NIHR research partnerships - liver disease

Summary

The National Institute for Health and Care Research (NIHR) is keen to support the building of capacity and capability in liver disease research. It wishes to ensure that NIHR research is conducted in geographical areas and with populations where health and social care needs are greatest, increasing the evidence base to improve prevention, diagnosis, treatment, delivery of services and outcomes for people who use health and care services, carers of people in receipt of services, and/or those working in the sector.

It is anticipated that commissioning research in this important area will comprise two parts:

• Part one – NIHR liver disease research partnerships call
• Part two - NIHR commissioned call: Building the evidence base

Through supporting the establishment and growth of enduring partnerships, networks and collaborations in liver disease research, it is expected that partnerships funded through this part one call will ultimately lead to the submission of high-quality proposals to the NIHR commissioned call for liver disease research (part two) that will launch in early 2024, although this date may be subject to change. 

Please note: NIHR research programmes will continue to welcome applications that fall outside of the scope of this particular call through their researcher-led workstreams at any time.

NIHR research partnership call key information

Deadline: Applications must be received by 1pm on Wednesday 14 September 2022.

Webinar: A webinar to support applicants to this funding opportunity was held on Monday 27 June 2022. If you would like access to the recording of the webinar, please email crossprogramme@nihr.ac.uk. For support developing applications, applicants are also encouraged to contact their local NIHR Research Design Service (RDS) or equivalent in the devolved administrations in the first instance.

Contact information: General questions about the call and/or further guidance may be obtained by sending a short summary (maximum of one A4 page) of the proposal to the following address: crossprogramme@nihr.ac.uk

Supporting information

Most liver disease is preventable - only about 5% of deaths are attributable to autoimmune and genetic disorders - over 90% are due to three main risk factors: alcohol, viral hepatitis and obesity. The last decade has witnessed significant advances in the management of viral hepatitis, in particular cure rates for hepatitis C have increased dramatically. Despite this, liver disease mortality has increased by over 250% since 1971 in contrast with mortality from the other major causes of premature mortality (diabetes, cancer, heart disease etc.) which has reduced. [The 2nd Atlas of Variation in risk factors and healthcare for liver disease in England: September 2017]

People in deprived groups in England are more likely to develop, be hospitalised by, and die from liver disease than the most affluent. There is a negative correlation between deprivation and age of death. Notably, there is a nine-year gap between the median age at death for patients with liver disease residing in the five most deprived areas (62 yrs) compared to those from the least deprived five (71 yrs). This is even more pronounced for deaths from alcohol-related liver disease where there is a six-year gap between the five most (53 yrs) and least (59 yrs) deprived areas. These deprived areas where disease burden is greatest have invariably been the same areas where research has traditionally not been conducted.

In its fifth report, The Lancet Standing Commission on Liver Disease in the UK (Williams et al, 2018) highlighted the growing burden of liver disease. It included a financial analysis estimating the full societal costs for alcohol misuse, including crime, lost productivity, and child services to be circa £21 billion per year in England and Wales, although this figure could be as high as £52 billion. The report also noted that for obesity, the total cost to society was circa £27 billion per annum, with some estimates as high as £45 billion.

It can take many years for liver disease to progress to a stage where symptoms develop and/or there is an impact on quality of life. Increasing levels of obesity, type 2 diabetes and alcohol consumption all have significant implications for a future increase in associated liver disease prevalence. Increasing collaboration through truly multidisciplinary partnerships and integrating care between and across health and care services, for people of all ages as this is not just a disease of older people, has potential to make significant impact to what is a large group of patients.

Underserved communities

Specifically for the purposes of this call, applicants are encouraged to include geographic areas where liver disease is prevalent and where populations which have historically been under served by research activity, in order to ensure that NIHR research is conducted in the areas where health needs are greatest.

