Calibration and analysis of complex models: methodological development and application to explore the impact of HAART in Africa

Lead Research Organisation: London Sch of Hygiene and Trop Medicine
Department Name: Epidemiology and Population Health

Abstract

Mathematical models are used routinely in government, the public sector, industry and academia to help predict the future and make policy decisions, such as what is the impact of ocean currents on the climate and how should we best prepare for the next flu pandemic? The usefulness of models in helping to make decision relies on how well they are can be matched to real data (model calibration) and how well we can analyse the models to find out how confident we should be about the predictions they make. In recent years models have become increasingly complex, but we don't yet have good methods to calibrate and analyse these more complicated models. The lack of these methods is a major obstacle to improving our predictions, and the policy decisions that affect all of us in the UK.

HIV/AIDS remains the leading public health problem in much of sub-Saharan Africa. While increased access to treatment for HIV (highly active anti-retroviral therapy or HAART) has successfully reduced suffering and deaths among people living with HIV/AIDS, it is unknown how best HAART can be used to reduce the number of new HIV infections. Models would help us determine the best strategy, but we need improved methods of model calibration and analysis to do this.

In this project we will develop new methods to calibrate and analyse complex individual-based stochastic models (these models are very computer-intensive as every individual is explicitly tracked through time). First we will develop two new model calibration methods specifically for stochastic models and also develop new methods that allow us to calibrate multiple models outputs at the same time (eg the number of people infected with HIV and the number of deaths from AIDS). Then we will compare these new methods with existing methods to see how they perform. We will go on to develop hybrid calibration methods that combines the strengths of our new and existing methods, to get the best of both. Finally we will apply our new methods to calibrate a complex model to data on HIV/AIDS trends in Africa, and use our fitted models to predict the impact of HAART on HIV/AIDS in Africa.

The development and evaluation of robust methods for the calibration and analysis of complex models should result in the generation of more reliable scientific evidence and better health policy and funding decisions. In addition, an effective method of assessing the likely impact of HAART should lead to better informed policies and improved public health in Africa. If the models are accurate, the benefits may include fewer people dying and being infected with HIV, alleviating the substantial social and economic burden of the epidemic as well as reducing the burgeoning costs of HIV-related health care.

An international multidisciplinary team will carry out this research. Statistical expertise is available from investigators from Durham University, Sheffield University and Cambridge University; expertise in the development and application of complex HIV models is available from investigators in the London School of Hygiene and Tropical Medicine; and virologic expertise and uniquely detailed high quality empirical data is available from MRC/UVRI in Uganda.

Technical Summary

Complex individual-based stochastic models are increasingly being used across science, engineering, medicine and public health. The utility of models for prediction & planning relies on how well they are calibrated to data and analysed for robustness of predictions. However, development of methods to calibrate and analyse complex stochastic models has greatly lagged behind their application, resulting in unreliable predictions and increasing the probability of incorrect policy and funding decisions

Aim
Develop and evaluate methods to calibrate and analyse complex individual-based stochastic models, and apply them to explore the impact of HAART on HIV/AIDS in Africa

Objectives
-Develop novel methods for Bayesian Emulation of stochastic models
-Comparative analysis of accuracy/efficiency of existing MCMC, ABC and novel Bayesian Emulation methods for the calibration and analysis of stochastic models
-Develop and analyse a novel hybrid model calibration strategy combining the strengths of ABC and Emulation methods
-Apply developed and analysed methods to predict the impact of HAART on HIV/AIDS in Africa

Methods
Development: Bayes linear and fully Bayesian emulation for calibration of stochastic models, and multivariate outputs
Hybrid ABC & Emulation methods for efficient generation of probabilistic statements about goodness of fit & joint estimation of posterior probability distributions
Experiments: Use new methods to estimate model parameters by calibrating model to simulated data with known 'true' parameter values, varying number and prior bias & variance of model parameters
Application: Use new methods to calibrate complex model to uniquely detailed HIV/AIDS data from African cohorts

Application/exploitation
Application within project to predict impact of HAART on HIV in Africa and engagement with international policy makers/funders to improve policy/funding decisions. Novel methods dissemination to other science areas/public sector/industry

Planned Impact

This research should benefit society as a whole, primarily through improved understanding and prediction of complex models, and thereby improved guidance to policy makers.

