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ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 03

Contents

03 Vision, Mission, Values 34 Department of Clinical Sciences 04 Chairman’s Foreword 36 SPECIAL REPORT: The impact of LSTM’s 05 Director‘s Foreword research on policy and practice 06 Treasurer’s Foreword 40 Department of International Public Health 07 LSTM designated higher education institution 41 Striving for global equality in maternal and newborn health 10 Department of Education & Training 43 Working with the NHS 14 Investing in the future: the continued expansion of LSTM’s campus 45 Well Travelled Clinics Ltd 16 Progress against Neglected Tropical Diseases: 46 Social mission a window of opportunity 47 Fundraising 21 SPECIAL REPORT: A new way of looking at 48 Governance an old disease: Thrombin and cerebral malaria 49 Officers 2012/2013 24 Department of Parasitology 50 Facts and figures 26 SPECIAL REPORT: Translating research 55 Awards into policy and practice 57 Consortium overview 28 Department of Vector Biology 58 115 years of excellence 30 SPECIAL REPORT: Research excellence through partnerships 59 Contributors and image credits Vision: To save lives in resource poor countries through research, education and capacity strengthening Mission: To reduce the burden of sickness and mortality in disease endemic countries through the delivery of effective interventions which improve human health and are relevant to the poorest communities Values: • Making a difference to health and wellbeing • Excellence in innovation, leadership and science • Achieving and delivering through partnership • An ethical ethos founded on respect, accountability and honesty • Creating a great place to work and study 04 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 05

Chairman’s Director’s Foreword Foreword

We will look back on 2013 as the year in But as I sit to write this message, news is Strategically, 2013 is an important Plans are well advanced to increase the range of services to include which Liverpool School of Tropical Medicine coming in of the attack on the Westgate “LSTM is thriving because of milestone in LSTM’s history. The LSTM’s physical footprint with building occupational health checks linked to was designated as a higher education shopping mall in Nairobi, Kenya and the recognition of LSTM as an HEI, with direct work about to commence on the new travel, providing an enhanced service institution (HEI) in its own right. This tragic loss of Dr Juan Jesus Ortiz-Iruri, the work of its outstanding links to HEFCE, will increase visibility, Centre for Maternal and Newborn Health, to local businesses. followed a very successful visit to Liverpool a health consultant for LSTM, who was women and men, together freedom to operate in a rapidly changing generously supported by a number by the Minister for Universities and Science, about to take up the post of Senior with their collaborators international market and bring greater of major donors. This will allow us to LSTM’s balanced portfolio of research, the Rt Hon David Willetts MP. Technical Officer with our Centre for around the world.” opportunities for funding and collaboration. accommodate up to 100 new staff. training, clinical service and technical Maternal and Newborn Health. It signals a change in our relationship assistance ensure that we continue to This designation recognises the world This unwelcome news serves to underline with the University of Liverpool but not a As the UK economy starts to pick up, benefit local, national and international class research undertaken at LSTM and its that LSTM is made successful by its lessening in our commitment to working LSTM’s Well Travelled Clinics is also seeing populations. The success of this approach So we celebrate a milestone in our 115 contribution to saving lives in resource poor dedicated people, who ‘go the extra mile’ with it in areas of mutual interest. increased trading in both its Liverpool and is evident from the continued expansion of year history; our financial results remain countries. It signals a further strengthening to help those who are less fortunate than Chester branches. In response to demand the organisation while it remains focused strong and our research grant base reaches of LSTM’s platform for continued growth in themselves – and in so doing, This year we have focused on strengthening from our major clients, we have extended on its core mission, values and strengths. new highs; we continue to attract new the future. It will enable access to further may put themselves in the way of those areas of LSTM that concentrate talent and we have put the financing in sources of funding and it will assist in unexpected danger. on delivering direct impact on health We thank our many friends, donors and place for an expansion of our buildings. raising the profile of LSTM at home and and working with overseas partners and collaborators for their continued support LSTM is thriving because of the work of its “LSTM’s balanced portfolio abroad. Together with the steps being taken normative bodies to influence policy and and look forward to meeting the outstanding women and men, together of research, training, to be granted degree awarding powers, it practice. We have made a number of challenges ahead with this excellent with their collaborators around the world. will facilitate a significant development of excellent appointments, both directly and clinical service and technical network of support. LSTM’s teaching capacity. jointly with the University of Warwick. assistance ensure that we continue to benefit local, We anticipate that these will catalyse a national and international step change in our ability to draw together multi-disciplinary teams that are able populations.” James Ross OBE to tackle major obstacles to improving Janet Hemingway CBE prevention and treatment of disease in different settings.

Minister for Universities and Science, the Rt Hon David Willetts MP Director Janet Hemingway with the Lord Mayor of Liverpool, Councillor Gary Millar (right) with Chairman James Ross (left) and Director Janet Hemingway (right) and Chairman James Ross (left) ahead of LSTM’s HEI announcement. 06 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 07

Treasurer’s LSTM designated Higher Report Education Institution

In recent years it has become customary It was with pride and a sense of purpose that LSTM’s Chairman James Ross for the Treasurer to report on continuing Number of New Awards Active Research £m growth in income and I am pleased to say and Director Professor Janet Hemingway announced at a press conference that this year is no exception. The year to 100 300 31st July 2013 saw the LSTM Group achieve on 24 July 2013 that LSTM had become a higher education institution (HEI). 250 its highest ever turnover, which at almost 80 The designation came into force a few days earlier on the 19th of July following £60M represents an increase of £2.2M on 200 the previous peak. 60 150 an Order in Parliament under section 129 of the Education Reform Act 1988. 40 Research grant income, at £46.6M, 100 amounted to approximately three-quarters 20 50 The Higher Education Funding Council for government compiled new lists of further of the total turnover and was more than 2008 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013 England (HEFCE) immediately recognised and higher education institutions on which “We are delighted that LSTM, 6% higher than the prior year. the change in status and added LSTM to LSTM did not appear, making it difficult which has always been an During the year, 84 new research grants were The total value of active research has been their list of directly funded institutions. for overseas students coming to LSTM Longer term retrospection shows a awarded to the Group, beating the record high of maintained at £276M (inclusive of IVCC & LATH). to obtain a visa. Those who managed to independent institution, particularly satisfying picture with income 69 achieved in 2011/12 in a single year. A total The Group was successful with 82% of funding The long-standing collaboration with the travel to the UK faced an additional hurdle is now recognised as an HEI of £43.6M new active research was added to the applications during 2012/13. having more than doubled in the past University of Liverpool (UoL) provided as they would have to return home if in its own right. Amongst research portfolio. eight years. LSTM with accreditation of its MSc and they did not pass examinations in English, many practical benefits whereas they may have been allowed to PhD programmes and access to HEFCE, it will improve our profile To achieve such growth, significant capital and council funding from the UK stay if LSTM appeared on the HEI lists. As a investments have been made in putting to note that the support of charities and Turning to the subsidiary companies, government. However, over time a great consequence some overseas governments nationally and internationally together a formidable team and providing funding bodies has been invaluable in the integration of much of the activity of deal of this funding became increasingly considered it a risk to send students to and support our ambitions first class facilities. This process, whilst progressing the improvement programme. Liverpool Associates in Tropical Health into difficult to access due to increased LSTM. This situation became unsustainable, for continued growth and ambitious, has been conservatively On the trading front, a surplus of £2.1M has the parent company has gone smoothly government regulations. In addition the incompatible as it was with LSTM’s managed to ensure that LSTM does not been achieved in the 2012/13 Income & and LATH achieved a profit of £75k on a strategic plan. expansion.” overstretch itself. This is reflected in the Expenditure Account. This retained profit turnover of £1.7M. Well Travelled Clinics - Professor Janet Hemingway CBE, Balance Sheet which now shows Net Assets is similar to that of the previous year and Ltd is steadily overcoming the problems Director of LSTM in excess of £57M, with no external debt. is providing LSTM with much needed cash it encountered due to the big reduction During the year £4.4M was invested in towards the development of its team and in overseas business travel and the loss of Chairman James Ross, Director Janet Hemingway and the fixed assets and further improvements to its property estate. £43k represents a significant improvement Lord Mayor of Liverpool during the HEI press conference at LSTM the estate are ongoing. It is appropriate from the prior year’s loss of £177k. Whilst Research has performed strongly, Teaching remains a challenging area. In summary, LSTM remains in a Income has shown a steady decline in financially strong position, with a recent years, partly due to depressed healthy balance sheet, satisfactory economic conditions reducing the number cash flow and a continually increasing of overseas students. Nevertheless Teaching level of research grants. continues to cover its own costs and it is hoped that LSTM’s change in status to a designated Higher Education Institution will bring benefits.

