Grantees announced for new TDR impact grants
Sixteen grants have been awarded as part of TDR’s new impact grants programme. These are designed to address specific research capacity or knowledge aspects in low- or middle-income countries, and they provide a good deal of flexibility to the applicants.
Brief descriptions of the projects
1. Health economics research capacity strengthening and knowledge management in Nepal to help break the vicious cycle of infectious diseases of poverty
Principal investigator: Dr Shiva Raj Adhikari, Institute for Nepal Environment and Health System Development, Tribhuvan University Patan Multiple campus, Department of Economics, Lalitpur, Nepal.
Allocating health resources efficiently and effectively is particularly important for resource-limited countries such as Nepal. This project aims to strengthen research capacity within health economics and to enhance knowledge management on issues related to resource allocation in health. It will provide policy-makers of the Government of Nepal with information necessary to set priorities in allocation of resources. The project will involve short-term training, mentoring and practical workshops alongside knowledge management and enhancing interaction and dissemination, with a particular focus on infectious diseases.The study will involve the Nepalese Ministry of Health and Population, the National Planning Commission and the Department of Health Services Policy and Management, University of South Carolina, USA. The research work should be completed by November 2014.
2. Research capacity strengthening and knowledge management to help improve disease control in Ghana
Principal investigator: Dr Evelyn Korkor Ansah, Research & Development Division, Ghana Health Service, Accra, Ghana.
A great deal of health information is collected by health staff in the course of their work. However, they often lack the capacity to systematically process, analyze and interpret that information in order to allow evidence-based decisions relating to the control and elimination of infectious diseases. This project is one of capacity building in operational research, with the primary aim of improving disease control. Over the course of one year, five 4-member multidisciplinary Regional Health Management Teams (RHMTs) will receive training and support to develop and implement their proposal – aimed at answering health-related questions that are relevant to their local setting using routine data collected in their own setting. There will be one or two regional teams per ecological zone where the three health research centres of the division are sited. The teams will produce reports and disseminate their findings; a record of the use of research findings within their locality will also be kept. The project, where team members will work closely with Regional Health Directorates in the regions, should help inform disease control efforts, lead to better allocation and use of limited resources, and ultimately lead to health improvement for the people of Ghana.
3. GetBetter - A collective sharing & learning system among health professionals towards quality healthcare in the Philippines
Principal investigator: Professor Arnulfo P Azcarraga, De La Salle University, Manila, Philippines.
Among the challenges for healthcare in the Philippines are the lack of qualified doctors and the lack of a sustainable mechanism for lifelong learning among healthcare professionals – particularly for those in remote regions. This grant aims to bridge critical gaps in the provision of quality healthcare to the poor by developing (1) a platform for continuous lifelong learning and research among medical professionals; (2) a system to detect, report and track diseases from remote areas; and (3) an automated mechanism to broadcast latest medical research breakthroughs. The grant will fund the integration of two information and communications technology (ICT) systems - Meeting Point (a hosted virtual learning environment) and CoDeS (a a web-based platform for decision-making) - into a single system, to be referred to as the GetBetter system. This system, through which health professionals can also help one another, should help medical professionals in remote health centers with decision making, including deciding on appropriate diagnosis and treatment.
4. Monitoring and evaluation of case investigation and reactive case detection for malaria elimination in China
Principal investigator: Dr Jun Cao, Jiangsu Institute of Parasitic Diseases (JIPD), Wuxi, The People’s Republic of China.
Surveillance and the response to finding cases of malaria are key elements to any elimination programme. The research team for this project proposes to optimize the current monitoring and evaluation tool for malaria surveillance and the subsequent response, which was adapted from the Global Health Group (GHG) at the University of California San Francisco (UCSF). The team aims to make the monitoring and evaluation tool consistent with the malaria epidemiological and programmatic context of China. The TDR impact grant will provide overseas training for young staff from JIPD and support a field pilot to improve the tool. The project will help to evaluate the efficiencies and best practices in surveillance and response and should provide useful information for malaria elimination programmes worldwide. The research will be carried out in collaboration with the Malaria Elimination Initiate (MEI) and the GHG at UCSF USA; it is expected to be completed by the end of 2014.
5. Monitoring of the level of insecticide availability in some samples of sprayed surfaces (IRS) and LLNS in Benin
Principal investigator: Dr Djogbénou Luc, Department of Health-Environment, Institut Régional de Santé Publique, Ouidah, Bénin.