Immediate beneficiaries will include the users and developers of complex models in government, the public sector, industry and academia. These users will have better methods with which to calibrate and analyse their complex models. Example beneficiaries include epidemiologists and public researchers who use models to compare different strategies to combat infection in the UK and elsewhere, and oil industry engineers who use models to provide information on where to drill exploratory wells. The former is an example where this research could have a relatively quick impact on public heath in the UK and elsewhere. The latter is an example where this research could have a direct and relatively quick impact on the UK economy. Investigators on the proposal have direct links to both groups of beneficiaries.

Direct beneficiaries also include national and international technical modelling committees who will be interested in these developments. An example includes WHO Quantitative Immunisation and Vaccines related Research Committee, on which one of the investigators sits.

This research should also benefit those who rely on information generated by models to make decisions. For example, UK governmental committees such as the UK Joint Committee on Vaccination and Immunisation (JCVI) and international body UNAIDS, both of which rely heavily on information generated by models in their decision making. These bodies would benefit from the higher quality information that could be provided if our novel methods are implemented. Investigators on the proposal are advisors to both these bodies.

The general public should benefit from the improved policy and funding decisions that can be made based on the higher quality information provided by our novel model calibration and analysis methods. They should also benefit from improved policy formation that should lead to improved health and well being, and improved resource allocation in public services.

Publications

10 25 50
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Andrianakis I (2017) History matching of a complex epidemiological model of human immunodeficiency virus transmission by using variance emulation. in Journal of the Royal Statistical Society. Series C, Applied statistics

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Biraro S (2013) Effect of HSV-2 on population-level trends in HIV incidence in Uganda between 1990 and 2007. in Tropical medicine & international health : TM & IH

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Dowdy DW (2014) Impact and cost-effectiveness of current and future tuberculosis diagnostics: the contribution of modelling. in The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease

 
Description Changed South African Govt Policy Announcement on TB screening in schools
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
 
Description Course - Introduction to impact and economics of TB control
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
Impact Trained medical professionals in quantitative methods to use in their decision making at country and global level.
 
Description Evidence used to set WHO post-2015 Global TB Targets
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in other policy documents
Impact My group generated evidence that was used to set ambitious WHO post 2015 global TB targets. This should have major impact on TB financing and control policies and practice over the next 15 years.
 
Description Global Fund Distribution of Funding by Disease
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in advisory committee
Impact I directly contributed to debate and the (eventual) consensus that led to an increase in proportion of funds allocated by the Global Fund to Tuberculosis. Global reach. Should increase survival and morbidity by reducing TB disease (no quantitative evidence yet)
 
Description Impact on TB control funding priorities and budget in South Africa
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact '2025 Global TB Targets' modelling for South Africa is influencing TB policy decisions in this countries (2014+). Where work is influencing SA Govt Budgets, Policy and Research Priorities. This work supported successful award of Global Fund Concept note and grant in 2015, and work was also used in first ever Govt/UNAIDS HIV and TB Investment Case, that supported the introduction of the first ever conditional (ie ringfenced) grant for TB and HIV in SA, and the allocation of an extra Rand500m (~£50m) to TB control by the SA Govt in 2016.
 
Description Impact on human TB vaccine development funding priorities
Geographic Reach Multiple continents/international 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact My group helped demonstrate that an new TB vaccine targeted at adolescent/adults would have considerably greater early impact on the global TB epidemic, than a vaccine targeted at infants, and would be cost-effective, even with a relative low efficacy and short protection duration (Knight et al 2015). This evidence led to a major change in BMGF TB vaccine policy and was cited to support the primary new BMGF TB vaccine strategy goal: "To accelerate discovery and development of a vaccine to prevent TB infection and/or disease in adolescents and adults" (2014-2015). (url below)
URL https://drive.google.com/file/d/0B2K5XWn1bjpORmpHLUdoOXJFTlk/view
 
Description Input into Global Fund Steering Committee on Modeling work to inform development of the Global Fund's Strategy goals & targets, Needs Assessment and Funding Allocation
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a advisory committee
Impact Methods agreed with input from my group into Global Fund Steering Committee on Modeling work to inform development of the Global Fund's Strategy goals & targets, Needs Assessment and Funding Allocation (2015) were used to prevent inappropriate methods being used to assess Global Fund's strategy goals & targets, needs assessment and funding allocation in 2016+. Specifically inappropriate methods were being considered for between-country resource allocation of the Global Funds TB funds. Use of these methods was prevented.
 