Ian Jones 08 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 09

LSTM began the HEI application in LSTM’s HEI status will strengthen the early 2012 with the support of, and in “This is a great moment ongoing collaboration with the University consultation with, the University of of Liverpool in the delivery of expanding Liverpool. The rules and criteria that the in LSTM’s long history. research and teaching portfolios. One such government had established, allowing It recognises our scientific collaboration is the Wellcome Trust Tropical colleges to become higher education achievements to date Centre (WTTC) recently renamed as the institutions, provided a framework for and greatly enhances the Wellcome Trust-Liverpool-Glasgow Centre LSTM. However, the LSTM differs from for Global Health Research. most colleges in that it only provides post- realisation of our future graduate teaching but nevertheless fulfilled plans such as the creation Closer to home, LSTM’s work with the NHS the required criteria. As the government of the Centre of Maternal and the pharmaceutical and agro-chemical could not introduce a separate system to and Newborn Health and industries in the region will be boosted as accommodate one institution it allowed new funding leads to new partnerships, LSTM’s application to progress along the our ongoing application to which will benefit and strengthen the ‘college-route’. be granted Degree Awarding local and regional economy. Collaborations Powers.” with industry including Small and Medium Following a visit to LSTM by Universities Enterprises (SMEs) will translate LSTM’s - James Ross OBE, Chair of LSTM Board and Science Minister David Willetts in April research into newly developed drugs of Trustees 2013, confirmation of HEI designation was and diagnostics to be used in the UK received and the Order laid in Parliament. and overseas. When it came into force Minister Willetts Amongst various benefits the new said that “this announcement is another Future physical expansion of the LSTM HEI status brings is also LSTM having step in creating a diverse and vibrant higher campus will facilitate stronger links immediately joined the Athena Swan education sector.” with the NHS and the University of charter which strives to advance the Liverpool, in turn adding to the Liverpool position of women in science. BioCampus developments and increasing collaboration across the wider Knowledge “I congratulate Liverpool While HEI status gives LSTM visibility Quarter in Liverpool. School of Tropical Medicine and access to funds it does not allow on this important for the awarding of many of our own achievement which will education programmes. An application for Taught Degree Awarding Powers allow them to expand and (T-DAPs) is being prepared for submission build on their already in 2014. Once granted all short-courses, excellent reputation globally.” diplomas and masters degrees will lead to LSTM awards. This will make it easier to - David Willetts, Universities and establish new as well as overseas-based Science Minister education programmes, in collaboration with Universities and institutions in resource poor countries where LSTM has a Becoming an HEI not only facilitates commitment to strengthen health systems. LSTM’s access to funding and gives more potential students access to LSTM, it will also increase LSTM’s national and international visibility, in turn enhancing LSTM’s position in the formation of UK and international partnerships with academic institutions; commercial corporations and international organisations. HEI status strengthens LSTM’s position as the partner of choice for relevant global health consortia. 10 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 11

Academic Registry Under the leadership of the Academic Evaluating the student experience Department of Registrar, the Academic Registry supports students on LSTM’s credit-bearing LSTM takes seriously its responsibility to listen to the ‘student voice’ programmes (Masters and PhD). and student representatives sit on all Boards of Studies and on the Education & Training These programmes continued to Staff Student Liaison Committee. The QAA review recommended that attract highly-motivated graduates LSTM should involve students more in its deliberative committees, from around the world in 2012-13. so two students have been elected to Programmes Board for 2013- The portfolio was enhanced by offering 14 and will be actively involved in strategic discussions about future two new modules - ‘HIV in Resource teaching developments in LSTM. Limited Settings’ and ‘Medical The learning and teaching activities in LSTM are diverse and wide-ranging. Bacteriology’ – which can also be The Student Experience and Accommodation Officer facilitates The prestigious Masters programmes continue to attract highly-motivated taken as short courses. student-led focus groups, runs surveys and questionnaires and communicates results of these surveys and important issues arising students from around the world and there is also a growing portfolio of The re-structure of the Education and from committee meetings to the student body. Training Department Registry included Professional Diploma and short courses, which give participants seeking the creation of three new posts. LSTM students are each year invited to participate in a national survey continuing professional development an opportunity for intensive study The Student Support Administrator, run by the Higher Education Academy, the Postgraduate Taught located in the new Student Support Experience Survey. A 61% response rate was achieved in 2012-13, within a specialist field related to health care in the tropics. Office, is the first point of contact for which was 24% higher than the University of Liverpool’s institutional student enquiries, allowing students response rate. All of the LSTM respondents indicated that the ‘overall to be signposted more effectively to experience of the course’ had ‘met expectations’. relevant support services. Support for This year saw a major restructuring of A ‘perfect storm’ is on the horizon for Looking to the future, LSTM plans to extend PhD students was previously covered by LSTM scored very well in the following areas: ‘Skills and Personal the Education and Training Department postgraduate education in the UK. Students its capacity to deliver courses overseas three members of staff as part of other Development (97% of our students felt that their MSc programme in order to better reflect the breadth of starting under the new undergraduate fees through strategic partnerships with other roles and the new post of Postgraduate had developed their research and transferrable skills); ‘Depth of these activities. Staff are now organised regime are likely to be less willing to incur institutions, both face-to-face and through Research Student Administrator will allow Learning’ (97% of students agreed that they were ‘frequently into three teams – the Academic Registry, further debt to undertake postgraduate distance learning. research students to have an enhanced expected to analyse ideas or examine a particular case or situation the Professional Courses Unit and the study, whilst the immigration system level of targeted support. The Student in depth’) and scores relating to the quality of teaching were above Quality Unit. As described below, these poses challenges for international students. An important milestone for this Experience and Accommodation Officer 80% across the board. teams work together to support LSTM LSTM has actively prepared for the storm development was the positive outcome this has replaced the previous role of Welfare students from application to graduation by expanding the diversity of what it year of a review by the Quality Assurance and Accommodation Officer and now A new Student Engagement Exit Survey was introduced this year and also help academic staff to deliver offers, recognising the requirement for Agency (QAA) as part of LSTM’s application includes responsibility for evaluating the based on the American National Survey of Student Engagement a Learning &Teaching experience of the staff in an expanding range of professions for HEI status. The QAA found that LSTM student experience. Completing the team, (NSSE), which measures factors that affect levels of student highest quality. to undertake continuing professional meets UK expectations in all areas of the Registry Manager and three Registry engagement as opposed to student satisfaction. Despite a relatively development (CPD) and upgrade skills teaching, including the academic standards Administrators provide ‘cradle to grave’ low response rate (26%), results showed that students at LSTM while in employment. In recent years, of the awards and the quality of student support for the Masters students, feel that their voice is valued and that there are ample LSTM has adopted a ‘pick and mix’ learning opportunities. It was particularly from processing applications right opportunities to provide feedback. approach to course development that pleasing that the QAA commented in through to the final Board of Examiners allows maximum use to be made of all particular on the very strong links between and graduation. learning opportunities (e.g. MSc modules research and teaching, noting that also offered as stand-alone short courses). research informs the design and delivery This strategy allowed a drop in the number of programmes and highlighting the of Masters students in 2012-13 (echoed contribution of research active academic across the UK) to be compensated by an staff to student learning. The review also increase in students following short courses complimented LSTM on its efforts to and professional programmes, notably the collect and respond to feedback from its new Diploma in Tropical Nursing (DTN). students. LSTM is now moving on apace in its application for independent Degree Awarding Powers, which will allow LSTM to consolidate its position as an international centre of excellence for high quality education and training in global health.

