Addressing the Social Determinants and Consequences of Tuberculosis (ASCOT): a pilot randomised controlled trial and process evaluation in Nepal

Lead Research Organisation: Liverpool School of Tropical Medicine
Department Name: Clinical Sciences

Abstract

BACKGROUND. Tuberculosis (TB) kills more people than any infection. Poorer people in low income countries (LICs) are disproportionately affected by TB. Once ill, people with TB face severe psychological, social, and economic (socioeconomic) challenges, including mental illness, discrimination, income loss, and catastrophic costs of accessing TB care. These challenges reduce patients' chances of cure, push households deeper into poverty, and impede global TB control efforts. To combat this, the World Health Organization (WHO) advocates socioeconomic support for TB-affected households.

RELATED WORK. In Peru, a middle-income country, members of our team previously showed that socioeconomic support for TB-affected households increases TB cure rates and reduces catastrophic costs. However, no related evidence exists in LICs with significant TB burden, like Nepal. Over the past two years funded by a Wellcome Trust Seed Award, our team worked with communities, people with TB, and the National TB Program (NTP) of Nepal to address this knowledge gap. We identified barriers to accessing TB services in Nepal including low TB knowledge, perceived stigma, isolation, and high travel costs to receive care. We then suggested feasible and locally-appropriate socioeconomic support packages to overcome these barriers, including cash transfers and peer support. We are ready to field-test these packages and select the most promising for large-scale trial evaluation.

OBJECTIVES
1. Field-test socioeconomic support packages for TB-affected households to identify which is most feasible and acceptable in Nepal;
2. Inform design and delivery of a definitive, large-scale trial to evaluate the impact of the selected support package on health, finances, and stigma of TB-affected households in Nepal; and
3. Consolidate partnerships with communities, the Nepal NTP, and WHO, to ensure the future trial is achievable, act as a model for other LICs, and informs TB policy and practice.

SETTING. Four districts of Nepal with high TB and poverty: Chitwan, Mahottari, Morang, and Pyuthan.

DESIGN. A randomised-controlled pilot trial of socioeconomic support packages for TB-affected households.

POPULATION. 100 people with TB diagnosed in NTP clinics in the study sites (25 consecutively diagnosed participants per site).

INTERVENTIONS. Computer software will randomly allocate participants to receive:

i) Control standard of care with no additional socioeconomic support;
ii) Social support through home-based peer-led mutual support groups to reduce stigma;
iii) Economic support with monthly cash transfers to mitigate costs and enable treatment adherence ; or
iv) Socioeconomic support integrating social and economic support.

Interventions will be delivered by Birat Nepal Medical Trust (BNMT), a well-established, Nepalese non-governmental organisation. Interventions will be flexible to refine size or frequency of cash or support groups where needed.

STUDY ACTIVITIES. Participants will be surveyed on TB knowledge, stigma, mental health, quality of life, poverty level, costs of TB, and satisfaction with interventions received. Focus groups and interviews with selected participants, project and BNMT team members, and NTP staff will be combined with project costs data to evaluate the feasibility of the interventions.

PRIMARY OUTCOME. To evaluate the feasibility and acceptability of the interventions in order to select the most promising intervention for large-scale trial evaluation.

SECONDARY OUTCOMES. To explore the impact of interventions on TB cure and catastrophic costs of TB-affected households.
Benefits and applications. This research will ensure the most fundable, achievable, and impactful design of a definitive, large-scale trial of socioeconomic support for TB-affected households in Nepal, the findings of which will be the first of their kind in a LIC and will inform regional and international TB policy and practice.

Technical Summary

BACKGROUND. Poverty drives TB rates and TB worsens poverty due to catastrophic costs of being ill and seeking care. WHO mandates ending catastrophic costs and providing social and economic (socioeconomic) support to people with TB. This has not been evaluated in low-income countries. With key stakeholders in Nepal, we designed locally-appropriate socioeconomic support packages for TB-affected households, which are ready to be tested.