Description Input into WHO Global Task Force on TB Impact Measurement Reference Methods Group
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a advisory committee
Impact Methods agreed with input from my group into WHO Global Task Force on TB Impact Measurement Reference Methods Group (2015) were used to determine if the WHO 2000-2015 global TB targets had been met. Published in 2015 WHO TB report. This also helped identify that TB is now the leading cause of death from an infectious disease globally, which should increase global resource allocation to TB over the next few years.
URL http://www.who.int/tb/publications/global_report/en/
 
Description Led creation of 'STROBE-RDS': Reporting Guidelines for Respondent Driven Sampling Surveys
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guideline committee
Impact Peer reviewed reporting guidelines have been published, have been incorporated into submission guidelines for at least two academic journals (2016), have already been cited in papers reporting findings from RDS surveys. This will increase the value of data collected using RDS. This should lead to improved health and funding decisions targeted (primarily) at the control and prevention of HIV, and later, improved survival, morbidity and quality of life, and the efficiency of health care delivery.
URL http://www.ncbi.nlm.nih.gov/pubmed/26112433
 
Description Policy recommendation document to Ugandan Ministry of Health
Geographic Reach Africa 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact We had a meeting with Uganda Ministry of Health Officials, and subsequently provided them with a policy recommendation document which they requested. We advised that adopting universal access to ART for all people living with HIV would be highly cost effective, and may be cost saving. Subsequent to this, the Uganda MoH revised its ART guidelines to recommend that ART be provided to all people living with HIV.
 
Description WHO/South African Department of Health Tuberculosis Meeting
Geographic Reach Africa 
Policy Influence Type Gave evidence to a government review
Impact This and subsequent meetings lead to a change in the South Africa Govt's National Strategic Plan policy to include continuous Isoniazid Preventive Therapy (IPT) to HIV infected individuals. IPT greatly reduces mortality in HIV infected individuals. This will have a near immediate impact on survival / morbidity / quality of life in HIV+ South Africans.
 
Description Aeras project grant
Amount $150,000 (USD)
Organisation Aeras 
Sector Charity/Non Profit
Country Global
Start 10/2012 
End 03/2013
 
Description Aeras studentship grant
Amount $150,000 (USD)
Organisation Aeras 
Sector Charity/Non Profit
Country Global
Start 06/2013 
End 12/2016
 
Description BMGF Project Grant
Amount £2,348,811 (GBP)
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 01/2017 
End 11/2019
 
Description BMGF project grant
Amount £90,848 (GBP)
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 11/2016 
End 12/2017
 
Description Bill and Melinda Gates Foundation: Global Health: Tuberculosis
Amount $2,000,000 (USD)
Funding ID OPP1110334 
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 06/2014 
End 09/2016
 
Description Bill and Melinda Gates Foundation: Global Health: Tuberculosis
Amount $20,000 (USD)
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 08/2015 
End 05/2016
 
Description Bill and Melinda Gates Foundation: Global Health: Tuberculosis
Amount $125,000 (USD)
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 01/2016 
End 06/2019
 
Description Bill and Melinda Gates Foundation: Global Health: Tuberculosis
Amount $2,300,000 (USD)
Funding ID OPP1084276 
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 04/2014 
End 12/2015
 
Description Bristish Heart Foundation Fellowship
Amount £1 (GBP)
Organisation Heart Centre Foundation, Hungary 
Sector Public
Country Hungary
Start 01/2016 
End 12/2019
 
Description MRC Fellowship (by team member)
Amount £287,454 (GBP)
Funding ID MR/N014693/1 
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 07/2016 
End 06/2019
 
Description MRC Project Grant
Amount £386,998 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 03/2017 
End 02/2019
 