Dr Sue Assinder Director of Education 12 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 13

Quality Unit Professional Courses Unit The PCU also welcomed a further 219 The launch of new courses continues to students from over 40 countries on short help diversity our course portfolio and The overall aim of the Quality Unit is to The Professional Courses Unit (PCU) was “I have enjoyed all of the courses. This was a rise of 43% on the show our teaching diversity and strengths help assure the quality and standards of launched as part of the restructuring. It lectures; the lecturers are previous year indicating that students are to the general public and the world at large. all our taught courses, both at home manages all Professional Diplomas and increasingly looking for CPD opportunities. We have also had a very positive response and overseas. The team expanded as short courses as well as undertaking excellent in their presentation Short course students are often sponsored to our efforts to strengthen links with part of the departmental restructuring, marketing activities for all LSTM teaching. skills and make complex by their employers, such as the NHS, our alumni and their feedback is actively reflecting the growing importance placed In its first year, the PCU welcomed 269 subjects accessible” Ministry of Defence, various large NGOs, informing future developments on academic quality and assurance in students on LSTM Professional Diplomas, - DTN Course Survey 2013 religious organisations, international in education. the UK Higher Education system. an increasing of 12.3% on the previous Ministries and other educational The Unit focuses on the development year. The Diploma in Tropical Nursing institutions, including University of and management of key quality assurance (DTN) continues to perform well and has Namibia, Bernhard Nocht Institute and processes and aims to ensure that these been re-accredited with the Royal College Chalmers University. are aligned with UK requirements. This of Nursing. With interest levels rising, the includes the approval, monitoring and course is now running twice per year, with This year, the PCU launched a pilot review of programmes, recording and a full class of 60 students forecast each programme called ‘Introduction to analysis of marks and monitoring of reports time. The DTN is also attracting overseas Ultrasound in Low Resource Settings’. from external examiners. A key element students, with over half the cohort This course was received very well by the of the Unit’s role is supporting external being from North America. students and all of them said they would reviews and it is now taking the lead in recommend the course to others. the preparations for LSTM’s application for Degree Awarding Powers.

In addition to its work in assuring quality “The practical sessions were and standards, the Quality Unit supports the enhancement of teaching. Ideas for excellent. The facilitators enhancing teaching are often identified were thorough, patient and during meetings and discussions and the explained the techniques Quality Unit maintains an action plan in detail. There was always that ensures that good ideas translate into tangible enhancements to the student a good positive learning experience. The Unit also runs the scheme environment. One of the for peer observation of teaching in which highlights of the practical staff are asked to have one teaching session sessions was indeed the observed each year by a colleague acting as a ‘critical friend’. As well as encouraging possibility of scanning staff to reflect upon their teaching, real patients.” the scheme highlights examples of - Ultrasound end of course survey innovative practice that would otherwise go unnoticed and provides a route for these to be disseminated. 14 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 15

A new building to house the A revamp of LSTM’s forecourt has taken Centre for Maternal and The new building will provide place over the summer of 2013. This included the reintroduction of partial Newborn Health an effective and efficient Investing in the future: railings to the right of the Nuffield Building. LSTM purchased Anson Court and Anson research environment to The original railings were removed during Terrace in December 2012, adjacent to the Second World War to be melted down the existing campus on Pembroke Place. support; stimulate and and used in armaments. the continued expansion It has now raised the necessary £7m of promote interdisciplinary funding to allow onsite repurposing and research activities and Further refurbishment work is planned for refurbishment work to commence to facilitate skills transfer in line the basement and third floor of the original create a modern building. of LSTM’s campus with LSTM values. building, ensuring that each area of the building is used in a sustainable manner It will house 180 staff and aims to become an internationally recognised centre of Future planning LSTM’s strategic plan for 2012-2017 outlines the direction of LSTM’s research excellence for maternal and child health. Improvements and The building will also provide additional enhancements At the current rate of expansion LSTM will portfolio for the next five years and beyond. To facilitate the ongoing growth space for translational research projects The past five years have seen a rolling in just a few years need to begin another of LSTM’s new and existing research initiatives a significant expansion and which will allow LSTM to further develop programme of refurbishment within the building project to accommodate larger a multi-national, multi-disciplinary team four existing interconnected buildings, teams of staff working in translational refurbishment of the current campus is required. of researchers and innovation experts, the oldest of which dates back to 1915. medicine. Current plans will involve starting delivering a range of research, teaching to raise funds to eventually acquire and and technical assistance programmes. Over that period the laboratory, offices and develop plots of land alongside the current teaching facilities have been refurbished. development opposite the existing LSTM Once complete in December 2014, More recently, improvement works to third estate. With the support of Liverpool City The Centre Tropical and Infectious as well as an international centre of the building will house LSTM’s Centre floor of the original building was completed Council and the Knowledge Quarter, there Diseases (CTID), LSTM’s state-of-the- excellence. The centre brings together for Maternal and Newborn Health, an in June 2013. are many options available to LSTM as it art research facility for researching and teams of multidisciplinary scientists expansion and re-branding of the former will continue to expand its campus. developing new drugs, diagnostics, to collaborate, share equipment and Maternal and Newborn Health Unit. The building has also undergone chathodic vaccines and pesticides to combat some facilities. This approach is echoed across protection: a technique employed to of the world’s most devastating diseases the existing campus and forthcoming The project is supported by grants from control the corrosion of a metal surface, was only completed in 2006 but already developments. the Regional Growth Fund; the European usually steel reinforcement, ensuring operates at capacity: around 200 staff Regional Development Fund and the that it will stand for a further 98 years. work on over 50 research projects. Since its completion attention turned to Wolfson Foundation. A computer-controlled direct current is the development of buildings and land introduced to the steel reinforcement, LSTM has with the CTID firmly established adjacent to the existing campus. which prevents corrosion, ensuring a sound itself as an important bioscience asset structure for the future.