OBJECTIVES
1. Identify the most feasible and acceptable support package
2. Inform definitive trial design
3. Optimise future chances of funding and trial success

METHODS

DESIGN. An adaptive randomised-controlled pilot trial and process evaluation

POPULATION. 100 people with TB registered at National TB Program (NTP) clinics in Chitwan, Mahottari, Morang, and Pyuthan districts of Nepal

INTERVENTIONS. Tablet-based software will randomly allocate participants equally to:
i) Standard of care (e.g. control)
ii) Social Support through home-based peer-led mutual support groups to reduce stigma
iii) Economic Support with monthly cash transfers to mitigate costs and meet NTP goals
iv) Socioeconomic Support integrating economic and social support

Interventions will be adaptive and delivered by the Nepal NGO, BNMT

ACTIVITIES. Poverty and TB costs will be measured by survey. TB treatment outcomes will be extracted from NTP registers. MRC process evaluation techniques will evaluate feasibility and acceptability by qualitative focus groups and interviews with participants and project staff to examine perceptions of the interventions; and quantitative data on intervention uptake, fidelity, and costs.

PRIMARY OUTCOME. Feasibility and acceptability of support packages

EXPLORATORY OUTCOMES. Impact of support on TB cure and catastrophic costs

APPLICATIONS. This work will ensure fundable, achievable, and impactful design of the first definitive trial of socioeconomic support for TB-affected households in Nepal.

Planned Impact

This Impact Summary gives an overview of the key pathways to and beneficiaries of impact. For clarity, the Impact Summary is divided by specific Pathways to Impact.

i) RESEARCH METHODS AND FINDINGS.
The adaptive trial design and rigorous process evaluation in this proposal are innovative and a world-first in this particular research field and low-income setting. To maximise impact, we will publish the research protocol on an open-access platform and write perspectives pieces on the process evaluation outcomes with a focus on barriers to implementation. We will also produce a practical manual on implementing socioeconomic interventions in LMICs. The health and other outcomes of the definitive trial and the resultant publications in high-impact journals will be ground-breaking (e.g. the first robust evidence from LICs in this field) and vital for other researchers.
BENEFICIARIES: research groups working in the same field in other LMICs; mixed-methods researchers and triallists; and intervention implementation teams.

ii) POLICY.
We involve national (NTP and Nepal government) and international (WHO) policy- and decision-makers throughout all stages of our research. We have worked with these collaborators to include catastrophic costs mitigation and socioeconomic support in the current National Strategic Plan 2020-2025. We have also forged collaborations with the Nepal Ministry for Health and Population including those working on social protection programs. We will continue to involve these colleagues and provide them with policy briefs detailing our ongoing research and findings. The PI and Co-I (Lonnroth) continue to work with WHO's Task Force for Catastrophic Costs of TB and will contribute to annual meetings and updates of the TB Patient Costs Survey Handbook 2017 (https://www.who.int/tb/publications/patient_cost_surveys/en/). They also co-lead the international Social Protection Action Research and Knowledge Sharing (SPARKS) network. SPARKS includes many policy makers from within and without the TB sphere (e.g. UNAIDS, UNICEF). This is a superb platform by which to influence policy through presentations at annual meetings, SPARKS mailing list, and depositing our papers in the SPARKS open-access depository.
BENEFICIARIES: Nepal NTP and government decision makers; WHO; SPARKS; multi-sectoral policy makers in poverty alleviation and social protection.

iii) RESEARCH INFRASTRUCTURE AND CAPACITY BUILDING.
A key theme within our four years of collaboration as a team has been to devise and execute a multi-stage collaborative plan to increase research infrastructure and capacity build in Nepal. At BNMT, this has been evidenced by comprehensive additional training for BNMT staff in in research methods and good research practice. Multiple BNMT team members have since published first author papers, won travel scholarships to international conferences, and registered for PhDs. Strengthening capacity at BNMT and collaboration with the NTP will be vital for the future, definitive trial and translation of our research into policy change in Nepal.
BENEFICIARIES: multi-disciplinary team BNMT members and NTP staff.

iv) ADVOCACY AND AWARENESS.
Our involvement of people with TB from study site communities in this work since its inception has driven the community-led design of potential socioeconomic support packages. We hope to formalise this collective of TB-affected people by registering an autonomous TB Civil Society group in Nepal. The PI and Sponsor Prof Squire of LSTM are part of the UK Academics and Professionals Against TB (www.ukaptb.org) UK network, which interacts with advocacy groups like TB Alert and Results UK and lobbies UK government. We continue to make in-roads into supporting other countries to form similar bodies.
BENEFICIARIES: TB Civil Society in Nepal/UK, TB Advocacy groups including UKAPTB and Results UK, and the general public.

