganda

The primary aim of the research project that I joined (at the MRC/UVRI & LSHTM Uganda Research Unit) was to evaluate the effectiveness of the introduction of a novel dual HIV and syphilis point-of-care test rolled out at antenatal clinics in achieving the first two indicators of the eMTCT programme. Using a before-and-after evaluation design, I helped collect and analyse data from antenatal clinic patient records of health facilities selected through a two-stage cluster random sampling in two districts in South Western Uganda. We compared the rates of testing, positive reactions and treatment among antenatal clinic attenders (N=2000) in the 9-months before (January 2018-September 2018) and 9-months after (January 2019-present) the introduction of a dual HIV/syphilis test kit instead of separate test kits. We also tracked the possible effect of syphilis screening by looking at maternity records of the same health facilities, documenting potential syphilis attributable birth outcomes and HIV infection rates.

Finally, we collected data on the management of sexually transmitted infections (STI), particularly patients with genital ulcer disease, seen at the clinics to make some inferences about the community burden attributable to syphilis, and the adequacy of treatment offered.

Lake Victoria

My interest in STI research was cultivated prior to my joining the Masters at the London School of Hygiene & Tropical Medicine. By attending the Control of STI module and meetings of the STIRIG group, I learned of current School field research opportunities and of the MRC/UVRI & LSHTM Uganda Research Unit. After the whirlwind of final exams, the rush of participating in primary data collection highlighted the conclusion of my Masters’ experience, applying skills I had developed during my module courses. Arriving in Uganda before commencing data collection and leaving two months later with the research underway, I got the hands-on experience in research, and gained a depth in surveillance research and evaluative strategies in STI global indicators.

After initially meeting with the research team, I settled in at the UVRI (Uganda Virus Research Unit) research center headquarters in Entebbe where the MRC/UVRI & LSHTM Unit is located. After a few short weeks, we headed into rural areas for surveying corresponding health facilities, and I was able to contribute to the field collection activities for the remainder of my two months. Study data collection used Open Data Kit (ODK) software on tablets provided by the Open Research Kits group, and I gained valuable coding experience outside of the analysis for my final project.

The data collection team on their way to collect data in Kalungu District, Uganda. (L-R, Damalie, Lauren, and Allan)

Collecting primary research data during the course may not suit all MSc students, but it constitutes an invaluable experience for those contemplating starting a research career overseas. As a fledgling researcher, I also experienced personal nadir points - like when data collection wasn’t going to schedule or visible health inequity daily. Yet, if my summer project had been too conscripted the inquisitive nature that I developed in Uganda, the project taught me key elements of critical analysis and reasoning, as well as quick thinking and adaptation - all very useful to help develop or adapt a research protocol to answer unexplored questions in the field. The summer project allowed me to develop independent reasoning while participating in a cohesive research group at the MRC/UVRI & LSHTM Uganda unit, which will help me going forward in the future.

Entering data for ODK tablets (L-R, Allan, and Damalie)

Highlights of my summer project included getting to explore the places and people of Uganda. I developed lasting friendships with researchers and health facility workers and got to explore Uganda during my weekends off.

Allan entering data

Vivian Wan-Cheong Yim

Thesis title

“I Have No Idea What to Choose”: A Mixed Methods Study of Parental Decision-making for HPV Vaccination and Vaccine Hesitancy Among Chinese Parents in Chengdu, China

Overview

In China, over 170 women die from cervical malignancy every day. The substantial morbidity and mortality associated with the disease pose a significant threat to the health of reproductive aged women. Despite the introduction of HPV vaccines into the Chinese market in 2016, uptake is low (<3%) among adolescent girls. Vaccine hesitancy, defined as a decision-making process leading to delay or refusal of vaccination despite availability of services is a major reason for low uptake. There is scant literature examining the decision-making process behind parents’ decision to delay HPV vaccination for adolescents, and fewer still looking at this in the Chinese context. This mixed methods study aimed to fill in the gap by exploring how Chinese parents came to the decision to delay HPV vaccination and identifying potential individual and contextual factors of hesitancy using behavioural health theories.  Quantitative data was collected using surveys, followed by a qualitative component using focus group discussions and semi-structured interviews. We hope the findings will inform future vaccine promotion and advocacy campaigns.

Top tip

Start as early as possible to give yourself plenty of time to explore possible projects with different supervisors. Starting early will also give you valuable time to deal with any issue that may crop up down the road. If you don’t know where to begin, think of a topic you’ve always been fascinated with or can see yourself working on it in the future. Don’t be afraid to be ambitious! This is the opportunity to step outside of your comfort zone, gain new skills and make mistakes under a controlled, supervised environment.  