There is currently a gap in quality assurance for the effective use of insecticides, a failing that undermines indoor residual spraying (IRS) and long lasting insecticidal nets (LLIN)-led vector control operations in West Africa. Researchers will use medical entomology and biochemistry to evaluate a field assay for quality control developed by the Liverpool School of Tropical Medicine and partners under the umbrella of the Innovative Vector Control Consortium (IVCC). The research activity aims to strengthen the capacity of the Integrated Malaria Vector Control group (of the National Malaria Control Program) to monitor the quality of vector control activities. This will inform future programmatic vector control strategies and malaria control policy in Benin. The work will be carried out collaboratively with the Benin National Malaria Control Programme, the Ministry of Health, and the Liverpool School of Tropical Medicine, UK. It will take the form of a pilot study that should be completed during November 2014.
6. Research integrity in Brazil: contribution for health-related research and public health policies
Principal investigator: Professor Dirce Guilhem, Nursing Department, College of Health Sciences, University of Brasilia, Brasilia, Brazil.
Scientific integrity is fundamental to the development and dissemination of research, especially when research evidence has the potential to be incorporated into public health policy. This project aims to strengthen good ethical practices and conduct in research practice and scientific communication in Brazilian and South American institutions. The research will be conducted in partnership with the University of Indiana, with the University of Brasilia as the locus of its development. The project has the following steps: (1) a one week workshop to identify gaps and priorities; (2) a three week training period on research integrity at the Center for Bioethics, University of Indiana; (3) development of a website for open consultation and information; (4) piloting a first version of guidelines; (5) guideline revision; (6) preparation of scientific article for publication; and (7) preparation of a training course. The research will use a participatory approach involving the scientific community, institutions, scientific journals, and decision makers who will work with researchers to identify scientific misconduct and develop guidelines for conduct in the scientific practices. The project will allow open discussion, help develop new practices in health related research, and highlight the need to establish clear institutional policies for monitoring the quality and integrity of research.
7. Establishing an effective disease surveillance system in Bangladesh to support the national programme for elimination of visceral leishmaniasis
Principal investigator: Dr Dinesh Mondal, ICDDR,B Dhaka, Bangladesh.
Visceral leishmaniasis (VL) or kala-azar is a major public health problem in Bangladesh, with an estimated incidence of 8000 to 12 000 per year. The disease, which is fatal if not treated, affects the poorest populations in rural areas. The Government of Bangladesh committed to eliminate VL by 2015 and a national VL elimination programme is ongoing. Early diagnosis and complete treatment, integrated vector management and vector surveillance, effective disease surveillance, social mobilization, and operational research are major strategies of the programme. The national programme – which has been doing well with respect to early diagnosis and treatment, integrated vector management, social mobilization, and operational research – is now facing challenges with VL disease surveillance that arise from a lack of a system, training and tools for effective surveillance. This project aims to fill this surveillance gap in and, in doing so, strengthen the national VL elimination programme of Bangladesh.
8. Operation research dashboard tool for district health management
Principal investigator: Oscar Rwegasira Mukasa, Impact Evaluation Thematic Group, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania.
Despite district health systems in The United Republic of Tanzania hosting a large number of operational research (OR) efforts, they disproportionately benefit from the outcomes of such research. The proposed project looks at ways to address this issue. It will cover five districts in mainland Tanzania to look at how the findings from OR carried out by external stakeholders might align with annual comprehensive district health plans. It will also include development of an information system tool to support the alignment process. The process will be phased as follows: (i) a baseline phase, generating district OR profiles using retrospective data, (ii) a development phase with system design and software development, and (iii) a monitoring phase in which researchers will work with district teams to integrate processes of the project into the day-to-day management of health services within the district. The work, which will be carried out in partnership with the Ministry of Health and District Councils, aims to help improve health system capacity at both national and district levels.