Publications

10 25 50

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Biermann O (2022) Use of big data on the social determinants of TB to find the "missing millions". in The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease

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Fyles M (2021) Using a household-structured branching process to analyse contact tracing in the SARS-CoV-2 pandemic. in Philosophical transactions of the Royal Society of London. Series B, Biological sciences

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Hobson G (2021) Family cluster of three cases of monkeypox imported from Nigeria to the United Kingdom, May 2021. in Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin

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Pedrazzoli D (2021) Biosocial Strategies to Address the Socioeconomic Determinants and Consequences of the TB and COVID-19 Pandemics. in The American journal of tropical medicine and hygiene

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Todd H (2023) Social Protection Interventions for TB-Affected Households: A Scoping Review. in The American journal of tropical medicine and hygiene

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Wingfield T (2021) Challenges and opportunities to end tuberculosis in the COVID-19 era. in The Lancet. Respiratory medicine

 
Description Consultant and editor for WHO on their upcoming Social protection for people with TB guidance
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in other policy documents
 
Guideline Title Framework for collaborative action on tuberculosis and comorbidities
Description Technical Consultant for WHO policy document: Framework for collaborative action on tuberculosis and comorbidities
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in clinical guidelines
URL https://www.who.int/publications/i/item/9789240055056
 
Description Academic Clinical Fellow in TB and Multimorbidity - Dr Greta Wood. I am Greta's primary research supervisor. Funding for 9 months of Greta's salary within this ACF post.
Amount £1 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 07/2022 
End 08/2025
 
Description Addressing TB and Covid-19 in Nepal - awarded to Ms Kritika Dixit under my supervision
Amount £5,000 (GBP)
Organisation Royal Society of Tropical Medicine and Hygiene 
Sector Charity/Non Profit
Country United Kingdom
Start 03/2020 
End 03/2023
 
Description Addressing the Social Determinants and Consequences of Tuberculosis (ASCOT): a pilot randomised controlled trial and process evaluation in Nepal
Amount £201,000 (GBP)
Funding ID MR/V004832/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 03/2021 
End 09/2022
 
Description An analytical framework for Test, Trace and Isolate in the UK: optimising and targeting deployment alongside other measures.
Amount £416,025 (GBP)
Funding ID MR/V028618/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 08/2020 
End 08/2021
 
Description Dorothy Temple Cross International TB Collaboration Award
Amount £30,000 (GBP)
Funding ID MRF-131-0006-RG-KHOS-C0942 
Organisation Medical Research Council (MRC) 
Department Medical Research Foundation
Sector Charity/Non Profit
Country United Kingdom
Start 03/2023 
End 10/2024
 
Description Farrar Institute Research Grant awarded to Project Manager on Wellcome Seed Award and AMS Starter Grant Research in Nepal, Ms Kritika Dixit
Amount £5,000 (GBP)
Organisation Farrar Foundation 
Sector Charity/Non Profit
Country United Kingdom
Start 08/2019 
End 09/2021
 
Description Health Policy and Systems Research
Amount £4,100,000 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 03/2022 
End 04/2026
 
Description Leaving no one behind: gender pathways to end HIV and TB "LIGHT" consortium
Amount £8,100,000 (GBP)
Organisation UK Department for International Development 
Sector Public
Country United Kingdom
Start 05/2020 
End 06/2026
 
Description London School of Hygiene and Tropical Medicine TB MAC Consortium
Amount £1,500 (GBP)
Organisation London School of Hygiene and Tropical Medicine (LSHTM) 
Sector Academic/University
Country United Kingdom
Start 08/2019 
End 09/2019
 
Description MRC PHIND
Amount £160,000 (GBP)
Funding ID MR/Y503216/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 06/2023 
End 01/2025
 
