Supervisory team
LSHTM
Nagasaki University
- Chris Smith ([email protected])
- Su Myat Han ([email protected])
External advisors
- San Lazaro Hospital: Dr. Ana Ria Sayo ([email protected])
- San Lazaro Hospital: Dr. Rosario Jessica Abrenica (MD, MPH, Head of the HIV/AIDS department)
Project
Background
The Asia Pacific region has the fastest growing HIV epidemic in the world, with new infections rising exponentially in recent years. This trend is markedly pronounced in the Philippines which is currently lagging far behind the UNAIDS 90-90-90 targets for epidemic control. As a result, the number of AIDS-related deaths in the region has increased by more than 500% in the last decade. Most AIDS-related deaths are caused by opportunistic infections including tuberculosis, cryptococcal meningitis, bacterial infections, and Pneumocystis pneumonia. Effective diagnostics and treatments for these infections exist; however, appropriately diagnosing and treating this complex patient group is challenging, and there is no standardised approach to diagnosis when individuals are hospitalised. In addition, diagnosis can be time-consuming and is not always definitive, preventing or delaying treatment. Sick patients with advanced HIV disease (AHD) are predominantly admitted to San Lazaro Hospital (SLH), a specialist tertiary care facility for communicable diseases. The clinical characteristics, aetiologies, and outcomes of those admissions are poorly characterised. The objective of this PhD project is to describe the clinical epidemiology of inpatient AHD in the Philippines through the design, implementation and evaluation of a diagnostic bundle for inpatient AHD.
The project
Initial formative research within an observational cohort at SLH will generate an understanding of the inpatient burden of AHD, diagnostic access and uptake, and outcomes of people hospitalised with AHD. This will be complemented by qualitative methods research with patients and providers to understand their pathways to care and identify healthcare system factors. Based on these findings a diagnostic algorithm will be developed with the aim of increasing diagnostic yield without introducing excessive cost or complexity. This bundle will include novel diagnostics for opportunistic infections. The bundle will then be implemented within a follow-on observational cohort with the aim of expediting diagnosis, reducing time to treatment and improving outcomes. The approach will be evaluated, including an economic evaluation and assessment of feasibility and acceptability.
Expected outputs
The PhD candidate will develop skills in clinical epidemiology, the evaluation of diagnostics, and implementation science. This work has the potential to describe in detail the clinical epidemiology of inpatient AHD in the Philippines and support the introduction of a bundle of diagnostics for this group of patients
The role of LSHTM and NU in this collaborative project
David Lawrence and Joe Jarvis visited San Lazaro Hospital in February 2025 and were hosted by Chris Smith from LSHTM/NU and the team based in Manila who are an extension of the NU team in Nagasaki. The team toured the inpatient wards and outpatient HIV clinic, with the support or Dr Ana Ria Sayo. There has thus far been limited research into HIV and advanced HIV disease conducted within the LSHTM/NU partnership and this project will draw on the expertise of LSHTM supervisors who have extensive experience of conducting similar research in the African context and Vietnam.
The supervisory and advisory team across LSHTM, NU and SLH will work closely with the PhD student, attending at least monthly supervisory meetings as a team and will arrange for face-to-face supervision in London, Nagasaki or Manila, as appropriate. It is hoped that this new collaboration, centred around this PhD studentship, will form the foundation for future projects and grant applications across the three institutions, including future PhD and post-doctoral opportunities.
Skills we expect a student to develop/acquire whilst pursuing this project
The PhD student will develop skills in the following:
- Clinical epidemiology
- Clinical infectious diseases
- Diagnostic validation studies
- Implementation science
- Qualitative methods research
- Community engagement and involvement
- Project management
- Team working
- Leadership
Entry requirements for this project
The PhD candidate should be a trained healthcare worker, with a preference for a doctor, nurse or laboratory scientist.