9. Evaluation of Disease Data Management system in Benin
Principal investigator: Dr Mariam Oke-Sopoh, Programme National de Lutte contre le Paludisme (PNLP), Cotonou, Bénin
Long lasting insecticide treated bednets (LLINs) and Indoor Residual Spraying (IRS) are key weapons in the fight against malaria in Benin. To ensure that these interventions are providing the protection needed, it is vital that materials and surfaces carry a sufficient concentration of insecticide; protection is lost and insecticide resistance is encouraged if insecticide levels fall below a biologically active threshold concentration. Good quality assurance and monitoring is therefore critical for successful IRS and LLIN programmes. HPLC and bioassays are currently the only available Quality Control (QC) methods. However, they are too expensive and technically demanding for field operations, precluding regular on-the-spot QC and increasing the risk of control failure. Robust field assays have recently been developed by the Liverpool School of Tropical Medicine and partners under the umbrella of the Innovative Vector Control Consortium (IVCC) for monitoring WHO approved insecticides. Our aim is to assess these in Benin in collaboration with LSTM and to identify and test potential improvements in the utility of the existing IQK technologies and demonstrate their use. As well as strengthening Africa-UK institutional ties, this will speed the integration of proper (auditable) quality assurance processes into the Benin malaria control programme to maximize the benefits of vector control and minimise risk to public health and environment.
10. Implementation of ICT mobile tools for research of cutaneous leishmaniasis in rural communities
Principal investigator: Dr Nancy G Saravia, Centro Internacional de Entrenamiento e Investigaciones Medicas (CIDEIM), Valle del Cauca, Colombia
A number of logistical and economic constraints hamper access by rural communities to medical attention and to participation in (and thus the benefits of) health research. Information and communication technology (ICT) has the potential to overcome many such constraints. This project is an inter-institutional endeavour involving the Latin American RTC (CIDEIM), the Telecommunications Department of the Universidad ICESI, community leaders and health promoters, as well as a mentor team from Distributed Health Labs/UC San Diego. The project team plans to build research and training capacity in the use of ICT for data collection and information management for field research on rural communities affected by cutaneous leishmaniasis and other diseases of poverty. Training will involve the design and pilot evaluation of two applications for mobile phones: (1) the diagnostic prediction rule and (2) a tool to promote adherence to and follow-up of treatment. The research team also plans to design a modular training course on the use of ICT in community-based research, based on the step-by-step training strategy used in TDR’s Effective Project Planning and Evaluation course.
11. Meta-analysis/systematic review of the treatment of Trypanosoma cruzi infection
Principal investigator: Dr Yanina Sguassero, CREP Cochrane Centre of the Iberoamerican Cochrane Network, Rosario, Argentina.
Chagas disease is endemic in 21 countries in the Americas and is estimated to cause the deaths of 12,000 people each year. The disease has two phases – acute and chronic. While helping to tackle the acute phase, trypanocidal drugs have shown variable results when used during the chronic phase. The current criterion for “cure” consists of negative parasitological tests and two non-reactive serological tests. The project team plans to conduct a systematic review of the literature to determine when and to what extent the administration of trypanocidal drugs in patients with chronic T. cruzi infection enables negative serology tests during follow-up. The project will have two parts – a qualitative and quantitative assessment. Findings from the 12 month project should contribute to the understanding of chronic Chagas disease and inform evidence-based clinical management during the post-treatment follow-up of patients with chronic T. cruzi infection.
12. Enhancing the WAHO Research for Health Platform with research capacity training opportunities
Principal investigator: Dr Issiaka Sombié, West African Health Organisation, Bobo-Dioulasso, Burkina Faso.
In 2011 the West African Health Organisation (WAHO) launched a programme for action for the development of research systems for health in collaboration with COHRED. This collaboration led to the development of a WAHO research for health platform, powered by Health Research Web. This project aims to enhance the WAHO platform by developing a module that would allow information on all the current research training opportunities in West Africa to be entered and aggregated. Common research opportunities in West Africa include research ethics training, grant/proposal writing, manuscript writing, research seminars, clinical trials management and a variety of health system or operational research opportunities. The project team believes that this platform module would become a searchable directory for all aspects of research training programmes. Information provided would include training topic, participants’ cost, mode of training, place of training, basic knowledge requirements, funding possibilities for participating (where applicable) and deadlines for application.
13. Strengthening the national malaria control programme (PNLP), Ministry of Health (MOH), Bénin capacity to conduct indoor residual spraying (IRS) for malaria control.
Principal investigator: Dr Filémon Tokponnon, Ministère de la Santé, Cotonou, Bénin.