Description Royal Society of Tropical Medicine and Hygiene Travel Grant
Amount £2,400 (GBP)
Organisation Royal Society of Tropical Medicine and Hygiene 
Sector Charity/Non Profit
Country United Kingdom
Start 08/2019 
End 09/2019
 
Description START4ALL UNITAID grant
Amount $14,000,000 (USD)
Organisation United Nations (UN) 
Sector Public
Country United States
Start 03/2022 
End 03/2027
 
Description Scoping review on TB and selected comorbidities including diabetes, mental health disorders, and malnutrition
Amount £29,980 (GBP)
Organisation World Health Organization (WHO) 
Sector Public
Country Global
Start 05/2021 
End 09/2021
 
Description Seed Awards in Science
Amount £99,800 (GBP)
Funding ID 209075/Z/17/Z 
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 08/2017 
End 12/2019
 
Description Starter Grants for Clinical Lecturers
Amount £15,000 (GBP)
Organisation Academy of Medical Sciences (AMS) 
Sector Charity/Non Profit
Country United Kingdom
Start 03/2018 
End 12/2019
 
Title All ASCOT pilot trial documents shared on Open Science Framework and Wellcome Open Research 
Description Longitudinal social determinants and consequences questionnaire Consent forms PIS 
Type Of Material Improvements to research infrastructure 
Year Produced 2022 
Provided To Others? Yes  
Impact Available internationally 
URL https://wellcomeopenresearch.org/articles/7-141
 
Description CHEST study 
Organisation Karolinska Institute
Department Department of Public Health Sciences
Country Sweden 
Sector Academic/University 
PI Contribution Co-applicant, co-investigator, and consultant on the CHEST project which aims to improve linkage of TB and social care in Mozambique. We were successful in receiving funding of 500,000 euros to conduct this research. I am going out to Mozambique in April for site visits and logistical planning. I will also present to the National TB Program and Ministry of Health about addressing the social determinants of TB.
Collaborator Contribution The study is being led and coordinated by Dr Salla Atkins of the University of Tampere, Finland. Other partners include Prof Knut Lonnroth, Dr Kerri Viney, and Ms Olivia Biermann of Karolinska Institutet, with whom I collaborate closely on other projects. Dr Atkins is making a visit to Liverpool to present at our cross campus research meeting "LIV-TB" later this year and has been helpful in terms of supporting my other research ideas including those related to the Academy of Medical Sciences Research Grant.
Impact Multi-disciplinary: clinicians, social scientist, trialists, TB researchers, health economists, social workers, national TB program, implementers. The project is in its infancy and so there are no outputs at the present time.
Start Year 2017
 
Description CHEST study 
Organisation University of Tampere
Country Finland 
Sector Academic/University 
PI Contribution Co-applicant, co-investigator, and consultant on the CHEST project which aims to improve linkage of TB and social care in Mozambique. We were successful in receiving funding of 500,000 euros to conduct this research. I am going out to Mozambique in April for site visits and logistical planning. I will also present to the National TB Program and Ministry of Health about addressing the social determinants of TB.
Collaborator Contribution The study is being led and coordinated by Dr Salla Atkins of the University of Tampere, Finland. Other partners include Prof Knut Lonnroth, Dr Kerri Viney, and Ms Olivia Biermann of Karolinska Institutet, with whom I collaborate closely on other projects. Dr Atkins is making a visit to Liverpool to present at our cross campus research meeting "LIV-TB" later this year and has been helpful in terms of supporting my other research ideas including those related to the Academy of Medical Sciences Research Grant.
Impact Multi-disciplinary: clinicians, social scientist, trialists, TB researchers, health economists, social workers, national TB program, implementers. The project is in its infancy and so there are no outputs at the present time.
Start Year 2017
 