Architect’s impression of the new building 16 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 17 Progress against Neglected Tropical Diseases: a window of opportunity

As consensus and resources build in the fight against Neglected Tropical Diseases (NTDs), we now require a multidisciplinary approach to research and treatment in order to capitalise upon political and financial commitments made at the ‘London declaration’ in 2010.

For the one billion people suffering from these infectious diseases, the effects can significantly impact upon physical and emotional wellbeing, as NTDs are often disabling, disfiguring and stigmatising. Typically this is combined with economic hardship, as when affected individuals are prevented from working and receiving education, NTDs ultimately perpetuate the cycle of poverty.

Important questions have been raised concerning current approaches to control and elimination of NTDs. Integrated mass drug administration (MDA) targets several NTDs using a combination of drugs administered at the same time to entire Elephantiasis patient populations, rather than just infected individuals. MDA usually continues for 4-6 years, leading to the control and A biosocial approach LSTM is leading drug discovery and sometimes elimination of those NTDs In an effort to improve the effectiveness of development research against human and the relief of ongoing suffering, MDA programmes, there is an increasing filariasis – the parasitic worm infections but this strategy remains insufficient call to introduce a biosocial approach. that cause river blindness and elephantiasis, for many NTDs. With more and more The introduction of social scientists to through the Anti-Wolbachia Consortium funding supporting MDA, questions are examine social, political and economic (A·WOL). The consortium is working with increasingly being asked as to whether the factors affecting MDA programmes is social scientist Eleanor MacPherson, progress made so far can deliver the results gathering momentum. Insights emerging to investigate if communities in Ghana, previously thought achievable by 2020. from disciplines such as anthropology, Cameroon, and Zanzibar are receptive to By examining the barriers that exist, NTD parasitology, epidemiology and a ‘test and treat’ approach to complement control programmes must adopt a more international development are combining MDA, in ‘hot spot’ areas, where existing flexible approach and consider alternative to produce a more holistic approach to strategies are failing to deliver the expected and integrated approaches to overcome NTD control and prevention. outcomes. The key question in pursuing this the challenges ahead. approach will be whether it is perceived as acceptable by everyone in the community who may be at risk of infection. By January 2014 investigators will commence qualitative studies to determine the acceptability to the communities involved. 18 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 19

Taking advantage of vector control The successful global elimination of elephantiasis could hinge upon the addition of insecticide-treated bednets to complement the current MDA strategy. Researchers from LSTM’s Centre for Neglected Tropical Diseases (CNTD) and Case Western Reserve University published a study in the New England Journal of Medicine in August 2013, finding that the MDA strategy nearly eliminated the parasite from the human bloodstream but did not stop its transmission by the mosquito vector. It stressed that elimination and control programmes should not rely exclusively upon MDA Electron micrograph of an adult male Schistosoma parasite worm to eliminate elephantiasis. Community distribution of ivermectin for onchocerciasis Professor Russell Stothard and colleagues Information gathered shows that filarial worms to kill their essential bacterial Insecticide-treated bednets are already from LSTM’s Department of Parasitology pre-school children are at daily risk of symbiont, Wolbachia. Such drugs could widely used in areas where elephantiasis across Papua New Guinea, the South In another study entitled ‘Can malaria are investigating the factors instrumental acquiring infection and therefore need to shorten the required treatment time and and malaria are both present. These Pacific and sub-Saharan Africa. A relatively vector control accelerate the interruption in improving the control of schistosomiasis be retreated throughout the year. At the fast-track the elimination of river blindness bednets work in several ways to reduce low-cost solution could complement of lymphatic filariasis transmission in Africa; in sub-Saharan Africa. This work particularly same time, more needs to be done to and elephantiasis. disease transmission by mosquitoes. the successes of the current elephantiasis capturing a window of opportunity?’, focuses in infants and preschool children, engage with the mothers with behavioural First, they serve as a barrier to female elimination programme while bringing researchers from CNTD published in the who are particularly susceptible to modification to reduce the risk of A second GCE grant was awarded to mosquitoes getting a blood meal, a process great benefit to both filariasis and February 2013 issue of Parasites and infection. Alongside the existence of becoming infected and to understand Dr Joseph Turner, to pursue an innovative that is essential for the adult female insect malaria control. Vectors a study examining the magnitude, a significant treatment gap is the problem exposure, which may in turn reduce the global health and development project to lay her eggs and produce offspring. geographical extent and potential impact of estimating the level of exposure faced disease burden. exploiting gene-knockout technologies Second, the insecticide works to reduce the An analytical review of past surveys of of vector control in the 17 African countries by young children. Children are particularly to develop a small animal model of river life-span of the insect by half, preventing elephantiasis in Papua New Guinea enables that are yet to or have only recently started at risk from schistosomiasis, as they New drugs under development blindness. The project is in collaboration it from living long enough to allow the better estimation of the national burden, MDA. The study found that vector control parasite to develop to a stage that is identifies gaps in knowledge, quantifies activities had increased significantly since often play in or are bathed in bodies The effectiveness of MDA is dependent with Professor Sam Wanji’s team at the capable of infecting more people. and locates the population at risk, and 2005, with a three-fold increase in the of water containing the parasite that upon keeping drug resistance at bay. Center for Tropical Research in Cameroon. can be used to predict the likely impact ownership of insecticide treated nets causes the disease. Antibiotics, antimalarial drugs and This new model could then be validated The study found that coupling the MDA of MDA and/or vector control. Better and coverage of indoor residual spraying. pesticides are all at risk of driving to increase the throughput of pre-clinical strategy with bednet distribution in targeting of districts by level of prevalence Coverage, however, varied dramatically In a study conducted in Uganda, the resistance, which represents a major testing for novel macrofilaricidal drugs malaria-endemic areas also protected will strengthen the control programme, across the 17 countries. findings of which were first published threat to achieving control of NTDs. under development by the A·WOL by Seto et al in Geospatial Health 2012, consortium and other macrofilaricide the same individuals from elephantiasis. facilitate monitoring of the disease trend Multiple bednet programmes already and increase the likelihood of reaching the The continued commitment and global Professor Stothard and colleagues used In June 2013, A·WOL announced drug development approaches. distribute the vector control tool for free target of elimination. financial support for NTD programmes and cheap GPS data-logging technology and the A·WOL II Macrofilaricidal Drug the concurrent expansion of vector control custom-made arm straps to measure the Development Project. The aim of the activities for malaria is promising, but levels of direct water contact that young project is to develop and optimise “It is quite an achievement monitoring and evaluating the impact of children and their mothers had along the drugs and regimens of registered and these activities over the next decade will be shoreline of Lake Albert, in North West re-purposed anti-Wolbachia to win one of these Grand critical to its success. Uganda. By comparing the GPS data- macrofilaricidal drugs selected from the Challenge Exploration grants, logging patterns of mothers and children, A ∙WOL I screening campaign and to let alone to win two of them, In July 2013 the WHO announced that results showed strong socio-cultural factors test these in combination with standard and even more so, both grants Colombia has become the world’s first associated with water contact behaviour. anti-filarial drugs. It brings together world country to eliminate river blindness. experts in drug development, chemistry are for researchers working This was made possible through the Mothers were occupied up to forty five and biology to fast-track active anti- for the same laboratory MDA of anti-parasitic drug ivermectin minutes each day at the lakeside with Wolbachia compounds into field trials within LSTM.” in affected parts of the South American domestic chores that increased their daily targeting river blindness and elephantiasis nation, combined with a sustained health risk of acquiring schistosomiasis. Pre-school in Africa. - Professor Mark Taylor, Head of Parasitology children who accompanied their mothers education campaign in local communities. in these chores were at significantly higher Professor Mark Taylor and Dr Denis Voronin risk of Schistosoma infection. The gathering were in May 2013 awarded a grant from of women and children in groups was the Grand Challenge Exploration (GCE) significant to researchers, who monitored initiative, funded by the Bill and Melinda these social interactions, centred on Gates Foundation to screen for drugs that domestic tasks, found to collectively activate the autophagy immune system of increase the risk of infection. Bednet 20 | LSTM ANNUAL REPORT 2012/13 SPECIAL REPORT LSTM ANNUAL REPORT 2012/13 | 21 LSTM’s Research Trajectory | 2012 – 2013