Description UNITAID Reserach Grant
Amount £2,709,550 (GBP)
Funding ID 4214-LSHTM-Sept15 (PO #8477-0-600) 
Organisation World Health Organization (WHO) 
Department UNITAID
Sector Public
Country Switzerland
Start 06/2015 
End 06/2019
 
Description USAID TB Treat Grant
Amount $1,499,000 (USD)
Funding ID GHN-A-OO-08-00004-00 
Organisation United States Agency for International Development 
Sector Public
Country United States
Start 04/2014 
End 03/2016
 
Description Wellcome Trust Fellowship
Amount £120,000 (GBP)
Funding ID 109915/Z/15/Z 
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 08/2016 
End 07/2019
 
Title TB ePAL (electronic PArticipant Locator tool) 
Description In high density urban settings without formal address systems, identification of the place of residence of patients presenting to health centres is often challenging and inaccurate. This type of information is essential for patient follow up in the community, for disease surveillance and identification of hotspots for efficient targeting of limited healthcare resources, for research study participant follow up and mapping, and for identifying populations suitable for enrolment into vaccine clinical trials. ePAL (electronic PArticipant Locator tool) is a tablet-based tool aiming to facilitate accurate identification of place of residence of patients presenting to health centres in Blantyre, Malawi. Points of interest relevant to the community were collected using GPS from across Blantyre city by community engagement through health surveillance assistants. Preceded by an eCRF, these points of interest combined with high resolution satellite maps constitute the ePAL app, which is being placed on tablets in TB registration centres across Blantyre city. ePAL is currently being evaluated in this setting and is hoped will be the first electronic data capture of TB registrations in Malawi and an important tool embraced by the Department of Health and Malawi-Liverpool-Wellcome (MLW) research centre for mapping and follow up of TB cases and identification of populations suitable for research including clinical trials. The tool is being developed in collaboration between LSHTM (London, UK) and MLW (Blantyre, Malawi). 
Type Of Material Improvements to research infrastructure 
Year Produced 2014 
Provided To Others? Yes  
Impact The tool itself has undergone validation for identifying place of residence of TB patients presenting at TB registration centres and the data are currently being analysed. The tool has been adapted for two other research projects at MLW: surveillance for an ongoing typhoid outbreak and a study on impact of PCV vaccines. Several other studies in Blantyre are soon to begin using ePAL. It is hoped once the tool is validated that it could be replicated in other similar settings. 
 
Title History matching of complex agent based computer models using emulation 
Description The developed method allows the calibration of multi-input, multi-output agent based computer models of high complexity. The method is based on a statistical approximation of the computer model, called the emulator, and tries to identify regions of the input space that are likely to lead to a match between the model's outputs and the calibration data. The computational efficiency of the emulator makes this method very applicable to computer models with long running times. 
Type Of Material Computer model/algorithm 
Year Produced 2013 
Provided To Others? Yes  
Impact None yet 
URL http://cmmid.lshtm.ac.uk/mrccalib/
 
Title New user-friendly country-level modelling tool for TB-HIV control projections and costings 
Description We created a user-friendly tool (a mathematical model) for TB-HIV control projections and costing. This tool is for use by country-level TB/HIV policy makers for decision making on TB control strategies and costing. It has been used in workshops at Global level by UNAIDS, the Global Fund and WHO, and at country level in South Africa, Viet Nam, Ghana, Nigeria. 
Type Of Material Computer model/algorithm 
Year Produced 2013 
Provided To Others? Yes  
Impact It was rolled out globally in 2015. So far it has been used by my group to update the Sudan, Bangladesh and Vietnam National Strategic Plan in 2013/4 (in Sudan, a move to more decentralized provision of TB patient care), and in Ghana, Nigeria. It will be used in about ~5 more high TB burden countries in 2016. 
URL http://www.avenirhealth.org/software-spectrum
 
Description In country modelling to support disease control policy making 
Organisation Ghana Health Service
Country Ghana 
Sector Public 
PI Contribution Intellectual and meeting organisational input, and modelling expertise fitting models to country disease TB epidemics
Collaborator Contribution Intellectual and meeting organisational input,
Impact Ghana - altered TB disease control strategy Viet Nam - contributed to increased funding from Global Fund to TB disease control in Viet Nam
Start Year 2015
 
