Frontline diagnostics play a critical role in the management of infectious and non-communicable diseases, particularly in resource-limited settings. The ‘TIYENI Dx’ project is designed to strengthen equitable access to community-based diagnostics across three disease contexts: HIV and Type I and Type II Diabetes in Malawi, and HIV and Ebola in Uganda. The work will inform national health strategies for scale-up of diagnostics and address inequalities in access to health empowerment through self-testing at a critical time as countries respond to the global call to address diagnostic gaps.
Our partnership is co-led by the London School of Hygiene and Tropical Medicine, Makerere University and the Malawi-Liverpool Wellcome Research Programme.
Summary
Frontline diagnostics play a critical role in the management of infectious and non-communicable diseases, particularly in resource-limited settings. The ‘TIYENI Dx’ project is designed to strengthen equitable access to community-based diagnostics across three disease contexts: HIV and Type I and Type II Diabetes in Malawi, and HIV and Ebola in Uganda. The work will inform national health strategies for scale-up of diagnostics and address inequalities in access to health empowerment through self-testing at a critical time as countries respond to the global call to address diagnostic gaps.
Project details
TIYENI Dx will focus on understanding ‘rational use’ of community diagnostics through the perspectives and lived experiences of individuals, families, communities and frontline health workers and the impact on management of health and well-being at home and through interactions with the health system.
Decentralised access to diagnostics through self-testing has substantial potential to address global diagnostic gaps, democratise health and contribute to Universal Health Coverage. The focus is on three conditions for which frontline diagnostics are available within the primary health system or the community: HIV, diabetes and Ebola, which represent three distinct, connected scenarios for investigation: 1) community self-testing for diagnosis of stigmatised conditions (HIV), 2) including in primary facilities during public health emergencies (Ebola) and 3) self-testing for monitoring of chronic conditions (blood glucose for diabetes).
Key research aims
- Define and document social and structural drivers of ‘rational use’ under conditions of stigma, emergency disease outbreaks and lifestyle and risk management
- Unpack the dynamic between empowerment through self-testing and engagement with public and private health services
- Explore uncertainty, trust and risk influencing decisions, embedded within complex socioecological environments and impact on intended and unintended, beneficial and potentially harmful health and social consequences
- Co-produce toolkits for ‘rational use’ of frontline diagnostics
- Promote health equity across mainstream and marginalised groups through ‘rational use’ of self-testing and monitoring that reflects direct to consumer markets.
Impact
The work will contribute community perspectives to advancing policy and regulatory frameworks for the advancement of self- and near-person diagnostics as sub-Saharan Africa moves to meet the World Health Assembly call to develop national diagnostic strategies.
The work will inform national health strategies for scale-up of diagnostics and address inequalities in access to health empowerment through self-testing at a critical time as countries respond to the global call to address diagnostic gaps.
TIYENI translates to ‘Let’s Make Progress!’ in Malawi and Uganda and reflects the aim to drive forward equitable and people-centred strategies to improve health outcomes.
This is an anthropological research project using qualitative methods and situated at the interface of technology and society. The project will be delivered through four work packages:
- Work Package 1: HIV and diabetes in rural and urban Malawi
- Work Package 2: HIV and frontline Ebola diagnostics in rural and urban Uganda
- Work Package 3: Community co-production of toolkits for ‘rational use’ of frontline diagnostics
- Work Package 4: Evidence to policy and development of framework for ‘rational use’
Responsiveness to technological innovation is informed structurally by the wider policy context and behaviourally by community and individual perceptions of risk. Access, engagement and response are additionally influenced by local and national, social and economic contexts, including modernisation through urbanisation and exclusion through social marginalisation and structural inequalities. Given this, the work will be undertaken comparatively across urban and rural settings in one low-income (Malawi) and one lower middle-income (Uganda) country. The project will be co-led by partners at Makerere University and Malawi-Liverpool-Wellcome Trust.
Nicola
Desmond
Professor
Nicola is an anthropologist who has spent over 20 years living and working in sub-Saharan Africa, most recently with the Malawi-Liverpool-Wellcome Programme where she established and led the Behaviour and Health Group, and the social science programme, building a strong team of qualitative and mixed methods researchers in social science. She moved to LSHTM from the Liverpool School of Tropical Medicine in November 2024 and is currently establishing a research group on the social and ethical dimensions, including intended and unintended harms and benefits, of health technologies for diagnostics, therapeutics and prevention. She is particularly interested in the interactions between society and technology and how health technologies are transformed, transforming and (re)imagined as they move across transnational and transcultural boundaries within global health.
David Kaawa-Mafigiri
Associate Professor of Medical Anthropology (Makerere University)
David Kaawa-Mafigiri is an Associate Professor in the School of Social Sciences, Makerere University, medical anthropologist with public health expertise in integrating socio-behavioural and community perspectives to infectious and non-infectious disease control in East and Central Africa. Utilizes anthropological techniques including ethnography for HIV, Ebola, and COVID-19 response to amplify community engagement in epidemic preparedness. Commitment to biosocial research is illustrated through his research and publications (https://orcid.org/0000-0002-2699-4248).