As an institution with a vision to translate its research findings into practical benefits for people living in low and middle- A new way of looking at income countries, the driving force for the development of our an old disease: Thrombin research questions comes from the communities where relevant diseases are prevalent. and cerebral malaria

This pathway leading from the field into the laboratory is often followed by taking research back into the field and, even during the laboratory phase, LSTM works together with its overseas partners to deliver as much of the science locally as possible, in order to support high-quality research and capacity strengthening.

In this Annual Report a series of four Special Reports looks back at LSTM’s research trajectory over 2012 – 2013 and its impact. The continuous search for, and development of, new products will help to improve prevention and treatment of many diseases and address global health issues, together with knowledge of their effective implementation and an understanding of their impact through monitoring and evaluation.

Our work on the pathology of cerebral malaria came from observations made in Malawi and fits with national Malawian policy to conduct research on malaria. Almost all of the work was carried out in Malawi using the strong links between the University of Malawi College of Medicine, the Queen Elizabeth Central Hospital in Blantyre and the Malawi-Liverpool-Wellcome (MLW) Programme. 22 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 23

The human malaria parasite Plasmodium surface of small blood vessels, thus normally associated with blood clots vessels and, in particular, what happens falciparum has been described as one withdrawing, or sequestering, them from (Figure 1). The ‘clots’ were not blocking when they have infected red blood cells of the biggest killers in human history the circulation. It is not clear why this vessels and the overall ability of people bound to them. He was able to show that, but although we know much about the human malaria parasite has developed with severe malaria to form blood clots during a malaria infection, the levels of TM biology of this parasite and its interactions this behaviour, particularly as other was not overtly affected so this was and EPCR in the blood vessels are reduced with the insect and human hosts, we human malaria species are able to survive something of a puzzle. and that in the presence of infected red have much less information about why it without it, but it is not difficult to see blood cells fibrin is produced in the blood kills people. On being bitten by a female that by packing the blood vessels in the To begin to solve this puzzle required vessels (Moxon et al (2013) Blood 122(5): Anopheles mosquito the infective forms brain P. falciparum could cause impaired thinking about how clotting takes place 842-851). This loss of proteins that control of the parasite invade the human liver consciousness and the coma associated and, more importantly, how it is controlled clotting and the production of fibrin was and develop there for about a week. At with one of the most dangerous forms of (Figure 2). When a blood vessel is injured, strongly associated with cerebral malaria. this stage the infection is asymptomatic, severe malaria disease, cerebral malaria. a protein called Tissue Factor is released. The loss of EPCR and TM leads to localized but once the liver cells have released the This clinical syndrome has a case fatality Through a cascade of reactions this results loss of control of thrombin production expanded population of parasites, a cycle rate of 15-20% but even in survivors can in the production of thrombin from its due to the inability to produce aPC and of growth is initiated in the red blood cells cause a range of neurological deficits inactive precursor prothrombin. Thrombin is therefore the conversion of fibrinogen Figure 2 - Tissue Factor (TF) is released by the cells lining the small blood vessels activating a that can eventually lead to disease and, ranging from subtle learning difficulties an enzyme that converts soluble fibrinogen into fibrin. However, thrombin does more cascade of reactions (1) leading to the production of thrombin (2). The production of thrombin in some cases, death. Although seen as a to epilepsy. into insoluble fibrin, the basis of a blood than just produce clots and whereas in the is controlled (3) by the conversion of Protein C (PC) into activated protein C (aPC) through ‘killer disease’ malaria results in death in clot. During tissue damage this reaction presence of EPCR and aPC it communicates the interaction between thrombomodulin (TM) and Endothelial Protein C Receptor (EPCR). EPCR and aPC working together also reduce the production of thrombin (4) and communicate approximately 1-2% of infections and the Several researchers have suggested that takes place at a highly localized level, with the cells lining the blood vessels to with the host cells reducing inflammation and strengthening the cell-cell barrier (5). Binding way in which immunity to malaria disease the reduction in blood flow in vessels in providing a means to repair the blood produce a ‘healthy’ phenotype; if EPCR of P. falciparum-infected red blood cells causes a reduction in aPC levels, over-production of develops in affected populations is a story the brain could explain the disease seen vessel, but clearly once this mechanism and aPC are not available it activates thrombin and the induction of a local inflammatory state in the blood vessel. in its own right. in cerebral malaria, but knowing for sure has been switched on, there needs to be a an inflammatory response in the blood In the curious way that science works, is difficult due to the lack of an animal way to switch it off again. The production vessel, leading to tissue damage and loss having made this discovery we found Why some people develop serious model and the reasonable restrictions of thrombin is switched off by activated of fluid through the vessel wall. In many out during a trip to colleagues at the complications and potentially lethal in comparing findings with the brains Protein C (aPC), which is produced at the tissues this movement of fluid would University of Copenhagen that they had “Translating this basic infections is not fully understood but a of people who do not die from cerebral surface of the vessel wall by the interaction have little consequence, but in the highly independently made a similar discovery clue to this comes from work conducted malaria. For a disease that involves of two important regulatory proteins circumscribed environment of the brain science into therapies is about the role of EPCR in severe malaria towards the end of the nineteenth century interactions between the small blood Thrombomodulin (TM) and Endothelial surrounded by the skull, swelling due to still some way off but the but using a very different approach. by two Italian pathologists Marchiafava vessels deep in the brain and infected Protein C Receptor (EPCR). vessel leakage can be very dangerous. insights provided from this and Bignami, who observed that the red blood cells binding in this tissue, Instead of looking at the host response, research at the clinical and blood vessels in the brains of people dying taking blood samples from the peripheral Under normal circumstances these proteins More work is needed to understand they had concentrated on the types of with coma from malaria infection had circulation can only tell us part of the story. work together to restore the host vascular the exact mechanisms driven by this laboratory interface provide malaria parasite associated with disease accumulations of infected red blood cells The breakthrough came with a simple system back to normal. Dr Chris Moxon, perturbation of the thrombin pathway a better understanding and found that these often bind to a new that were at higher densities than observed observation by scientists working in the then a Wellcome Trust Clinical Fellow in causing cerebral malaria, but by drawing host receptor, namely EPCR (Turner et al into the basis of one of the in peripheral blood vessels. We now know MLW Programme and the Blantyre Malaria working in the MLW Programme under parallels with the brain swelling seen (2013) Nature 498(7455): 502-505). major aspects of pathology that this concentration of infected cells is Project who noticed that the blood vessels the supervision of Professors Rob in other diseases such as meningitis a In doing so they block the conversion of due to the ability of P. falciparum infected with sequestered infected red blood cells Heyderman and Alister Craig, developed number of potential interventions based of severe malaria.” Protein C to aPC and hence the control red blood cells to bind to receptors on the binding to them from the brains of children a way to look at the cells lining blood on augmenting the feedback control Professor Alister Craig, LSTM of thrombin production. These findings mechanisms of the clotting pathway provide confirmation of the importance of come to mind. this pathway and a great opportunity to work together to generate new knowledge to take back into the field.

