Research Highlights

Targeting Underserved Communities in Research: Caravan Park Residents on Lincolnshire’s East Coast

Despite urgent calls to address the significant burden of physical and mental health, lower life expectancy, and high rates of preventable conditions in coastal communities, little is known about coastal residents living in mobile or temporary housing (e.g., caravans and park homes). The aim of this study led by LIIRH Director Professor Mark Gussy was to investigate the extent and characteristics of residents living in mobile or temporary housing on England’s East Coast. For this research data were from two main sources; the UK Office for National Statistics (ONS) and the Consumer Data Research Centre (CDRC), the United Kingdom’s leading consumer data source.

This research identified that those living in mobile or temporary housing along England’s East Coast tend to live in areas with high levels of deprivation and have low income, lack of education and skills attainment, and limited employment. These factors are key social determinants associated with poor health and wellbeing. The study provides important insights on how place, geographical distribution, and population characteristics converge on health and wellbeing outcomes.

In conclusion we found that the idyllic beauty of England’s coastal areas can mask some of the worst health outcomes in the United Kingdom. Coastal communities may be valued for their natural and scientific importance, but without immediate action, poor health and wellbeing outcomes will continue. The LIIRH are now developing this work further by working with coastal communities and caravan park residents to transform these findings into accessible summaries as well as, co-designing health-promotion materials.

AIR-POP: Novel use of drones to improve HIV diagnosis among infants in Guinea

Early diagnosis is needed to enable immediate treatment initiation among HIV-infected children. In Guinea, less than 2 out of 10 HIV-exposed children are diagnosed early. Without diagnosis and treatment, the majority of infected children are likely to die in their first month of life. However, in Conakry, there are few laboratories capable of carrying out early HIV diagnosis, and traffic jams are a major obstacle to the rapid transport of blood samples. In partnership with the NGO Solthis.

This project led by LIRCH researcher Dr Maxime Inghels aims to explore the use of uncrewed drones as a potential solution to the delays in the transportation of blood samples. The research is investigating the conditions and costs where transport by drone would be more cost-effective than transport by motorbike. When the samples arrive in the laboratory at Donka Hospital the "point of care" machine allows the early HIV diagnosis test to be carried out in 90 minutes, and the result is communicated to the carers by telephone.

Failure for a sample to arrive in time at the laboratory leads to a postponed analysis till the following day or risks having the mother leave the hospital with her baby and coming back for the result at a later date when it may be too late for effective treatment to be initiated. When a new-born is diagnosed in time, he or she will have a much better chance of being linked to an appropriate care pathway, thereby increasing his or her chances of survival. The success of this project has led to significant support from the Guinean Ministries of Health and Transport, and the team are developing an ambitious research project to test this transport system on a larger scale.

Understanding the Impact of Distance and Disadvantage on Lung Cancer Care and Outcomes

There are wide variations and stark inequalities in lung cancer care and survival across the UK. Most work to date has focussed on improving clinical services and much less on the factors affecting patients’ access to treatment. This place-based study led by LIIRH investigators Dr David Nelson and Dr Sam Cooke in collaboration with colleagues from Queen Mary University of London and funded by Cancer Research UK and will explore and characterise how personal circumstances and distance from the location of specialist services intersect and impact on access to optimal lung cancer care and therefore on outcomes for patients with lung cancer.

In-depth, semi-structured qualitative interviews will be carried out with patients with lung cancer diagnosed within the prior three months and their informal carers, who live in an urban (Northeast London) or rural (Lincolnshire) setting. A framework approach to thematic analysis will be applied to initially explore how patient and carer characteristics, and factors related to their location relative to specialist lung cancer services, interact to influence patients’ capability, opportunity, and motivation to engage with the optimal lung cancer care pathway. Subsequently we will compare and contrast these factors between rural and urban settings.

The findings will be used to develop a patient-centred engagement intervention which ensures that lung cancer services and support are tailored to the needs of local people in both urban and rural areas. This intervention will be co-designed with health professionals and people living with and affected by lung cancer.

HIV Research in Sub Saharan Africa

The LIRCH team has been at the forefront of HIV research in Sub-Saharan Africa, with a particular focus on HIV epidemiology and improving access to HIV testing and prevention. LIIRH researchers, Dr Paul Mee and Dr Maxime Inghels are key investigators in two £1.7m international research projects funded by the US National Institutes of Health (NIH). At the heart of the “Harnessing male peer networks to enhance engagement with HIV prevention" (Imperative) trial, lies the promotion of Pre-Exposure Prophylaxis (PrEP) as a highly effective method for preventing HIV infection.

In this study which will be conducted in collaboration with the Manicaland Centre for Public Health in Zimbabwe and other international partners from Africa, the United Kingdom, Denmark, Germany and the USA, the team of researchers will seek to establish the population impact of HIV self-test distribution through male social networks, coupled with innovative community-based support on PrEP uptake.  Zimbabwe, like many other countries in sub-Saharan Africa, faces the harsh reality of the HIV epidemic. With a substantial portion of the population affected by the virus, innovative approaches are urgently needed to combat its devastating impact.  The research findings hold promise for the development of a generalisable, multicomponent male peer-based HIV self-testing and PrEP uptake model that could be applied in other high HIV incidence settings, bringing hope for progress in the global fight against HIV.

Findings from the second project “The changing face of HIV in the era of COVID-19: Maximising HIV incidence reduction through dynamic targeting of current and future distributions of acquisition risk", will be used to inform the future implementation of HIV prevention programmes. Although recent research has shown that there has been a substantial reduction in new HIV infections in rural areas in sub–Saharan Africa, events such as Covid-19 which disrupted HIV care and the shift to Dolutegravir-based regimens (a new antiretroviral medication to control HIV infection) could alter the burden of unsuppressed viral load and new HIV infections.

Together with researchers from the French research institute Inserm, Dr Maxime Inghels is modelling the size and spatial distribution of the paediatric and adolescent HIV epidemic in Cote d’Ivoire. In partnership with the French NGO Solthis, the French Institut de Recherche et Développement (IRD), and the Guinean Centre de recherche et de formation en infectiologie (CERFID). With funding from French Agency on AIDS (ANRS) (£424,000). Dr Maxime Inghels is also investigating the impact of the introduction of injectable ARV treatment for people living with HIV in Senegal and contributed to two recent NIH-funded HIV research projects aimed at understanding and reducing HIV incidence in rural South Africa: the HITS trials “Can HIV hot-spots be eradicated?” (£2.1m) and Causal Pathways to population health impact of HIV antiretroviral treatment (£1.8m).