Description In country modelling to support disease control policy making 
Organisation Government of Vietnam
Country Viet Nam 
Sector Public 
PI Contribution Intellectual and meeting organisational input, and modelling expertise fitting models to country disease TB epidemics
Collaborator Contribution Intellectual and meeting organisational input,
Impact Ghana - altered TB disease control strategy Viet Nam - contributed to increased funding from Global Fund to TB disease control in Viet Nam
Start Year 2015
 
Description TB Diagnostics Forum Modelling Workgroup 
Organisation Amsterdam Institute for Global Health and Development (AIGHD)
Country Netherlands 
Sector Private 
PI Contribution Intellectual input to discussions on characteristics of desired target product profiles for new diagnostics
Collaborator Contribution JHU leads the working group. AIGHD provides scientific input.
Impact Publications. Target Product Profiles of new diagnostics.
Start Year 2012
 
Description TB Diagnostics Forum Modelling Workgroup 
Organisation Johns Hopkins Medicine
Country United States 
Sector Hospitals 
PI Contribution Intellectual input to discussions on characteristics of desired target product profiles for new diagnostics
Collaborator Contribution JHU leads the working group. AIGHD provides scientific input.
Impact Publications. Target Product Profiles of new diagnostics.
Start Year 2012
 
Description TB Modelling and Analysis Consortium 
Organisation Bill and Melinda Gates Foundation
Country United States 
Sector Charity/Non Profit 
PI Contribution Intellectual and meeting organisational input. This consortium funds 50% of my time and 100% of two of my group members (1 research, 1 admin).
Collaborator Contribution Has resulted in significant intellectual and in-kind research time of many other research groups input to my groups research (e.g. Global TB Targets work was a collaboration of 11 international research groups contributing results to this research question, largely unfunded).
Impact Huge amount of outputs, please see other sections of report Publications in Modelling research agenda, TB Diagnostics Impact on Policy, Govt Budgets, and Research Priorities in South Africa
Start Year 2012
 
Description TB Modelling and Analysis Consortium 
Organisation Centers for Disease Control and Prevention (CDC)
Country United States 
Sector Public 
PI Contribution Intellectual and meeting organisational input. This consortium funds 50% of my time and 100% of two of my group members (1 research, 1 admin).
Collaborator Contribution Has resulted in significant intellectual and in-kind research time of many other research groups input to my groups research (e.g. Global TB Targets work was a collaboration of 11 international research groups contributing results to this research question, largely unfunded).
Impact Huge amount of outputs, please see other sections of report Publications in Modelling research agenda, TB Diagnostics Impact on Policy, Govt Budgets, and Research Priorities in South Africa
Start Year 2012
 
Description TB Modelling and Analysis Consortium 
Organisation Harvard University
Department Harvard T.H. Chan School of Public Health
Country United States 
Sector Academic/University 
PI Contribution Intellectual and meeting organisational input. This consortium funds 50% of my time and 100% of two of my group members (1 research, 1 admin).
Collaborator Contribution Has resulted in significant intellectual and in-kind research time of many other research groups input to my groups research (e.g. Global TB Targets work was a collaboration of 11 international research groups contributing results to this research question, largely unfunded).
Impact Huge amount of outputs, please see other sections of report Publications in Modelling research agenda, TB Diagnostics Impact on Policy, Govt Budgets, and Research Priorities in South Africa
Start Year 2012
 
Description TB Modelling and Analysis Consortium 
Organisation Intellectual Ventures
Country United States 
Sector Private 
PI Contribution Intellectual and meeting organisational input. This consortium funds 50% of my time and 100% of two of my group members (1 research, 1 admin).
Collaborator Contribution Has resulted in significant intellectual and in-kind research time of many other research groups input to my groups research (e.g. Global TB Targets work was a collaboration of 11 international research groups contributing results to this research question, largely unfunded).
Impact Huge amount of outputs, please see other sections of report Publications in Modelling research agenda, TB Diagnostics Impact on Policy, Govt Budgets, and Research Priorities in South Africa
Start Year 2012
 