Figure 1 – Blood vessels from the brain of a child dying from cerebral malaria showing the accumulation of infected red blood cells (black dots) in the vessels and (see detail) the production of fibrin (stained red) associated with the presence of these sequestered forms. 24 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 25

PARASITE PATHOGENESIS NTD PARASITE ELIMINATION AND BIOINFORMATICS AND Department of & IMMUNITY CONTROL PROGRAMMES TECHNOLOGY PLATFORMS Professor Alister Craig and Dr Chris Professor Stothard’s work on LSTM’s Bioinformatics Unit expanded with Moxon and colleagues in Malawi made schistosomiasis in Uganda and Namibia the appointment of Dr John Archer and 3 Parasitology an important breakthrough in our with the Wellcome Trust SIMI project PhD students to collaborative projects understanding of the mechanism of (Schistosomiasis in Mothers and Infants) within the Parasitology and Vector Biology cerebral malaria that results in localised finished this year. Highlights of this Departments. Together with Warwick coagulation and inflammation and damage study revealed that young children from Systems Biology Centre, the group is to the blood vessels, published in the the age of 6-months can have active developing tools and methodologies to journal Blood. schistosomiasis and need treatment with address some of the key obstacles that DRUGS & DIAGNOSTICS praziquantel (PZQ). Data support the limit our ability to fully extract biologically The department’s pipeline for product Dr Britta Urban’s group uncovered another international initiative headed by Merck- meaningful information from non-model discovery, development and delivery new mechanism by which malaria causes Serona to develop a paediatric formulation organism datasets. Investments have genuinely extends from molecule to man disease, published in Nature Medicine. of PZQ. provided a boost to our Bioinformatic Unit to policy. Our portfolio includes two novel They show that parasites activate mast support for high throughput omics and two antimalarials in preclinical development, cells, an immune cell normally linked to The Centre for NTD (CNTD) continues to Operetta imaging platforms. Dr Joe Turner an anti-TB drug in preclinical development allergic reactions. Dr Urban and colleagues support Ghana, Burkina Faso, Tanzania, and Amber Fanthorne with a BBSRC / and large discovery and development from the KEMRI-Wellcome Trust Research Liberia, Guinea, Mozambique, Malawi, Integrative Mammalian Biology MRes programmes focused on anti-Wolbachia Programme showed that the mast cell Zambia, Ethiopia, DRC, Nepal and Studentship have developed bio-imaging based therapies for lymphatic filariasis and factor is increased in children with Bangladesh in their efforts to eliminate with laser scanning microscopy to visualize onchocerciasis (A·WOL). severe malaria. lymphatic filariasis. It has received renewed and quantify lymph flow and vascular funding from DfID and additional funding remodelling in models of lymphatic The recently launched Research Centre for VECTOR PARASITOLOGY of the END Fund, OFID and the BMGF and filariasis as a pre-clinical screen for new Drugs & Diagnostics (RCDD) is headed Our renewed linkage with the Vector partnership with Sightsavers. therapies for lymphoedema and by Dr Giancarlo Biagini (drugs) and Biology Department has begun to bear elephantiasis (pictured). Dr Emily Adams (diagnostics). Dr Adams, fruit. Professor Moses Bockarie, Director CNTD hosted a meeting of programme a Leishmania expert and a joint of the Centre for NTD (CNTD), has long managers from our 12 project countries appointment with Warwick University, been a champion of the use of vector in Africa and Asia. The Chair of the UK was soon in the media spotlight as control, such as bednets, to augment MDA parliament’s All-Party Group on Malaria diagnostic expert on tick diseases. RCDD Dr Giancarlo Biagini control programmes for lymphatic filariasis & Neglected Tropical Diseases (APPMG), will work with industry, academia and (LF). Evidence was published in the New Jeremy LeFroy MP, attended the meeting NGOs to discover, develop and deliver England Journal of Medicine together with to discover more about neglected tropical novel therapies and diagnostics against Probing Primaquine – Dr Giancarlo Biagini A·WOL II – This year saw the renewal of lead author Dr Lisa Reimer, a new joint diseases (NTD) control programmes. major human pathogens and exploit our and colleagues work on the mode of action the A·WOL programme (Bill & Melinda appointment with Vector Biology. state-of-the-art facilities. of the anti-malarial drug primaquine Gates Foundation), to find new cures for Another joint appointee, Dr Alvaro Acosta- CNTD is leading efforts to complete the (MRC funded). Together with Professors river blindness and lymphatic filariasis. Serrano, is part of the team lead by the mapping of NTDs in the ‘mega’ countries Ward and O’Neil (UoL) the group published Headed by Professors Taylor and Ward it Wellcome Trust Sanger Institute that of DRC and Ethiopia. It also carries out a their discovery of a new class of quinolone will develop registered and repurposed sequenced the genome of the tsetse fly - coordinated mapping of multiple NTDs anti-malarial drugs in Proceedings of drugs identified in the first five years of the the vector of trypanosomes. PhD student in Nigeria together with a high resolution the National Academy of Sciences. programme to select the best candidates Clair Rose studied the proteome of the fly’s micro-stratification overlap mapping The potent activities of these drugs fulfill for clinical trials and in parallel carry out a peritrophic membrane to identify potential (MOM) strategy as a prerequisite for the requirements for the generation of lead optimization programme to work out targets for transmission blocking vaccines control and surveillance in areas where a potent, safe and inexpensive drug with which of a group of six classes of new anti- for sleeping sickness and Nagana. LF and onchocerciasis are co endemic the potential for clinical deployment Wolbachia drugs can progress to a with Loa loa. in the control and eradication of pre-clinical candidate. falciparum malaria. Professor David Molyneux led the WHO A·WOL members Dr Joe Turner, Dr Denis Evaluation Mission for Guinea Worm Modeling malaria - Dr Ian Hastings Voronin and Dr Kelly Johnston received Eradication in Nigeria. They concluded that and colleagues have been refining and Grand Challenges Exploration (GCE) grants there was no longer transmission in what validating pharmacological models to to develop new ‘blue-sky’ approaches to was formerly the most endemic country develop computer simulations of malaria the discovery and development of anti- with over 650,000 annual cases. It gives drug treatment in patients. It is being used Wolbachia drugs. LSTM holds three GCE hope that Guinea Worm will be the first of in the design of drug regimens reducing grants out of the seven awarded in the UK. the NTDs to be eradicated. the numbers of patients required in clinical trials (MRC); evaluating how current drug regimens are threatened by drug resistance (Bill & Melinda Gates Foundation) and investigating whether increased drug dosage can overcome drug resistance in Professor Mark Taylor South East Asia (WHO). Head of Parasitology SPECIAL REPORT LSTM ANNUAL REPORT 2012/13 | 27 LSTM’s Research Trajectory | 2012 – 2013

Ongoing research into insecticide resistance remains an essential component of LSTM’s work, particularly important as insecticide resistance is the biggest Translating research threat to malaria control. The ongoing development of new tools to improve the quality of work to monitor this resistance G into policy and practice informs the various programmes that aim to develop new insecticides. Commercial partners recognise LSTM’s international expertise in this area and are keen to Translational research, alongside product development against well-defined collaborate on product development based on LSTM’s research outcomes. To facilitate target product profiles, resonates strongly with many national and international this collaboration LSTM established the higher education oversight and funding bodies. If such research includes a Liverpool Insecticide Testing Establishment (LITE), an insecticide-based product testing strong focus on strengthening health systems and capacity building it will initiative which is at the forefront of the enable potentially comprehensive interventions that will improve health battle to manage insecticide resistance and A technician in Ethiopia sprays insecticide to counteract the spread of infection by on the outside of a building to prevent malaria-carrying mosquitos outcomes and therefore fulfil LSTM’s mission. insecticide-resistant vectors.