How did you identify your project?

I was interested in the control of STIs, especially HPV and cervical cancer prevention.  To collate a list of potential supervisors, I looked at the list of existing projects posted by STIRIG and past projects of interest in the library, then reached out to them for an in-depth conversation about my research interests and goals. One supervisor connected me to my current supervisor and her research team because their work aligned with my interests, and I knew I wanted to be a part of the work they were doing.   

What are you doing now?

I am currently working as a medical doctor (OBGYN) in Hong Kong.  

How has your project helped your post-MSc life?

Previously I had no experience in either qualitative or mixed methods approaches, so this Project definitely expanded my research skills set. This research topic has also been one of significant interest to me for a long time, and it has been a pleasure to collaborate with a wonderful team who is as passionate about the topic as I am.  We’re currently in the process of preparing the manuscript for submission. Finally, this Project offered a valuable glimpse into the world of academia.

Blog: interview with staff

Claire Broad

Claire Broad, Research Fellow at Faculty of Public Health and Policy, LSHTM

Tell us a bit about yourself - where are you from and what do you do?
I'm Claire, originally from Kent. I studied biomedical sciences in Leicester, then completed a PhD through the MRC-LID scheme at LSHTM and City St George’s. I now split my time between both. I’m doing lab-based STI research at City St George’s, specifically on Mycoplasma genitalium. At LSHTM, I’ve moved into policy-focused projects. I'm currently working in the Faculty of Public Health and Policy as a Research Fellow on SWERV (Sex Workers Evaluate Reporting Violence project), where we’re evaluating various sex worker safety reporting tools.

How did you end up in this area of work? Was there anything in particular that drew you here?

I first got a job in an NHS biochemistry lab. That was great, but about a year in, it felt quite limiting. I thought I’d like to work in a research role, but I didn't know how to segue into that. I then saw a poster for a job as a sexual health clinic healthcare assistant (HCA), which provided training and opportunities to do research. So, I quit my job, and started in a sexual health clinic as an HCA. I started working with a clinician who had a couple of research projects looking at rapid tests for chlamydia. I also met another clinician who was based at City St George's doing his PhD, and he needed someone to assist on a much larger project. So, I ended up in that job- which was more of a research assistant coordinator role based at City St George's. From there, I got onto the MRC-LID programme, which is an interdisciplinary PhD programme between LSHTM and City St George's. I did a sexually transmitted infection (STI)-based PhD and the rest is history! STIs kind of found me and I loved the whole field. I couldn't work anywhere else after that! I really appreciated the openness and acceptance of the STI research community and the sexual health community in general. I'd been working in a rather rigid clinical setting that was quite depressing in some respects, because a lot of the time it was just monotonous work or results for cancer biomarkers. Then the culture in the STI field and the sexual health research was so different to what I was currently in, and the outcomes could be much more positive. You don't have diseases that always result in death. I liked the openness, the acceptability, and the work culture!

What does a typical day look like for you?

My day will really vary depending on where I am based. At LSHTM, a lot of my work is around data collection methods - I’m in the throes of developing and finalising the questionnaire that we're going to use to capture the SWERV data. Because it's a co-produced project, we also have a lot of meetings with people of lived experience, and they can influence and direct how we navigate the questionnaires and the delivery of the study in general. I also have certain teaching responsibilities at LSHTM, for example I gave a lecture and was seminar lead for the Applied Communicable Disease Control module.

As part of the City St George's arm, I switch back to lab work - trying to get PCRs to work, doing some sequencing and working with some mycoplasma, which is really hard to grow and really hard to work with (and I have a little cry!)

What have been the highlights of your career to date?

My PhD was my career highlight! A PhD is a very difficult thing to do, especially during a pandemic. I got to collaborate with a team based at the International University of Ecuador in Quito. They are a really amazing group of people, and I made a lot of friends. It also opened my eyes to the world of STI research, particularly working with a different narrative to what I was so used to in the UK. Working there and understanding the intricacies, the politics, the difficulties of doing work abroad and in a country where there is no STI testing that's freely available. Some of the results that we generated from that were so fascinating, and it was just a really good thing to work on.

Have you noticed any changes in the field over your career?

I started working in sexual health in 2013 and have certainly noticed a lot of changes.

I’ve seen the influx of online testing and reduction of face-to-face contact in healthcare, which then changed access to care. I think that the use of online testing is quite a contentious subject, but it has really made it more accessible. It has been revolutionary in some areas, but I appreciate the intricacies of that.

We also had the M-Pox outbreaks and the changes there in vaccination schedules. Since I’ve always very much been a bacterial STI person, antimicrobial resistance has obviously been a huge problem.