Description Collaboration with IMPACT TB study team 
Organisation Liverpool School of Tropical Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution The research of our team and our outputs from the CRESIPT study have directly informed the IMPACT TB team. IMPACT TB is an international study involving collaborations with LSTMed, Karolinska Institutet, KNCV, and the National TB Programs of Nepal and Vietnam, examining active case finding.
Collaborator Contribution Using methodology developed by our research team, including measurement of TB patient costs and socioeconomic interventions to mitigate such costs, we have been able to develop some add-on studies for IMPACT-TB which will bring added value to their work and disseminate/broaden the impact of the CRESIPT study.
Impact 1) Presentation on CRESIPT findings at IMPACT-TB meeting in Liverpool March 2017 2) Further presentations and workshops with Nepal and Vietnam National TB Programs planned for late March 2017 3) Funding applications for add-on studies ongoing.
Start Year 2017
 
Description KEMRI Kisumu and Gates Medical Research Institute 
Organisation Kenyan Institute for Medical Research (KEMRI)
Department KEMRI CGMRC Programme
Country Kenya 
Sector Charity/Non Profit 
PI Contribution Working up to be international investigator on Gates MRI funded TB early bactericidal activity trial with trial site partner being KEMRI Kisumu
Collaborator Contribution Infrastrtucture, laboratory logistics, trial sites, relationship with study communities, intellectual capability,
Impact Grant applications to follow
Start Year 2021
 
Description Leave no one behind: gender pathways to end HIV/TB: the DFID-funded LIGHT consortium 
Organisation London School of Hygiene and Tropical Medicine (LSHTM)
Country United Kingdom 
Sector Academic/University 
PI Contribution Co-investigator
Collaborator Contribution Co-investigators. This DFID funded consortium was funded £8m by DFID and has partners in Malawi, Kenya, Uganda, and Nigeria.
Impact None yet
Start Year 2019
 
Description NIHR Health Policy and Systems Research Grant 
Organisation LVCT Health
Country Kenya 
Sector Charity/Non Profit 
PI Contribution Co-investigator on recently awarded NIHR consortium grant. I lead health economics stream. Still in negotiation.
Collaborator Contribution Capacity / delivery / monitoring and evaluation Intellectual input Community engagement
Impact Funding of 4.1m (still in negotiation)
Start Year 2021
 
Description UNITAID bid for combined TB diagnostic algorithm 
Organisation World Health Organization (WHO)
Department UNITAID
Country Switzerland 
Sector Public 
PI Contribution Seven country multi-continent study into combined TB diagnostic algorithms (still in negotiation)
Collaborator Contribution Kenya Brazil Malawi Nigeria Vietnam Bangladesh Country partners providing intellectual support, logistical support, and delivery, monitoring and evaluation support
Impact None yet
Start Year 2021
 
Description WHO Core Writing Team for TB Patient Costs Survey Manual 
Organisation World Health Organization (WHO)
Country Global 
Sector Public 
PI Contribution Member of core writing team. First draft of manual published in 2017: https://www.who.int/tb/publications/patient_cost_surveys/en/ Now been rolled out in 16 countries. Second updated edition due 2021.
Collaborator Contribution Other WHO TB Programme members involved too plus other experts in the field.
Impact WHO TB Patient Costs Survey: a Handbook https://www.who.int/tb/publications/patient_cost_surveys/en/
Start Year 2018
 
Title Addressing the social determinants and consequences of tuberculosis 
Description Despite preliminary evidence from middle-income Peru, there is no evidence for socioeconomic support for TB-affected households in low-income countries. To address this, we developed a locally-appropriate support intervention for TB-affected households in Nepal. The aim of the ASCOT pilot trial is to field-test the feasibility and acceptability of the support intervention. The pilot trial aimed to recruit 120 people with TB notified to the Nepal National TB Program (NTP) to participate. The integrated process evaluation aimed to recruit 40 multisectoral stakeholders to participate including NTP staff, civil society members, policy makers, and ASCOT field team members. The study expected to run March 2021 to October 2022 and was funded by MRC. Overall trial status: Completed - SAP not yet available - Results not yet available and study completed for less than 1 year - Raw data not yet available 
Type Support Tool - For Medical Intervention
Year Development Stage Completed 2021
Development Status Closed
Impact N/A 
URL https://www.isrctn.com/ISRCTN17025974
 
Description 'We will not forget our colleagues who have died': two doctors on the frontline of the second wave 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact During the first wave of coronavirus in April, we wrote about our experiences as frontline healthcare workers in Liverpool. While working on COVID-19 wards, we described the stark psychological and health vulnerabilities faced by health workers around the UK. In those early days of the pandemic, our health systems were bogged down by inadequate communication, PPE shortages, and testing limitations.