Description TB Modelling and Analysis Consortium 
Organisation Johns Hopkins University
Department Johns Hopkins Bloomberg School of Public Health
Country United States 
Sector Academic/University 
PI Contribution Intellectual and meeting organisational input. This consortium funds 50% of my time and 100% of two of my group members (1 research, 1 admin).
Collaborator Contribution Has resulted in significant intellectual and in-kind research time of many other research groups input to my groups research (e.g. Global TB Targets work was a collaboration of 11 international research groups contributing results to this research question, largely unfunded).
Impact Huge amount of outputs, please see other sections of report Publications in Modelling research agenda, TB Diagnostics Impact on Policy, Govt Budgets, and Research Priorities in South Africa
Start Year 2012
 
Description TB Modelling and Analysis Consortium 
Organisation World Health Organization (WHO)
Department Department of Control of Neglected Tropical Diseases
Country Global 
Sector Public 
PI Contribution Intellectual and meeting organisational input. This consortium funds 50% of my time and 100% of two of my group members (1 research, 1 admin).
Collaborator Contribution Has resulted in significant intellectual and in-kind research time of many other research groups input to my groups research (e.g. Global TB Targets work was a collaboration of 11 international research groups contributing results to this research question, largely unfunded).
Impact Huge amount of outputs, please see other sections of report Publications in Modelling research agenda, TB Diagnostics Impact on Policy, Govt Budgets, and Research Priorities in South Africa
Start Year 2012
 
Title New user-friendly country-level tool for TB-HIV control projections and costings 
Description We created a user-friendly tool (a mathematical model) for TB-HIV control projections and costing. This tool will be freely available for download by country-level TB/HIV policy makers for decision making on TB control strategies and costing in 2015. It has been used in workshops run by UNAIDS, the Global Fund, WHO and at country level. 
IP Reference  
Protection Copyrighted (e.g. software)
Year Protection Granted 2013
Licensed Yes
Impact I was released globally in 2015. So far used to update Sudan, Bangladesh and Vietnam National Strategic Plan in 2013/4 (in Sudan: it led to a move to more decentralized provision of TB patient care), and in South Africa, Ghana and Nigeria. It will be used in about ~5 more high TB burden countries in 2016.
 
Title History matching of complex agent based computer models using emulation 
Description The developed method allows the calibration of multi-input, multi-output agent based computer models of high complexity. The method is based on a statistical approximation of the computer model, called the emulator, and tries to identify regions of the input space that are likely to lead to a match between the model's outputs and the calibration data. The computational efficiency of the emulator makes this method very applicable to computer models with long running times. 
Type Of Technology Software 
Year Produced 2013 
Open Source License? Yes  
Impact None yet 
URL http://cmmid.lshtm.ac.uk/mrccalib/
 
Title New user-friendly country-level modelling tool for TB-HIV control projections and costings 
Description We created a user-friendly tool (a mathematical model) for TB-HIV control projections and costing. This tool is for use by country-level TB/HIV policy makers for decision making on TB control strategies and costing. It has been used in workshops run by UNAIDS, the Global Fund and WHO over the coming years. 
Type Of Technology Software 
Year Produced 2013 
Open Source License? Yes  
Impact It was released globally in 2015. So far used to update the Government of Sudan, Bangladesh and Vietnam National Strategic Plan in 2013/4 (in Sudan, a move to more decentralized provision of TB patient care), South Africa, Ghana and Nigeria. It will be used in ~5 more high TB burden countries in 2016. 
URL http://www.avenirhealth.org/software-spectrum
 
