NIHR Global Health Research Group on prevention and management of non-communicable diseases and HIV-infection in Africa, Liverpool School of Tropical Medicine

a) Hosts’ strategy LSTM conducts research that reduces disease burden in low-resource settings. To date its research has been in infection, but the institution recently committed to expand to the interface between infection and non-communicable diseases (NCDs). It has recently made senior appointments to facilitate this expansion and will use its environment in communicable diseases to nurture the new group. b). Why LSTM now? LSTM has made two new appointments to facilitate its move to the interface between communicable diseases and NCDs: Prof Shabbar Jaffar (Epidemiologist) and Prof Louis Niessen (Health Economist). In addition, LSTM is to fund a further senior epidemiologist (currently advertised with a preference for applicants in the HIV- NCDs interface). Support will also be provided by the Head of Clinical Sciences, Prof Luis Cuevas, who desires to move to the interface between tuberculosis and diabetes research. At LSTM, the group will employ and train an epidemiologist, an health economist and a statistician. c). Links to partnerships. The key partners will be the MRC/UVRI Uganda Research Unit and the National Institute of Medical Research (NIMR) in Tanzania. Both have strong backgrounds in HIV research. The MRC/UVRI Unit has just appointed an NCD researcher (Prof Moffat Nyirenda) and provided £2m core funding to expand NCDs research. However, the Unit risks polarised programmes (on HIV and on NCDs) and the proposed group will bring the two together. NIMR now prioritises NCDs research, including providing core-funding for NCDs surveillance and NCDs research capacity development. The formation of a research centre would be catalytic to develop a new research area on integrated approaches.. The research will be done through partnerships with health programme managers and policy makers, and patient and community representatives. We will invest in staff training. The studies outlined will generate data that will be used to design large-scale intervention studies, making our grant proposals competitive. The expertise and research questions will be diverse to ensure that we can target diverse sources of funding. The group members will be part of institutions that have been highly successful in infection-related research. We will have a clear long-term vision in the HIV-NCDs interface with a focus on rigorous innovative globally policy-relevant research to attract and retain staff. d) Proposed activities African countries are undergoing an epidemiological transition, with NCDs increasing rapidly in locations where infections are still highly prevalent (1, 2). Although delivering HIV services continues to be a challenge, these services are now decentralised to primary care centres run by nurses and part-qualified doctors (3). About 50% of HIV-positive African persons know their HIV status (4, 5), and about half of the HIV positive patients who present at health facilities remain in care and have virus suppressed at 12 months (6). For diabetes and hypertension, coverage of services is more limited, services are more centralised and patient outcomes, such as loss from care, are far poorer (7, 8). It will be impossible to increase the coverage of NCD services or make them cost-effective while they are organised as stand-alone services (9). Our group will evaluate integrated approaches for prevention and management in HIV, diabetes and hypertension control, taking account the local context, in particular limited health staff and resources and the challenges that patients face in accessing care. Our initial NCD focus will be hypertension and diabetes as these are very prevalent, lead to severe and costly complications and are, of all NCDs, the most preventable and treatable. What are the knowledge gaps? There has been limited research done, mostly small studies around adding NCDs services for people living with HIV-infection (which exclude those with NCDs who are not HIV-infected) (10-12). Emp