We also warned of the need to plan ahead to mitigate an inevitable second wave and avoid the negative knock-on effects on routine hospital care. Now, that second wave is here.

After a lull over summer, Liverpool has been at the forefront of the second wave seeing a dramatic increase in COVID-19 cases. The city was one of the first areas to be placed under "very high" alert tier 3 as part of the government's three-tier system of coronavirus restrictions. During November, numbers of hospital admissions for COVID-19 were higher than the first wave and intensive care units were close to capacity.

Around the country, healthcare workers continue to put our lives and those of our families on the line. We arrive at work to face daily, sometimes dangerous, staff shortages but also to see the inherent resourcefulness of NHS healthcare workers. In Liverpool, genito-urinary medicine and palliative care specialist colleagues have again expanded their care to cover or lead COVID-19 wards. Other hospital doctors have "upskilled" to look after people needing ventilators. What is unclear is how long we can keep stepping up.

As frontline workers, we are concerned about the long winter that looms for the UK. Here, we set out the problems we and our colleagues are facing around the country, some lessons we might be able to learn from the first wave, and some positive developments which will make the future a little brighter.
Year(s) Of Engagement Activity 2020
URL https://theconversation.com/we-will-not-forget-our-colleagues-who-have-died-two-doctors-on-the-front...
 
Description 160 public engagement and media activities in 2020 including BBC, Wall Street Journal, BMJ, Medscape, ITV, Sky, Daily Mail, Telegraph, Guardian, Observer, Independent, The Conversation, Reuters, Associate Press 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Please see all activity here: https://covid19.elsevierpure.com/en/persons/tom-wingfield
Year(s) Of Engagement Activity 2020,2021
URL https://covid19.elsevierpure.com/en/persons/tom-wingfield
 
Description Article in The Conversation 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Experience of covid-19 for healthcare workers in 2021
Year(s) Of Engagement Activity 2021
URL https://theconversation.com/covid-19-2020-was-horrendous-for-health-workers-early-2021-was-even-wors...
 
Description Article on SpringerNature Sustainability Community 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact In this invited "SDG 3 and me" blog , Bhola Rai, Kritika Dixit, and Tom Wingfield of Birat Nepal Medical Trust and Liverpool School of Tropical Medicine explain how their team's mixed methods research to address tuberculosis informs -and is informed by- the Sustainable Development Goals framework. The Sustainability Community forum is a space for members to communicate with the wider research community; the blog post is also open to the general public.
Year(s) Of Engagement Activity 2022
URL https://sustainabilitycommunity.springernature.com/posts/ascot-addressing-the-social-determinants-an...
 
Description Head Talks - Covid, medicine, and the media 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact See https://www.lstmed.ac.uk/news-events/events/head-talks-at-carnival-brewing-with-lstms-dr-tom-wingfield-and-friends
A talk about the role that the media has in spreading information and misinformation about Covid-19
Year(s) Of Engagement Activity 2021
URL https://www.lstmed.ac.uk/news-events/events/head-talks-at-carnival-brewing-with-lstms-dr-tom-wingfie...
 
Description Heroism now means keeping going - interview and article in Telegraph 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact 'Heroism now means keeping going': on the frontline of the Covid-19 second wave in Liverpool
From helping families see each other to watching staff return exhausted, still recovering from the virus, two doctors on their experiences
Year(s) Of Engagement Activity 2020
URL https://www.telegraph.co.uk/global-health/science-and-disease/heroism-now-keeping-going-frontline-se...
 
Description LEAP talk for MSF regarding Covid-19 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact https://www.youtube.com/watch?v=YT4dYty_-wY

As we near the one-year anniversary of the first COVID-19 cases recorded in East Asia, followed by the dramatic spread and impact across Europe, North America and other continents, there is still great concern about its expected impact across further communities.

The potential impact on populations affected by humanitarian crises and/or living in poor resource settings; in particular in overcrowded urban contexts, detention sites, displaced people in camps, is still unknown.