This approach is supported by LSTM’s Professor Taylor’s breakthrough drug research strategy, which sets out the discovery and development research research direction and priorities for the against human filariasis, a group of parasitic period 2012 - 2017. It outlines how the “LSTM will use the award worm infections causing river blindness strategic decisions underpinning LSTM’s to strategically fund and elephantiasis affecting up to 150 research activity will have maximal impact specific early discovery million people in 83 countries, received on global health, in particular in saving lives research. This will US$10 million from the Bill & Melinda in resource poor countries. Gates Foundation. This so-called 2nd pump-prime research to phase funding will allow the global Anti- As a result LSTM has made major progress develop drugs that are Wolbachia Consortium (A·WOL) to further in the translational field throughout the active against multi-drug expand on their pioneering research and past academic year. resistant tuberculosis, focus on macrofilaricidal drug discovery as well as optimising and developing As a sign of confidence in the market identification of new existing drugs. To facilitate this translational potential of LSTM’s scientific research, chemical starting points research further partnerships between the Medical Research Council (MRC) and for new anti-malarial academic groups and pharmaceutical the Technology Strategy Board awarded drugs or resistance companies are essential. A·WOL has set up LSTM £250,000 through the joint a collaborative project with AstraZeneca Biomedical Catalyst in 2012. This will help breaking insecticides where the latter allows open access to its LSTM to progress research ideas towards which will all play a role in facilities and compound collection. clinical testing. the war against diseases in developing countries.” LSTM’s Centre for Maternal and Newborn Health (CMNH), previously known as the

“LSTM is ideally placed to Maternal and Newborn Health Unit, has - Professor Steve Ward, established itself as an internationally Deputy Director LSTM work with others to define, recognised centre of excellence and evaluate and support the currently is the largest academic group implementation of effective in Europe focusing on global issues of interventions across a maternal and newborn health. The Centre’s research is being applied through a new broad range of disease areas evidence based competency based ‘skills including Neglected Tropical and drill’ training in Emergency Obstetric Diseases; maternal and child and early Newborn Care (the EOC&NC health; respiratory and vector training package) using proven adult education techniques borne diseases.”

- LSTM Strategic Plan 2012 - 2017 28 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 29

Another example of LSTM leading the way CAHRD is a virtual network of organisations in translational research is the Cooking “Effective, innovative, co-ordinated by LSTM. It brings together and Pneumonia Study (CAPS). Pneumonia individuals and disciplines, working and affordable policies Department of kills almost 1.6 million children each year. together across the full range of applied This particular study tracks 10,000 children and practice are essential health research encompassing operational, under five in rural Malawi after supplying for improving health. implementation, and health systems their homes with two cook stoves which research. Members of CAHRD also engage Vector Biology Developing and successfully have reduced emissions of almost 90%. directly in supporting the delivery of a Researchers monitor whether or not implementing such policies range of health interventions and services these new and cleaner stoves reduce and practices to scale for within developing countries. the pneumonia incidence rates among the benefit of the health of The Department of Vector Biology is made up of a diverse set of researchers, these children. poor populations is the focus CAHRD works across all four LSTM Departments and features a number of based in the UK and overseas, who are united by our mission to conduct and Emerging from this study is the of the Centre for Applied large research and delivery initiatives. establishment of the tropical Clinical Trials Health Research & Delivery It also collaborates with a range of implement high quality research to reduce the burden of insect borne disease. Unit (tCTU), which will – based on lessons (CAHRD).” organisations around the world including learned from the CAPS study – provide Ministries of Health, international and guidance, support and advice to clinical -Professor Bertie Squire, Director CAHRD national non-governmental organisations, trials as part of wider studies in low and disease control programmes, public health New appointments in Dr Lisa Reimer joins us after four years AvecNet, a 16 partner consortium middle income countries. institutes and universities. as the head of entomology at the Papua coordinated by LSTM, continues to The work of the CAHRD requires a range Neglected Tropical Diseases New Guinea Institute for Medical Research. generate new evidence for alternative of disciplines in addition to biological, Two new members of faculty joined the A key objective in LSTM’s organisational As a result the CAHRD webpages on the Dr Reimer brings a wealth of laboratory malaria control tools that can tackle the clinical, epidemiological and public health Department in 2013 to strengthen our strategy is ‘to provide a co-ordinated LSTM website provide a range of practical and field experience on the mosquito rapid evolution of insecticide resistance in approaches. Social and management activities in the control of Neglected multi-disciplinary approach to resources, reports and policies developed vectors of filariasis and malaria. the mosquito vectors. New tools to track sciences, economics, mathematics, Tropical Diseases. Professor Steve Torr strengthening capacity for delivering with key global stakeholders that will help Her research spans from studies to the behavior of insecticide susceptible and statistics and modelling are among the has joined us from the University of key large scale operational and to pave the way in meeting one of the identify the most efficient mosquito resistant mosquitoes have been developed many disciplines that bring new solutions Greenwich. Professor Torr has spent translational research’. To achieve this, objectives of LSTM’s Research Strategy: vectors of filariasis to field trials to evaluate and are being used in field studies in to major health challenges. over 30 years working on the behaviour and in close collaboration with the To translate research and knowledge into how vector control can help reduce the Burkina Faso and Tanzania. A clinical trial and ecology of tsetse flies which spread University of Warwick, LSTM set up policies and practices that improve health transmission of lymphatic filariasis. comparing the efficacy of a traditional sleeping sickness (Human African the Centre for Applied Health Research outcomes, particularly for people living in bednet with a ‘next generation’ bednet, Trypanosomiasis) and nagana (African and Delivery (CAHRD), directed by resource-poor settings. LSTM have also been key partners in the containing two active ingredients, will Animal Trypanosomiasis). Field studies, Professor Bertie Squire. efforts to sequence and annotate the commence shortly in an area of West Africa using a wide variety of research methods, genome of Glossina morsitans, one of where resistance to existing insecticides is have determined how and why tsetse the key vectors of trypanosomiasis. already compromising malaria control. Clean cookstove distributed in Malawi flies are attracted to particular hosts. The publication of this dataset will The outputs from AvecNet will help The results have led to novel methods spearhead much needed research into develop sustainable malaria control of controlling flies by attracting them novel control methods. solutions for Africa. to lethal baits. These simple and cost- effective technologies have been widely The Department’s research into insecticide applied to control human and animal Supporting malaria control resistance has been further strengthened trypanosomiasis in many parts of Africa. programmes in Africa by the award of a prestigious Wellcome Research and technical assistance to Trust Senior Fellowship to Dr Charles evaluate alternative methods of malaria Wondji. This will enable Dr Wondji to control continues to be a major activity expand his successful current research on of the Department. New activities in 2013 the mechanisms of resistance in Anopheles have included the implementation of an funestus to field trials to assess the impact entomological data management system of this resistance on control interventions. in Ethiopia; a review of the Indoor Residual Spraying programme in Ghana and development of an insecticide resistance management programme in Zambia.

