The NIHR has awarded nearly £20 million through its global health funding programme to help tackle multiple long-term conditions.
A total of £19.3 million will be shared between four projects that will examine clusters of chronic conditions that represent a significant disease burden in low and middle income countries (LMICs). These can particularly affect children and adolescents in these countries due to the effects of poverty, hunger and infectious diseases.
The research will explore the links between depression and tuberculosis (TB) in Pakistan, how multiple long-term conditions can be managed in South African primary care, and improving outcomes for emergency hospital admissions in Malawi and Tanzania, as well as multiple long-term conditions in children with HIV and severe malnutrition in sub-Saharan Africa.
‘An enduring impact’
The awards were made through the NIHR's Research and Innovation for Global Health Transformation (RIGHT) programme, which funds applied health research in areas where strategic and targeted investment can directly benefit people in LMICs.
NIHR Chief Executive Lucy Chappell, said: “I am proud to announce the award of £19.3m of funding to support four projects through the NIHR's RIGHT programme.
“Cutting-edge applied global health research like this can have an enduring impact and play a significant role in developing health systems to tackle the growing burden of multiple long-term conditions.”
Each project is jointly led by a UK investigator and an investigator based in an LMIC, to ensure the research recognises local challenges, reflects the capacity of healthcare systems and encourages knowledge sharing.
Dr Jamie Rylance, from The Liverpool School of Tropical Medicine, is leading one of the studies with Social Science Research Associate Dr Felix Limbani, based in Malawi.
“Co-leadership of the project is a joy,” said Dr Rylance. ”Felix is a Malawian social scientist and health systems expert, and I am a UK-trained respiratory doctor. We have complementary skills, background, and viewpoints, which brings real strength, and fun to our work.”
Dr Limbani said: “Just as the diseases are multiple in individuals, addressing multiple long-term conditions requires a multidisciplinary approach. Our study has brought together experts across different disciplines including patient representatives to design and test the most effective and context relevant ways of identifying and treating patients with multiple long-term conditions in low income settings.”
The funded projects
Multimorbidity in children with HIV and severe acute malnutrition in sub-Saharan Africa
Professor Andrew Prendergast (Queen Mary University of London) and Dr Mutsa Bwakura-Dangarembizi (University of Zimbabwe) - £4,979,419
This study looks at severe acute malnutrition (SAM) and HIV in sub-Saharan Africa among children under the age of 5.
About 20% of young children with SAM die in hospital and 10% die in the year after discharge. If they have HIV as well, the risk of death triples, and there are long-term effects on learning, growth and risk of heart problems into adult life.
Prof Prendegast and Dr Bwakura-Dangarembizi’s project will investigate the underlying medical and social causes of ill-health in children with both conditions, with the aim of improving their recovery after they leave hospital. This will involve analysis of blood and urine samples from children with HIV-SAM and interviews with caregivers to understand the challenges they face when their children are discharged from hospital.
The data collected will be used to develop new treatments for children with HIV-SAM, including therapeutic food and antibiotics, as well as social and mental health support for caregivers. Ultimately, the study will seek to compare the new treatments against current interventions and pass the findings on to policymakers.
Development and evaluation of a targeted, integrated, coherent and people-centred approach to the management of Multiple Long-Term Conditions (MLTC-M) in South African primary healthcare
Professor Lara Fairall (King's College London) and Professor Naomi Levitt (University of Cape Town, South Africa) - £4,486,021
How to effectively manage the healthcare of people with multiple long-term conditions is the focus of this King’s College project that will be conducted in South Africa. The country has a high prevalence of long-term conditions including HIV, diabetes, TB and depression, but little is known about how commonly they occur together and in what combinations.
Prof Fairall and Prof Levitt’s team will examine health records of more than 10 million people to identify the most common patterns of multimorbidity. This data will be used to inform improvements to the Practical Approach to Care Kit (PACK), a collection of guidelines used by health workers to decide how to look after their patients.
A new system, PACK multimorbidity, using the revamped guidelines will be tested across a number of clinics, and the outcomes measured to adapt and strengthen the approach. The results and experiences will be shared with policymakers and other countries using PACK, including Ethiopia and Brazil.
The CONTROL (COgNitive Therapy for depRessiOn in tubercuLosis treatment) programme of research to improve outcomes for depression and TB in Pakistan and Afghanistan
Professor Saeed Farooq (Keele University) and Dr Zohaib Khan (Khyber Medical University, Pakistan) - £4,844,707
This project will carry out research into TB and mental health within Pakistan, particularly among its population of refugees from neighbouring Afghanistan. Both countries have a high burden of TB.
Almost half of patients receiving TB medication may also have depression, which can increase the chances of a relapse or the disease progressing. Mental health issues can also reduce how closely a patient follows their course of treatment, leading to drug-resistant TB, a public health crisis and health security threat.
Prof Farooq and Dr Khan’s CONTROL study will explore the use of cognitive behavioural therapy to improve the mental health of people on TB treatment and test if this intervention helps more patients stick to their medication. If successful, the research team will see how the CONTROL could be modified for other chronic conditions such as Hepatitis C.
Multimorbidity-associated emergency hospital admissions: a ‘screen and link’ strategy to improve outcomes for high-risk patients in sub-Saharan Africa
Dr Jamie Rylance (Liverpool School of Tropical Medicine) and Dr Felix Limbani (Malawi-Liverpool-Wellcome Trust Clinical Research Programme) - £4,999,665
In LMICs, poverty can deter people from seeking medical help until they are severely ill and, as a result, hospital emergency departments play a key role in healthcare delivery.
This study, conducted in Malawi and Tanzania, will design and test a system that identifies patients suffering from multiple diseases when they seek emergency care in hospitals. It has the aim of improving early treatment of conditions and helping to prevent complications, disability and hospital readmission.
Working with patients and healthcare professionals, Dr Rylance and Dr Limbani’s team will look to improve hospital diagnostic testing for multiple long-term conditions, and - with the help of community groups and primary healthcare facilities - find how best to link patients with long-term care. Once the most efficient diagnostic approach has been found, it will be trialled in 20 hospitals, including about 2,800 patients.
The project will also offer four PhD training posts - in health systems, social science, health economics and clinical care - to help train the next generation of African research leaders.
A third round of RIGHT
The NIHR Global Health Research Portfolio was established in 2016 by the Department of Health and Social Care (DHSC). It funds research in LMICs that are eligible for the UK government’s Overseas Development Assistance.
These new multiple long-term conditions projects represent the third round of RIGHT funding, following previous awards into mental health in LMICs in May 2020 and epilepsy, infection-related cancers and severe stigmatising skin diseases in November 2019.
Improving the lives of people with multiple long-term conditions through research is an area of strategic focus for the NIHR, with our ambitions set out in last year’s NIHR Strategic Framework for Multiple Long-Term Conditions Research.