NIHR Global Health Research Unit on Neglected Tropical Diseases, BSMS

The NIHR Global Health Research Unit on NTDs at BSMS is developing new projects in under-researched but debilitating conditions that affect the lives of millions, causing stigma and poor mental health that worsen existing poverty. Since opening in 2003, Brighton and Sussex Medical School has developed a thriving programme of world-class GH research that is truly interdisciplinary in its approach, working in partnership with low and middle income country (LMIC) institutions. Unit researchers have a track record of world-class, equitable and enduring research collaboration with institutions in Development Assistance Committee (DAC)-listed countries. With a strong focus on capacity building for independent research, we are committed to creating supportive environments that empower scientists to contribute to a wider African research enterprise. This GHRU allows us to build on existing mature partnerships whilst researching greatly under-researched neglected diseases. It also enables us to deliver social science and health economics research, develop community-based interventions, strengthen health system responses and inform policy, translating our research into tangible benefits for our stakeholders. Our vision is to undertake world-class interdisciplinary research to provide an evidence base for interventions targeting the neglected tropical disease (NTD) epidemic with approaches that 'leave no one behind' . We have developed these approaches through a decade of work on podoconiosis, a disabling geochemical lymphoedema considered an 'other neglected tropical condition' by WHO that is estimated to affect over 4 million people in Africa. Over the last ten years we have researched the epidemiology, mineralogy, genetics, bioethics, economics, clinical management and social impact of podoconiosis. We are now applying our experience in translational research on podoconiosis to other neglected conditions - mycetoma and scabies - that significantly affect the communities we already work with, and we have extended our methodology to include expertise in health economics and service development. WHO adopted mycetoma (a chronic destructive infection that spreads from subcutaneous tissues to involve the deep structures and bones) as a NTD in 2016 . The 69th World Health Assembly specifically called for research to develop new tools to diagnose, treat and prevent mycetoma. We focus on tools and strategies for prevention, using our experience developing and testing behavioural interventions to prevent podoconiosis. Scabies (a skin infestation that causes profound itching and can lead to serious bacterial infections) was endorsed by WHO as a neglected tropical disease in 2017,It is estimated to infest 130 million people at any given time and disproportionately affects children and vulnerable people. Like mycetoma and podoconiosis, scabies has received little investment in laboratory, epidemiological or operational research. A recent outbreak in Ethiopia driven by drought, overcrowding, malnutrition and poor access to sanitation, led the Ministry of Health (MoH) to highlight scabies as a high research priority that we have the expertise to respond to. Our long term aims are to work with our partners to: improve our ability to diagnose, prevent and treat podoconiosis, develop tools to prevent mycetoma (given the lack of effective treatment), improve the ability of LMICs to respond to scabies outbreaks and provide a sustainable long term framework for research across a range of other NTDs including leprosy, lymphatic filariasis, Buruli ulcer and yaws. Our specific objectives are to: • integrate and scale up community-level care for podoconiosis with that of other foot-related diseases in Ethiopia; • develop tools with which to diagnose podoconiosis and measure lymphoedema; • improve understanding of the pathogenesis of podoconiosis; • identify endemic plant extracts suitable for lymphoedema limb care; • ascertain environment