Governments and public health authorities are facing unprecedented challenges of planning, implementing and adjusting multi-sectoral responses in their respective societies balancing the public health good with the economic priorities and public perception.

Join us(link is external)(opens in a new tab) for a panel discussion with leading humanitarian practitioners and academics who will reflect on first-hand experience and research, to discuss the approaches and challenges for adapting humanitarian responses to the reality of the COVID-19 pandemic.

Registration via Eventbrite, click here(link is external)(opens in a new tab)

Chair:

Tom Ellman, Director of Southern Africa Medical Unit, MSF

Tom is Director of the Southern Africa Medical Unit (SAMU). Since first working for MSF in Rwanda in 1995, he has over 15 years of experience in humanitarian medical work mostly with Medecins Sans Frontieres. His focus has been on HIV, TB, and malaria in Africa and South-East Asia, apart from a three-year 'break' working on Chagas disease - the 'AIDS of the Americas' - in Bolivia.

Panel:

Dr Raji Tajudee, Head of Division of Public Health Institutes and Research, Africa CDC

Taj is a medical doctor with postgraduate qualifications in Pediatrics and Public Health. He is a Fellow of the West African College of Physicians and African Public Health Leaders Fellow of the Chatham House Royal Institute of International Affairs, UK. He has years of senior level experience in Child Health, Health System Management, Health Diplomacy, Maternal and Child Health, and Health in Humanitarian Emergencies. He has worked in different settings in the developing world; Nigeria, Saudi Arabia, Liberia, Guinea, Sierra Leone and Ethiopia.

He is currently the Head of Public Health Institutes and Research at the Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia. He heads the healthcare preparedness and countermeasures section of the Africa CCD COVID-19 response. He co-chairs the case management technical working group of the Africa Taskforce on COVID-19.

Dr Tom Wingfield, Consultant Infectious Diseases Physician and Senior Clinical Lecturer, LSTM

Tom is a Consultant Infectious Diseases Physician and Senior Clinical Lecturer at the Liverpool School of Tropical Medicine, UK. He is passionate about addressing the social determinants and consequences of tuberculosis and other poverty-related illnesses.

Since February 2020, Tom has cared for many with people with Covid-19 in Liverpool. He contributed to health systems' response and preparedness at Liverpool University Hospitals NHS Trust, Liverpool School of Tropical Medicine, and the Malawi-Liverpool-Wellcome centre. Tom leads quality improvement projects aiming to improve the care of people with Covid-19. Alongside Covid-19 clinical work and research, Tom is committed to providing accurate information about Covid-19 to the public, whether living in urban informal settlements in low-income countries or in the UK.

Lucas Molfino, Deputy Medical Director, MSF OCG

Reem Mussa, Humanitarian Affairs Advisor (Migration), MSF OCB

The panel session is hosted by the LEAP Programme in Humanitarian Practice, a unique partnership between Médecins Sans Frontières(link is external)(opens in a new tab), The University of Manchester's Humanitarian and Conflict Response Institute(link is external)(opens in a new tab) and Liverpool School of Tropical Medicine(opens in a new tab).
Year(s) Of Engagement Activity 2021
URL https://www.lstmed.ac.uk/news-events/events/leap-programme-panel-discussion-the-approaches-and-chall...
 
Description Lancet Global Health Podcast on original research article about MDR-TB in Sierra Leone 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Podcast about original article in Lancet Global Health where Dr Rashidatu Fouad Kamara and I explained our research and Rashida's role as MDR-TB lead in Sierra Leone.
https://www.thelancet.com/in-conversation-with
Year(s) Of Engagement Activity 2022
URL https://www.buzzsprout.com/1358155?client_source=large_player&iframe=true&referrer=https://www.buzzs...
 
Description Long read in Independent: https://www.independent.co.uk/news/long_reads/coronavirus-nhs-dead-doctors-nurses-second-wave-frontline-b1764456.html 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact 'We won't forget our dead colleagues': NHS doctors on life on the frontline
Tom Wingfield and Miriam Taegtmeyer share their experiences of Britain's second coronavirus wave
Year(s) Of Engagement Activity 2020
URL https://www.independent.co.uk/news/long_reads/coronavirus-nhs-dead-doctors-nurses-second-wave-frontl...
 