Information is included in the supporting documentation to illustrate the potential mismatch between levels of research and burden of disease. This can be explored in greater levels of detail through the NIHR Clinical Research Network Research Targeting Tool (Liver Disease), which has been created to support identification of the geographical mismatch between where research has historically been conducted and where health needs are greatest across the whole of the UK. This geographical information reinforces the need to expand research activity into under-represented areas, aligning with NIHR’s ambition to increase research taking place in underserved communities and ultimately increasing patient benefit through participation in research. NIHR is also interested in receiving applications to this call that address the health challenges in coastal communities featured in the Chief Medical Officer’s Annual Report 2021. Acknowledging that conducting research in sites that are inexperienced or research naïve presents risks, challenges and perceived barriers to engaging with new recruitment sites, NIHR is looking to address and alleviate some of those barriers through this two-part call, open to researchers across the UK.

Part one commissioning: NIHR liver disease research partnerships call

We anticipate that a range of projects in size and scope will be commissioned for between £50,000 and £100,000, running for a period of 12 to 18 months, to support the establishment and growth of enduring partnerships, networks and collaborations in liver disease research, with the expectation that this activity will result in high-quality submitted research proposals in part two of the call. For Higher Education Institutions the Full Economic Cost may exceed £100,000, as long as the cost to NIHR is £100,000 or less.

The objective of the research partnerships includes (but is not limited to) building capacity, exploring and establishing infrastructure, forming professional multiagency and multidisciplinary relationships, both inside and outside of hospital settings, which span health, social care, local authorities, charities, voluntary and community organisations, driving the enthusiasm and ability to carry out future research in new or less experienced sites.

Justification as to how the award will lead to the development of sustainable partnerships between research and practice will be required to support applications for funding; networking or research activities alone are out of scope and are likely to be rejected.

Within the allocated 12 to 18 month period for part one, partnerships are expected to make preparations for high-quality liver disease research applications within the remits of the participating NIHR programmes in readiness for part two.

This could be achieved through a combination of the following areas:

• Funding protected research time for clinicians keen to become or be more research active
• “Buddying” systems that partner experienced research active institutions with research naïve or less experienced sites to expand involvement, share and build research expertise
• Upskilling R&I/R&D departments to support research delivery in naïve sites
• Formation of research hubs/networks
• Establishment and initiation of agreed mentorship plans to develop future joint lead applicants
  N.B. potential applicants may be interested in considering the NIHR Academy mentoring programme
• Sharing of research infrastructure across sites
• And/or other arrangements justified by the applicants

Who can apply?

The partnership must be led by the lead applicant or joint lead applicants, who will be responsible for ensuring the successful delivery of the proposed partnership activities and will manage the funding in accordance with the NIHR standard research contract. Lead applicants may be based in any appropriate host institution or organisation within the UK e.g. Local Authorities, NHS or voluntary organisations, Universities and HEIs. Applicants should check the guidance documents to find out the specific eligibility requirements, and contact the NIHR if they have further questions regarding eligibility.

The roles and responsibilities of the co-applicants should be clearly justified in the application; specifically their contribution to the partnership and how they will work together to deliver the objectives.

Specifically, NIHR expects these research partnerships to include co-applicant representation within the core research team from at least one geographical area demonstrating a mismatch between disease prevalence and research activity, as well as representation from NIHR Infrastructure e.g. Clinical Research Network (CRN), Applied Research Collaborations (ARC), Clinical Trials Units (CTU).

Please note: a number of Clinical Trials Units (CTUs) have prospectively expressed interest in participating in this call. The list of CTUs and their contact details can be found in the supporting information document.

