Epidemiological and statistical research on health problems of developing countries: MRC Tropical Epidemiology Group
Lead Research Organisation:
London School of Hygiene & Tropical Medicine
Department Name: Epidemiology and Population Health
Abstract
While there have been major improvements over the past century in the health of populations all over the world, there are still deep inequalities between the rich and poor nations. Gains in health in many of the poor countries have been reversed recently due to the global epidemic of HIV/AIDS and steep increases in TB and malaria. Life expectancy in some parts of Africa has fallen by more than 20 years. There is an urgent need to find effective means of controlling these major killer diseases in order to bring down the high burden of mortality and ill health.
The MRC Tropical Epidemiology Group is a group based at the London School of Hygiene and Tropical Medicine whose main aim is to conduct research on these infectious diseases in Africa and other parts of the developing world. We collaborate with scientific groups overseas, assisting especially with the planning and analysis of research studies. These studies are designed to improve our understanding of risk factors for these diseases, and to evaluate the impact of different control measures.
During the next five years, our main focus will be on HIV, TB and malaria which between them cause around eight million deaths each year. We will study various ways of preventing HIV infection, as well as approaches to providing treatment for HIV-positive people in Africa where health-care resources are limited. Because the risk of TB is increased by HIV infection, TB is now out of control in some countries with major HIV epidemics, and we will therefore study new ways of preventing and treating TB. In malaria, our research will focus on intermittent preventive treatment, a new approach whereby all children and pregnant women are given periodic doses of antimalarial treatment, and on improved methods of controlling the mosquitoes that transmit malaria. We will also carry out work to develop new methods that can be used to study these health problems in developing countries.
As well as reporting our work in scientific journals, we frequently write articles aimed at a non-specialist audience, as well as contributing to television and radio programmes.
The MRC Tropical Epidemiology Group is a group based at the London School of Hygiene and Tropical Medicine whose main aim is to conduct research on these infectious diseases in Africa and other parts of the developing world. We collaborate with scientific groups overseas, assisting especially with the planning and analysis of research studies. These studies are designed to improve our understanding of risk factors for these diseases, and to evaluate the impact of different control measures.
During the next five years, our main focus will be on HIV, TB and malaria which between them cause around eight million deaths each year. We will study various ways of preventing HIV infection, as well as approaches to providing treatment for HIV-positive people in Africa where health-care resources are limited. Because the risk of TB is increased by HIV infection, TB is now out of control in some countries with major HIV epidemics, and we will therefore study new ways of preventing and treating TB. In malaria, our research will focus on intermittent preventive treatment, a new approach whereby all children and pregnant women are given periodic doses of antimalarial treatment, and on improved methods of controlling the mosquitoes that transmit malaria. We will also carry out work to develop new methods that can be used to study these health problems in developing countries.
As well as reporting our work in scientific journals, we frequently write articles aimed at a non-specialist audience, as well as contributing to television and radio programmes.
Technical Summary
The MRC Tropical Epidemiology Group initiates and collaborates in research on the epidemiology and control of public health problems of developing countries. We provide statistical and epidemiological support for the MRC Units in Uganda and The Gambia while also collaborating with other groups carrying out high-quality research overseas. We carry out observational and experimental studies, but the main emphasis is on intervention studies, including cluster-randomised trials (CRTs) in which we have special expertise. We have major programmes of work on HIV and other sexually transmitted infections (STIs), tuberculosis (TB) and malaria, but also carry out research on other diseases of public health importance.
In HIV/STI research, we will complete trials of adolescent sexual health interventions and of the Pro-2000 vaginal microbicide, continue our work on herpes control for HIV prevention, and develop research on the implementation of male circumcision services. A trial of home-based antiretroviral treatment (ART) will be completed and new research conducted on adherence, drug resistance, and different models of ART provision. Work on human papilloma virus (HPV) will include a bridging study of HPV vaccine and seroepidemiological studies to guide vaccination policy. In TB research, we will continue to collaborate with the CREATE consortium and three CRTs of TB control interventions in HIV-endemic populations will be completed, as will a trial of a four-month TB treatment regimen. Malaria research will focus on trials of different strategies of intermittent preventive therapy (IPT) in children and pregnant women, with special emphasis on IPT regimens in areas of seasonal transmission. We will collaborate in trials of two malaria vaccine candidates and research on the effectiveness of improved methods of vector control. Research on acute respiratory infections will focus on population-level effects of vaccination programmes. We will expand our work on mental health, with trials of interventions against common mental disorders and alcohol misuse.
Mathematical modelling work will include studies of HIV transmission in adolescents, and the evolving HIV epidemic in Uganda; studies aimed at interpreting the CRTs of TB control interventions; and research to explore the effects of household clustering on trachoma control. Methodological work will be carried out on the analysis of CRTs, analytical methods for zero-inflated data and highly skewed endpoints such as viral loads and parasite counts, and implementation of GCP procedures in resource-poor settings. We will support the development of the new MRC-supported Intervention Trials Unit in Mwanza and strengthen our programme of TEG training fellowships.
In HIV/STI research, we will complete trials of adolescent sexual health interventions and of the Pro-2000 vaginal microbicide, continue our work on herpes control for HIV prevention, and develop research on the implementation of male circumcision services. A trial of home-based antiretroviral treatment (ART) will be completed and new research conducted on adherence, drug resistance, and different models of ART provision. Work on human papilloma virus (HPV) will include a bridging study of HPV vaccine and seroepidemiological studies to guide vaccination policy. In TB research, we will continue to collaborate with the CREATE consortium and three CRTs of TB control interventions in HIV-endemic populations will be completed, as will a trial of a four-month TB treatment regimen. Malaria research will focus on trials of different strategies of intermittent preventive therapy (IPT) in children and pregnant women, with special emphasis on IPT regimens in areas of seasonal transmission. We will collaborate in trials of two malaria vaccine candidates and research on the effectiveness of improved methods of vector control. Research on acute respiratory infections will focus on population-level effects of vaccination programmes. We will expand our work on mental health, with trials of interventions against common mental disorders and alcohol misuse.
Mathematical modelling work will include studies of HIV transmission in adolescents, and the evolving HIV epidemic in Uganda; studies aimed at interpreting the CRTs of TB control interventions; and research to explore the effects of household clustering on trachoma control. Methodological work will be carried out on the analysis of CRTs, analytical methods for zero-inflated data and highly skewed endpoints such as viral loads and parasite counts, and implementation of GCP procedures in resource-poor settings. We will support the development of the new MRC-supported Intervention Trials Unit in Mwanza and strengthen our programme of TEG training fellowships.