Title TB ePAL (electronic PArticipant Locator tool) 
Description In high density urban settings without formal address systems, identification of the place of residence of patients presenting to health centres is often challenging and inaccurate. This type of information is essential for patient follow up in the community, for disease surveillance and identification of hotspots for efficient targeting of limited healthcare resources, for research study participant follow up and mapping, and for identifying populations suitable for enrolment into vaccine clinical trials. ePAL (electronic PArticipant Locator tool) is a tablet-based tool aiming to facilitate accurate identification of place of residence of patients presenting to health centres in Blantyre, Malawi. Points of interest relevant to the community were collected using GPS from across Blantyre city by community engagement through health surveillance assistants. Preceded by an eCRF, these points of interest combined with high resolution satellite maps constitute the ePAL app, which is being placed on tablets in TB registration centres across Blantyre city. ePAL is currently being evaluated in this setting and is hoped will be the first electronic data capture of TB registrations in Malawi and an important tool embraced by the Department of Health and Malawi-Liverpool-Wellcome (MLW) research centre for mapping and follow up of TB cases and identification of populations suitable for research including clinical trials. The tool is being developed in collaboration between LSHTM (London, UK) and MLW (Blantyre, Malawi). 
Type Of Technology Webtool/Application 
Year Produced 2014 
Impact The tool itself has undergone validation for identifying place of residence of TB patients presenting at TB registration centres and the data are currently being analysed. The tool has been adapted for two other research projects at MLW: surveillance for an ongoing typhoid outbreak and a study on impact of PCV vaccines. Several other studies in Blantyre are soon to begin using ePAL. It is hoped once the tool is validated that it could be replicated in other similar settings. 
 
Company Name Avenir Health 
Description Futures Institute, founded in 2006, is a global health organization that works to enhance social and economic development by providing tools and technical assistance in policy, planning, resource allocation and evaluation. In particular, we focus on developing and implementing demographic, epidemiological and costing models for long-range planning to assist with setting goals, strategies, and objectives. We assist in both developing and implementing programs in HIV/AIDS, reproductive health, maternal health and other programming areas. We work with government agencies, foundations, corporations, and nongovernmental organizations around the world. Areas of program concentration include family planning and reproductive health, maternal and child health, the prevention and treatment of HIV/AIDS, and infectious diseases. With staff based in the United States and Africa, we work collaboratively with our in-country counterparts to improve policies and programs that address population issues, reproductive health, HIV/AIDS, infectious diseases, and maternal and child health. 
Year Established 2006 
Impact Impacts are many and varied across a variety of health sectors. Impacts that my (Tuberculosis) work with them has supported includes: 1) generating country-level TB/HIV estimates for the WHO report 2013 and 2014, 3) Generating evidence for the STOPTB/WHO Tuberculosis Global Plan (2015) - global resource needs estimates, that are used to motivate for funding from international partners (Gates, Global Fund, ...) 3) Futures working with countries to develop TB/HIV National Strategic Plans in 3+ countries globally, affecting governmental TB/HIV strategies and resource allocation within these 3 countries. This is an active and growing collaboration and much more activity will happen over the next 12 months.
Website http://www.avenirhealth.org/
 
Description Emulation workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact We organised a workshop for 30 participants who attended a 1 day hands on workshop which showcased the research methodology that is being developed in this project. Special software was prepared that allowed the participants to try out the methods in their own laptops during the workshop.

The workshop places were filled up within two days and there was strong encouragement for a second edition, which we plan to run in 2015.
Year(s) Of Engagement Activity 2014
URL https://sites.google.com/site/emulationday/
 
Description Meeting with Uganda Ministry of Health Officials 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Meeting with Uganda Ministry of Health officials involved with the HIV programme in the country, to present research findings on the potential costs and effects of different ART scale-up activities
Year(s) Of Engagement Activity 2016
 
Description Newsnight lead story - PrEP for HIV in uk MSM 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact BBC Newsnight lead item. Video: Intro & WHITE, WHITE excerpts + BBC website, & many newspapers incl Guardian, Telegraph. Prep for HIV in UK MSM. Jan 15th 2016
Year(s) Of Engagement Activity 2016
URL https://drive.google.com/open?id=0B2K5XWn1bjpOQTJLRXpNMDBTdUU
 
Description Press release - PrEP for HIV in uk MSM 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact Press release taken up by many global news paper, BBC, newsnight, ...
Year(s) Of Engagement Activity 2016
URL http://www.lshtm.ac.uk/newsevents/news/2016/prep_drugs_could_reverse_hiv_epidemic.html
 
Description Tipping points in health and society - public workshop on uncertainty in health. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact A lot of interest, many questions and an increased awareness of the potential and limitations of public health models, and their associated uncertainty.


Participants showed an appreciation of the impact of uncertainty in public health models.
Year(s) Of Engagement Activity 2014
URL http://www.esrc.ac.uk/news-and-events/events/festival/festival-events/general-public/Tipping-Points-...