Criteria for assessment

Research partnership applications will be assessed primarily against the following criteria:

• Well balanced, genuine partnerships involving co-applicants from geographical areas with historically low research levels, including coastal communities
• A range of multidisciplinary representation from across clinical areas, institutions and sectors, including but not limited to: hepatology, primary care, cancer, gastroenterology, diabetology, mental health, cardiovascular disease, public health, metabolic diseases, nutrition, social care, local authorities, charities, voluntary or community organisations, patients and the public.
  N.B. There is a particular interest in seeing metholodolgists/methodological input involved in these partnerships and recognition that this may come about through the early involvement of a CTU and/or RDS
• Evidence of confirmed involvement in the research partnership or defined plans to create links with partners within the 12 to 18 month period
• A clear description of the planned partnership activity, including any new work specifically related to the creation of the partnership, ensuring that none of the activities undertaken are already receiving funding from elsewhere
• Clear justification of partnership benefits and outcomes
• Clear description of mentorship plans (if appropriate)
• Clear description of meaningful patient and public involvement in the partnership, from the partnership activity, through to design, development and submission of applications in part two of the call and beyond
• Realistic timeline for partnership activity, demonstrating a clear pathway to a high-quality research application submission in part two of the call

Part two NIHR commissioned call: Building the evidence base

This commissioned call will be advertised in early 2024, although this date may be subject to change, in order to follow on from the initial research partnership funding in part one.

The aim of this commissioned call will be to stimulate high quality, evaluative, applied healthcare research proposals to address important and enduring evidence gaps; there is a particular interest in research focussed on the detection and prevention of liver disease. Proposals should support health and care services to facilitate joined up care, helping people with liver disease to access the best advice, treatment and care possible.

Please note that the part two commissioned call will be open to researchers from across the UK regardless of whether they received funding through the part one NIHR partnership call.

Four NIHR research programmes will be participating in this part two commissioned call, and applications that span the remit of one or more of the following programme are welcomed. Proposals that fall outside of the overarching programme remits will not be considered. Therefore, applicants are advised to pay close attention to the information about remit and tips for success contained in the following links.

• Efficacy and Mechanism Evaluation (EME) Programme
• EME efficacy of interventions that have ‘proof of concept’ with integrated mechanistic studies
• Health Technology Assessment (HTA) Programme
• HTA clinical and cost-effectiveness studies with evidence of intervention efficacy
• Health and Social Care Delivery Research (HSDR) Programme
• HSDR quality, accessibility and organisation of health and social care services
• Public Health Research (PHR) Programme
• PHR public health research at a population level to inform delivery of non-NHS interventions

Areas of particular interest with outstanding evidence gaps include, but are not limited to:

1. Reducing health inequalities:
   1. Applications addressing differences in outcomes, as well as inequity of access to high quality care, preventative interventions, and research.
2. Identification strategies and engagement between services:
   1. Strategies to identify patients with liver disease, or at high risk of developing liver disease, at earlier stages in their natural history, including non-invasive testing and determination of cost-effectiveness
   2. Evaluation of integrated pathways between primary and secondary care as well as public health and social care including long-term data follow-up and consideration of referral pathways
3. Behavioural interventions:
   1. For prevention and for post diagnosis self-management, including brief interventions, use of technology and consideration of the determinations of durability of effect
4. What to do once liver disease has been identified:
   1. Delivery of secondary care after admission with liver disease (e.g. care bundle to prevent re-admission)
   2. Appropriate management in primary care
5. Non alcohol related fatty liver:
   1. Diagnostic tests/bio-markers
   2. Prevention and management
   3. Evaluation of new treatments/precision medicine
6. Hepatitis:
   1. Identification strategies, particularly in under-served groups
7. Paediatrics:
   1. Prevention and management of fatty liver
   2. Management of chronic liver disease(s) including transition to adult services particularly in those with other long term/chronic conditions
8. Services and workforce:
   1. Variation in access to services and evaluation of targeted interventions to reduce inequalities
   2. Communication and working across relevant general and specialist services (including information-sharing). This will include interface between central liver units and others from endoscopy to alcohol care teams as well as wider services in the community.
   3. Evaluation of new models of care including one-stop shops and new forms of multidisciplinary teams and outreach services
   4. Patient, carer and staff experience of service delivery and models of care
   5. Transitions of care and support for self-management, taking into account needs of vulnerable populations, carers and families
   6. Optimal skill mix, training and experience of workforce to support quality care, including role of specialist nurses and those providing care in the community for patients with liver disease and multi-morbidity.