Epidemiological and statistical research on health problems of low and middle-income countries: MRC Tropical Epidemiology Group (TEG)

Infectious diseases, including malaria, HIV, tuberculosis (TB) and neglected tropical diseases (NTDs), remain a main focus of our research, as they are the leading causes of ill-health in Africa. In the next grant period, the team will expand our research on emerging diseases, adolescent health and non-communicable diseases – particularly hypertension, diabetes and chronic obstructive pulmonary disease, which are major disease problems in LMICs. This research focuses on conditions that are major causes of ill-health, and for which improved prevention or treatment leads directly to improved economic and social outcomes. The importance of these issues to the UK is highlighted in the 2015 Government strategy for overseas aid, on tackling global challenges in the national interest.
The scale-up of malaria control tools, primarily long-lasting insecticidal nets, and effective combination therapies, has prevented an estimated 663 million clinical malaria cases in sub-Saharan Africa since 2000, and has made malaria elimination an achievable goal in some countries. However, these gains may be threatened by insecticide resistance, drug-resistance, and resource-constraints. Within the next grant period, our focus will be on evaluating new tools, combining new and existing control strategies, and investigating sustainable and more effective deployment of these strategies.
For HIV, the team will focus on the goal that 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. For example, we are leading a major trial in South Africa and Zambia to evaluate the impact of a combination prevention intervention on new cases of HIV in the community. The intervention includes household-based HIV testing and linkage-to-health services by community care providers, and immediate initiation of treatment delivered through routine healthcare services.
TEG research on TB includes studies to evaluate improved TB treatment strategies, improved diagnosis, prevention and control of drug-resistant TB, improved TB case finding and prevention, and evaluation of structural interventions (social support and monetary incentives) to control TB. For example, the team is working on a trial to evaluate an improved electronic medication device for TB patients to reduce treatment failure and subsequent recurrence/retreatment in the absence of directly observed treatment.
The team will continue our long-standing work on intervention strategies for the control and elimination of NTDs, and the team’s more recent involvement in the control of outbreaks such as the Ebola and Zika virus outbreaks. We will also continue our work on the effectiveness of lay-health worker interventions to treat common mental disorders (depression and anxiety), focusing particularly on treatment of these conditions among adolescents, in whom over half of mental health disorders start.
Through the MRC Programme Grant, we leverage additional funding for research projects and support salaries for around 30 statisticians and epidemiologists, based at LSHTM. The grant is critical to enable us to recruit and retain these scientists, who have disease and methodological expertise in the design and analysis of epidemiological studies in LMICs. The team collaborates with the MRC Units in The Gambia and Uganda, and over 50 other research institutes in LMICs. We will continue our initiatives to increase capacity in medical statistics in sub-Saharan Africa, for example by expanding the MRC TEG Fellowship scheme, which to date has trained 17 medical statisticians through a Masters in Medical Statistics at LSHTM, followed by a placement year. All are now working as medical statisticians in Africa.

Technical Summary
The aim of TEG is to conduct cutting-edge epidemiological studies on health problems of low- and middle-income countries (LMICs). TEG will continue to have a major focus on the epidemiology and control of infectious diseases, with increased emphasis on evaluating delivery strategies for interventions of proven effectiveness. We will expand our research on emerging infectious diseases, adolescent health, non-communicable diseases and applied epidemiological methods. We will also expand our capacity building initiatives, including the TEG Fellowship scheme to train African statisticians. These issues are critical to the UK Government strategy for overseas aid, as indicated by the £1.5 billion Global Challenges Research Fund to support challenges in LMICs.

TEG malaria research includes assessing the scale-up and combination of malaria control tools, e.g. investigating sustainable and more effective deployment of long-lasting insecticidal nets, and effective combination therapies. For HIV, we focus on community-based approaches to improving HIV testing and linkage-to-care in sub-Saharan Africa, and interventions for key populations in high-incidence settings. Our TB research includes studies to evaluate improved TB treatment strategies, improved diagnosis, prevention and control of drug-resistant TB, improved case finding and prevention, and structural interventions. We will continue research on the control and elimination of NTDs, including the Ebola and Zika virus outbreaks. Finally, we conduct applied methodological work to advance the design and analysis of epidemiological studies in LMICs.

Through the Programme Grant, we will continue to leverage funding to recruit and retain a critical mass of scientists who have expertise in design and analysis of epidemiological studies in LMICs, and relevant disease-specific expertise. We collaborate closely with the African MRC Units and many other institutes in LMICs, with whom we published 700 papers in the past 5 year

Project details

Epidemiology
Leadership & Governance

Nov 2018 — Oct 2024

$5.5M

United Kingdom