What do you think are the next big things coming in the field of STI/HIV research?

My immediate answer to that feels quite negative, but with political changes globally bringing uncertainty of access to certain medicines, I think there might be quite an increase in STI numbers. You know, access to antiretroviral therapy and the impact on HIV prevalence, lack of access to certain antibiotics contributing to the amount of resistance we’re seeing. There are some positives- vaccines on the horizon look really exciting! The use of Doxy-PEP- I'm excited to see the outcomes for that!

What challenges have you faced in your career, and how did you overcome them?
Lab-based research always has its own challenges, and it's not to minimise other areas, but it always feels like you are kind of walking up a hill in treacle. Particularly when you're working with bacterial STIs, things like Mycoplasma genitalium are very hard to investigate. One of the biggest challenges I've had is developing sequencing-based tools that we can use rather than inaccessible and costly bacterial cultures. 
Funding is a major challenge for everyone in the STI field – it’s just so poor and gets rerouted to other areas that are seen as more important. What keeps me motivated is the exposure I had whilst working with the team from Ecuador. You just remember that it really does impact someone's life, and it is an important thing to do. Lab-based work can have that, but I’m also seeing that with my SWERV co-produced research work.

I think that our teams are generally such nice people and that’s motivation too. You’re never working in an unpleasant space, despite the political pressures that are around that.

What advice do you have for people entering the field now?

I always recommend that people take a chance! Even if you have to take a step down from what you're currently doing. I appreciate that it can come with financial stress and has to be within the realms of your capacity. But if you do have to take a slight step sideways or downwards to get to get forward, I think that's really important to try. What I did was a bit of a gamble, and that was easy at the time for me because I was young and didn't have a family to support. But it's sometimes worthwhile taking a gamble on something you're unsure of and just trying it and seeing if that works.

Sometimes people are very stuck on the experiences that they have and that’s the only way that they can get somewhere. You never know what you can bring to a team, so just put yourself out there and try, even if you're not fully qualified for something. Let someone else make that decision and see if you can actually provide other experiences that you weren't aware of that might benefit that study or project or job.

What’s one myth or misconception about STI research you’d like to dispel?

The main myth is that STIs only happen to certain people or with certain behaviours. We don't stigmatize people for other infections. We don’t say “well you got a cold because you hugged someone the other day”, but we would if it was an STI. They're still just infections. Everyone has sex, and sometimes, unfortunately people get infected. And that stigma is really the thing that we're all trying to break.

A selfie I took sending and receiving stuff from Ecuador during my PhD, and the excitement of it being possible despite being 3 months into the pandemic!

Dr Chido Dziva Chikwari

Dr Chido Dziva Chikwari, Assistant Professor at Faculty of Epidemiology and Population Health, LSHTM

Can you tell me a bit about your academic journey, and how you got to where you are today?

I grew up in Zimbabwe, then did my undergraduate at the University of Newcastle in the UK in biomedical science and business. I really liked the biology angle of my degree, but I also thought the business teaching would be new and different, and potentially helpful somehow in the future, because my parents run their own businesses. After finishing my undergrad, I realised I didn't want to be in the lab – I wanted to interact with people in my day-to-day work. I started looking for job opportunities that were people-facing and ended up working as a research assistant on a research study here in Zimbabwe. That piqued my interest in doing epidemiological research, and that's how I ended up doing a part-time master's in epidemiology at LSHTM.

Once you'd finished your master's, did you immediately know you wanted to do a PhD?

No. Once I finished my master's, my then-boss asked if I would lead a new study as the study coordinator. Then she was like, well, if you're leading the study and doing all the work, you might as well get a PhD out of it. Because I was working at an LSHTM overseas collaborating site, I was eligible for the Capacity Strengthening Research Degrees Scheme, which meant I got reduced fees.

You mentioned enjoying the people-facing side of research. Can you talk more about what else drew you specifically to STI research?

I actually started off in HIV research. My PhD is on HIV testing strategies among children and adolescents in Zimbabwe, and my work generally has been centred around adolescents and young people. So my HIV work with adolescents transitioned into sexual and reproductive health, of which HIV is a part. So it’s been a natural flow, all the things fitting together. Most of my work is focused on adolescents and young people. In my context, Zimbabwe, young people face many barriers accessing sexual and reproductive health services - there's social and cultural stigma, policy issues around age of consent and service access, and complex cultural factors restricting young people's sexual well-being and health. It’s a space I'm really passionate about.

I wanted to ask about the highlights of your career to date. And please don’t be modest - what achievements have you been most proud of, days you remember where you felt, "I’ve made it"?