The U.S. President's Malaria Initiative (PMI), through its indoor residual spraying (IRS) partner the Africa Indoor Residual Spraying (AIRS) Program, has operationalized a highly effective IRS programme in collaboration with the national malaria control programme of Benin (PNLP). Under this latest project the team will run a year-long mentoring programme for a select group of four PNLP individuals – i.e. the chief of the vector control service (national level), plus the three key department (Atacora)-level health officials. As part of the project each candidate will spend the 2013-2014 IRS spraying season shadowing their AIRS counterparts. The mentoring activity will include the creation of a 2014 work plan for PNLP, when one commune of the Atacora IRS target area will be entirely managed by PNLP. The PMI partner for IRS entomological monitoring and evaluation, the Centre for Entomological Research-Cotonou (CREC), will evaluate the independent IRS and compare the result to those from the PMI/AIRS-treated communes.
14. Workshop for transfer of high resolution meltdown genotyping technology from Australia to Ghana, Cameroon and the WHO/Multi-disease Surveillance Center
Principal investigator: Dr Michael Wilson, Noguchi Memorial Institute For Medical Research, University of Ghana.
Annual Community-Directed Treatment with Ivermectin (CDTI) is the basis for the control of onchocerciasis in the 19 countries of the African Programme for Onchocerciasis Control (APOC) and several countries of the former Onchocerciasis Control Programme in West Africa (OCP). Emergence of resistance to ivermectin is therefore a threat to onchocerciasis control in the continent – a ‘suboptimal response’ phenotype has already been identified in Ghana and Cameroon. As part of this project on malaria control the project team will run a training workshop alongside an ongoing research project which aims to determine the genetic correlate of this phenotype. They also plan to develop a tool that will allow onchocerciasis control programmes to monitor changes in the frequency and distribution of the resistance phenotype. The workshop will transfer technology developed in Australia to 12 trainees (from Ghana, Cameroon and the multi disease surveillance centre at APOC [MDSC/APOC]) so that they can conduct the genetic analysis and interpret the data. The project work will be conducted at the MDSC/APOC laboratories in Africa.
15. Implementation of a system for telediagnostics of tuberculosis (TB) in the Tuberculosis Center of Excellence in Peru: Towards the establishment of a national policy for fast TB diagnostics
Principal investigator: Professor Mirko Zimic, Department of Cellular and Molecular Sciences, Faculty of Science, Universidad Peruana Cayetano Heredia, Lima, Peru.
The microscopic observation drug susceptibility (MODS) assay is a fast, simple, and inexpensive way to diagnose tuberculosis (TB) and multidrug resistant TB (MDRTB). In the developing world, however, its use is limited as it requires the presence of technical staff with expertise in MODS interpretation. The advent of new technologies means that new systems can be developed to overcome this issue. In this project researchers will implement the telediagnostics of MDRTB in the National Center of Excellence of Tuberculosis in Trujillo (the TB reference laboratory of the northern of Peru). In essence, after the MODS culture is performed, digital microscopic images of the culture will be transmitted through the internet (or cellphone telephony) to a web system where a special pattern recognition algorithm will rapidly interpret the image. The technique could thus be used in remote laboratories where experts in reading MODS patterns are unavailable. The researchers hope to demonstrate that telediagnostics will help with early diagnosis of MDRTB, with diagnosis time cut to just 7-10 days. Their experience will help develop a public national policy for TB telediagnostics in Peru.
16. Research for health capacity strengthening through the institutional review board
Principal investigator: Professor Eleonora Espinoza Turcios, Scientific Research Unit, Faculty of Medicine, National Autonomous University of Honduras Tegucigalpa; Honduras.
Institutional review boards (IRBs) play a crucial role in research, particularly research involving human subjects. For instance, the IRB of the Faculty of Medical Sciences at the National Autonomous University of Honduras (UNAH) performs a methodological and ethical review of research proposals from institutions inside and outside UNAH, including the Ministry of Health and international organizations such as PAHO/WHO. This project aims to strengthen the IRB’s capacity to ensure that research involving human subjects is performed according to ethical principles. It includes: (1) training IRB members in operation/administration of an IRB; (2) strengthening the IRB’s capacity for registering information; (3) improving infrastructure; and (4) training researchers and other health sector personnel in research ethics. The work includes collaboration with the Instituto Antonio Vidal and will support the creation of new institutional review boards where needed.