Augustine Choko
Senior Lecturer in Public Health Epidemiology (Liverpool School of Tropical Medicine)
Augustine Choko is a Senior Lecturer at LSTM with over 14 years of research experience. Augustine, along with Liz Corbett are the pioneers of population-based HIV self-testing (HIVST) in Malawi. He showed through a complex adaptive trial that HIV testing by male partners can be increased by providing HIVST kits via a pregnant partner. Augustine’s work in HIVST focusing on underserved populations has informed national and international policies.
Wezzie
Lora
Assistant Professor
Wezzie Lora is an anthropologist and Assistant Professor at the London School of Hygiene & Tropical Medicine with over 12 years' experience conducting qualitative research in Sub-Saharan Africa. Her expertise centres on self-testing technologies, including HIV self-testing amongst marginalised and vulnerable populations. Formerly involved as qualitative researcher in the STAR HIV Self-Testing Consortium, she has extensive experience examining the social dimensions of diagnostic technology adoption and implementation in resource-limited settings across multiple African countries.
Mark
Marchant
Research Fellow
Mark Marchant is a Research Fellow at the London School of Hygiene & Tropical Medicine and a qualitative social scientist working at the intersections of anthropology, political theory, and public health. His research focuses on community engagement, health technologies, and trust in health systems, with experience leading qualitative and ethnographic research in East Africa on infectious disease, gender-based violence, and health policy.
Henry Sambakunsi
PhD Student (LSHTM/MLW)
Henry Sambakunsi is a PhD student at LSHTM based at the Malawi-Liverpool-Wellcome Programme. With over seven years' experience in qualitative health research in Malawi, his work spans HIV self-testing, antimicrobial resistance, pandemic preparedness and gender-based violence among female sex workers. Formerly a qualitative researcher on the STAR HIV Self-Testing Consortium, he holds an MSc in Global Health from LSTM.
Robert Okello
PhD Student (LSHTM/Makerere)
Robert (Bob) Okello is a Ugandan researcher based in Kampala. Before commencing the TIYENI Dx PhD studentship, Bob worked as a researcher and consultant with the Centre for Public Authority and International Development at the London School of Economics. He also served as a researcher on the Wellcome Trust-funded project, Pandemic Preparedness. Bob holds an MSc in Control of Infectious Diseases from the London School of Hygiene & Tropical Medicine.
Yasmin
Dunkley
Research Student - MPhil/PhD - Infectious & Tropical Diseases
Yasmin Dunkley is a health systems researcher based in Botswana, working at the interface of global health programming and research. Her work examines decentralised health technologies as socio-technical interventions, focusing on how bringing services closer to people reshapes health systems and the social worlds they are embedded in. She is completing her PhD, which included developing an infectious disease model examining conditions under which self-testing can support epidemic preparedness, including Ebola.
Cora
Dee
Project Coordinator
Cora Dee is a Programme Manager at LSHTM based in the Faculty of Public Health and Policy, working on two large NIHR-funded anthropological global health projects, TIYENI-Dx and Nurture4Youth. She also holds an MSc in Global Health and Development from UCL.
Asimenye Kayuni
Head of Grants Reporting
Asimenye is responsible for End-to-End Grants Management for MLW. From initial award stages through to close-out, audits, and institutional due diligence. She is responsible for reviewing budgets grant budgeting, oversight, compliance, and ensuring value for money and making sure best practices for budgeting, managing grant funds in research organizations, and avoiding common mistakes. She brings +18 years of experience of working within Grants and Finance Department and Multiple Donors. Over time, Asimenye has won multiple funder travel grants to participate in Grants Management and Budgeting plus Contract Management. In 2025, she won 3 Travel awards from NIHR, EDCTP and Science of Africa Foundation (SFA) to participate in their LMIC programmes.
Isabella Judith Achokotho Akol
Program Manager (USHS)
Mrs. Isabella Judith Achokotho Akol holds a honours Bachelor of Arts degree in Social Sciences from Makerere University, a Postgraduate diploma in General Management (Uganda Management Institute) and a Masters of Arts degree in Public Administration and Management (Makerere University) possesses over 20 years’ experience in human resource management, grants management, project administration, financial management, conference organizational skills, procurement and monitoring and evaluation.
Bright Lipenga
Research Student – MSc-Regulatory Sciences (MLW)
Bright Lipenga is medicine regulation enthusiast based at MLW where he works in clinical research governance & trial implementation as the Pharmacist of Record. His work is in investigating the role of medicine regulatory agencies in promoting equitable access to medical devices & diagnostics. He is an MSc in Regulatory Sciences student, focusing on clinical research regulation & translational research in Drug/Medical Device Discovery and Development.