Description Qiagen TB presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact https://www.qiagen.com/us/clp/-/media/2CCF595A5E7346508A09C7EBA734167E.ashx

Global TB Summit
Year(s) Of Engagement Activity 2022
URL https://www.qiagen.com/us/clp/-/media/2CCF595A5E7346508A09C7EBA734167E.ashx
 
Description Social Protection Action Research and Knowledge Sharing (SPARKS) network annual meeting 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Organised, gave presentation, and co-led workshop session at this annual international meeting of SPARKS, a network I co-founded.
Year(s) Of Engagement Activity 2022
 
Description The Conversation Article - Future covid treatments 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Description of current and future treatments for people with Covid-19
Year(s) Of Engagement Activity 2022
URL https://theconversation.com/covid-is-unlikely-to-be-eliminated-heres-how-well-treat-it-in-the-future...
 
Description Two doctors describe working on the frontline of Liverpool's second wave - In Depth Out Loud podcast 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This episode of The Conversation's In Depth Out Loud podcast features a report from two doctors on the frontline of the second wave of coronavirus in Liverpool.

Tom Wingfield, an infectious diseases physician at Liverpool School of Tropical Medicine and the University of Liverpool, and Miriam Taegtmeyer, professor of global health at Liverpool School of Tropical Medicine, describe what it's like for healthcare workers who continue to put their lives and those of their families on the line.


Listen on Apple Podcasts

They describe arriving at work to face daily, sometimes dangerous, staff shortages but also seeing the inherent resourcefulness of NHS healthcare workers. Some specialist colleagues have expanded their care to cover or lead COVID-19 wards. Other hospital doctors have "upskilled" to look after people needing ventilators. What is unclear, they say, is how long they can keep stepping up.

They set out the problems they and their colleagues are facing around the country, some lessons we might be able to learn from the first wave, and some positive developments which will make the future a little brighter.

You can read the text version of this in-depth article here. The audio version is read by Megan Clement and produced by Gemma Ware.

This story came out of a project at The Conversation called Coronavirus Insights supported by Research England.
Year(s) Of Engagement Activity 2020
URL https://theconversation.com/two-doctors-describe-working-on-the-frontline-of-liverpools-second-wave-...
 
Description https://theconversation.com/comparing-pandemic-responses-in-australia-and-the-uk-watch-our-live-webinar-151920 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The UK has been one of the countries hit hardest by the coronavirus pandemic, and is currently in the grip of a deadly second wave alongside many of its neighbours in Europe. More than 60,000 people have died of the disease in the UK so far.

Like success stories Taiwan, Vietnam and South Korea, Australia was feted early for its robust response to the crisis, but a second wave engulfed the state of Victoria in July this year after the virus escaped the country's hotel quarantine system. The capital city of Melbourne entered a lockdown that lasted almost four months and more than 800 people died in the southern state.

Today, Australians are out of lockdown and gathering in groups, going to the theatre and getting ready for Christmas gatherings. Meanwhile, much of the UK remains under heavy restrictions as a long winter looms ahead and the first priority groups receive the new Pfizer/BioNTech vaccine. Yet the countries had similar rates of infection in the middle of this year.

What can the UK and Australia learn from one another, and why were their responses so different?

Containing COVID: comparing pandemic responses in Australia and the UK
Wednesday December 16, 8.30am GMT/7.30pm AEDT. CC BY
The Conversation's Megan Clement will chair the webinar at 8.30am GMT, 7.30pm AEDT on December 16, with Professor Catherine Bennett, an epidemiologist who has followed Melbourne's remarkable trajectory from one of the world's strictest lockdowns to more than a month of zero cases a day and Dr Tom Wingfield, a doctor and infectious diseases expert who has been working on the COVID wards in Liverpool throughout 2020.

You can also watch the webinar via Facebook, YouTube or Twitter from 8.30am GMT/ 7.30pm AEDT on December 16.
Year(s) Of Engagement Activity 2020
URL https://theconversation.com/comparing-pandemic-responses-in-australia-and-the-uk-watch-our-live-webi...