Getting my PhD - actually finishing it, submitting it, and getting the award. Publishing one of my PhD papers in The Lancet HIV was a really big deal. My PhD also contributed to changes in WHO guidelines for HIV testing for children and adolescents. That was a wow moment for me - I realised the research we do can lead to policy and programming changes beyond just my community or country. It's powerful to help one family, but amazing knowing our work can change things everywhere.

I also got the Woodruff Medal for my PhD at LSHTM. A lot of the PhD journey involves being unsure - am I doing the right thing? Does this matter? The Woodruff Medal is about the most outstanding and clinically relevant PhD, so having that stamp after years of questioning was meaningful.

Another landmark moment was more like a low point: during my PhD upgrade, receiving feedback to revise my PhD and crying about it for a long time, taking six months for corrections. It was a landmark moment because it was a teaching moment. I became a better researcher and epidemiologist because the changes included different methods and deeper exploration of the subject.

I’m four years post-PhD now, and these years have been an identity crisis. Your PhD becomes your baby, then it’s gone, and you’re finding your feet again. Grant writing is excruciatingly painful - you question your capabilities, your ideas, your role, your career path. Coming out of that, having failures and a few successes has been humbling and life-changing.

It’s reassuring speaking to academics you admire and finding out that they’ve also struggled and questioned themselves.

Yeah, absolutely. I get wary when people see me and my outputs over the years and say, "Oh, you're amazing, you do everything well, you've had all these successes." I'm like, great, thank you, but actually, I've had many tough days, impostor syndrome, worrying about giving my son attention. This is hard - not to discourage people but to show the human side of success.

Going back to grant writing - do you have practical tips?

Get help! Talk to people, identify mentors, present your ideas to groups, locally and internationally, to get feedback. Writing takes time - give it the time needed. Often it gets deprioritised because nobody pays you to write grants; you're paid for other work, so find the time intentionally. Write early so you have time to get input from your peers and mentors, and practice doing the presentations beforehand. And hold onto things that help you get by - take care of yourself, positive affirmations, don’t take rejections personally. Keep putting one foot in front of the other.

Can you describe a typical day in your life?

I work best in the morning, so I have a weird routine (please don’t do this at home!). I wake up at 4:00 AM, do emails and writing until about 5:30. Then I take a 45-minute walk - I call it my board meeting with myself. After, I take my son to school. Then I work from home most days, meetings start at 11:00, so 8:00-11:00 is quiet work time. I sometimes finish work late, around 6:00 or 7:00 PM due to time differences. Then dinner with my son, bedtime for him, and reading or watching series until I fall asleep.

What are you reading and watching at the moment?

I just finished "The Boyfriend" by Freida McFadden. Previously, I read "The Housemaid" by her, which is now a movie. Today I'm starting "Dreamcount" by Chimamanda Ngozi Adichie.

More generally around STIs, what in your field specifically are you most excited about - any new developments or innovations?

What I'm excited about is that we've got many new STI diagnostics in the pipeline, and that the latest WHO guidelines recommend STI screening in some populations and contexts with high prevalence. The work I'm doing now is exciting because I'm looking at using these new diagnostics combined with self-care approaches - like getting people to self-sample and, potentially in the future, self-test for STIs. I’m also looking at how to use digital technology in low-resource settings to facilitate self-care. I'll be using smart lockers and mobile phones to help young people access sexual and reproductive health commodities, including STI tests, in Zimbabwe. I'm super excited about innovating around the delivery of these products and helping people screen and get results in low-resource settings.

Are there any myths or misconceptions about STI research you'd like to dispel?

Coming from HIV and general sexual reproductive health worlds, I think the STI field is really fun and exciting. The people in this space are really cool, and it's a nice, tight-knit community - I love that. A misconception is around the scary pictures of genital warts and penises looking really gory. That's something people need to get over, because the majority of STIs are asymptomatic. Not everyone with an STI looks like those pictures. Also, thinking about sexual health more broadly - sex is fun! We need to get those gory pictures out of our minds and instead think of preventing and managing STIs as facilitating sexual pleasure. Sex is amazing, people have sex all the time, and that's what we should focus on, not the scary pictures.

Agreed! Is there anything else you'd like to add - any last pieces of advice for people reading this?

Keep pushing toward the things you're working on - your master’s, PhD, postdoc, or actual job. Keep moving toward things you're passionate about. If you’re feeling lost or confused, listen to your inner voice or to things you lose track of time doing, because that might be the direction you're supposed to go. I do lots of positive affirmations. I have some right here at my desk - one says, "You're doing much better than you think, so keep pushing," and another one says, "You are capable and exceptional." If you're reading this, you're associated with LSHTM one way or another, so you are capable and exceptional!