Professor Hilary Ranson Head of Vector Biology SPECIAL REPORT LSTM ANNUAL REPORT 2012/13 | 31 LSTM’s Research Trajectory | 2012 – 2013

Demonstrating evidence for scaling- INTERNATIONAL up health interventions is increasingly “LSTM’s new status as an PARTNERSHIPS important to global health. Governments, GLOBAL ALLIANCE TO ELIMINATE funders and policy makers require evidence independent HEI recognises LYMPHATIC FILARIASIS (GAELF) Research excellence concerning the costs of interventions, their world-class research in their acceptability to communities tackling some of our most Formed in 2000, GAELF brings together and health system requirements. The challenging health problems.” public and private health partners in through partnerships combination of UoW and LSTM expertise support of The Global Programme to creates a complementary team to improve Sir Howard Newby, Vice-chancellor of the Eliminate Lymphatic Filariasis (GPELF). University of Liverpool evidence to support the scale-up of global It mobilises political, financial and technical health interventions such as TB treatment resources to eliminate LF and alleviate the and diagnostics. physical, social and economic hardship Until LSTM is granted degree-awarding LSTM works in partnership with governments; international organisations; brought by the disease. powers, the delivery of specialist Staff and students at both institutions are industry and other stakeholders to shape the global research agenda teaching programmes is the main area of finding seminars given by respective visiting GAELF includes 12 academic and collaboration with UoL. Eight education and to advocate for an environment where research, and its successful academics to be a valuable method of research institutions, including LSTM, programmes and research degrees are accessing the latest research findings and who are strengthening the scientific and demonstrable implementation, is central to the health and designed and delivered by LSTM and at facilitating this collaboration. Throughout basis of knowledge in LF, testing new present continue to be awarded by UoL. the past academic year CAHRD ‘themed’ treatment tools and strategies; providing development agenda. However with LSTM’s recent designation talks featured prominently in the LSTM postgraduate human capacity development as a higher education institution (HEI), Seminar Series. and carrying out operational research. the process towards LSTM awarding its Its secretariat is based at LSTM’s With the ongoing changes in the funding own diplomas, both in Liverpool and Alongside joint research initiatives, Centre for Neglected Tropical Diseases and policy landscape around tropical overseas, has begun. LSTM will continue to explore how this (CNTD) and contributes to the GAELF infectious diseases and global health partnership can support the expansion communications strategy, primarily it is essential that LSTM continues to Vice-chancellor of UoL, Sir Howard Newby, of education programmes. With further through the organisation of biennial position itself as a global leader and the congratulated LSTM on receiving HEI status joint appointments and projects planned meetings. To address activities related to ‘partner to turn to’ in its core expert and highlighted the ongoing collaboration over the coming years, research from the GPELF the Centre receives funding areas of Neglected Tropical Diseases; between both institutions by saying that this collaboration will translate into from the UK Department for International malaria; maternal and child health; TB and “It will help build on Liverpool’s reputation cost-effective, affordable and scalable Development (DfID) and GlaxoSmithKline respiratory diseases. Strategic partnerships as a hub for knowledge and expertise interventions for the world’s poorest (GSK). These include the implementation that are consistent with the reputation in infectious disease. Together with the populations. of mass drug administration (MDA) in 12 University’s Institute of Infection and and prestige of LSTM are essential to countries; laboratory strengthening within Global Health, we can make a significant achieve this. 6 countries; in-country workshops; PhD LSTM AND THE UNIVERSITY contribution to the health and wellbeing fellowships; operational research; advocacy OF LIVERPOOL of millions of people and we are proud STRATEGIC PARTNERSHIPS and communications. The work is led by to continue to partner with LSTM in this LSTM AND UNIVERSITY Since 1900, only two years into its GAELF executive group member and CNTD important area of research.” OF WARWICK LSTM’s expertise in infectious disease existence, LSTM has worked with the Director, Professor Moses Bockarie. control and international health University of Liverpool (UoL) to deliver The past academic year has seen the “The collaboration between One of several joint initiatives is the complements UoW’s strength in non- scientific achievement, excellence in Prof. Bockarie’s Centre works closely with strategic collaboration between LSTM Wellcome Trust-Liverpool-Glasgow Centre LSTM and University of communicable diseases, health economics teaching, improvements in global health Professor Mark Taylor and his Department and the University of Warwick (UoW) for Global Health Research (CGHR), Warwick has, in the previous and statistics. The largest collaboration and exceptional clinical services via the of Parasitology at LSTM, which, through go from strength to strength. Five previously known as the Wellcome Trust academic year, resulted in within this partnership is the Centre for local NHS trusts throughout Merseyside. the Anti-Wolbachia Consortium (A·WOL), joint appointments have been made, Tropical Centre (WTTC). This was formed by Applied Health Research and Delivery It was with the help of temporary is developing new LF treatments to supported by a £4.5 million investment 5 joint appointments and the expansion of a pre-existing partnership (CAHRD). It is a network covering the laboratory facilities at the University of address the growing threat of drug from both institutions and the Wellcome between LSTM and UoL, funded by the £4.5 million investment from full spectrum of applied health research, Liverpool that LSTM scientist Ronald resistance. The public health benefits Trust. The appointments are in the areas Wellcome Trust, which now includes the both institutions and the including research into the operation Ross made the discovery that mosquitoes gained from the falling prevalence of LF of Diagnostics, Evidence Synthesis, University of Glasgow. Other partners of Wellcome Trust.” and implementation of health systems. transmit malaria to humans and, in are significant: analysis revealed that Mathematics, and Neglected Tropical the Centre include the National Institute It seeks to bring together a broad range doing so, was awarded the Nobel Prize mass drug administration averted 32 Diseases, including leading Entomologist CAHRD strategic plan 2012 - 2017 for Mental Health and Neurosciences, of disciplines, in collaboration with for Medicine in 1902. LSTM and UoL, million disability-adjusted life years and Steve Torr, Professor of Neglected Tropical Bangalore, India; Instituto de Microbiologia, ministries of health and non-governmental collaborating in this manner to further an estimated 6.6 million newborns were Diseases within LSTM’s Vector Biology Universidad San Francsico de Quito, organisations in developing countries, research and teaching, laid a foundation for protected from clinical disease. Department. Professor Torr is developing Ecuador and Malawi-Liverpool Wellcome to improve the health of poor and a long-term partnership. integrated approaches to controlling Trust Clinical Research Programme, vulnerable populations. LSTM’s strategic As a large-scale international public-private vector-borne diseases, including the use of Blantyre, Malawi. CGHR is promoting partnership with UoW is an essential health partnership, GAELF is delivering insecticide-treated cattle to control tsetse, excellence in science; building capacity and component of CAHRD’s strategy. Once advances towards the elimination of LF ticks, mosquitoes and midges, offering the driving strategic research collaboration in of its current collaborative research by 2020. prospect of controlling a range of diseases Global Health by supporting researchers projects is developing and implementing with a single intervention. in partner institutions to become TB diagnostics in developing countries, led independent researchers and future leaders by CAHRD Director and LSTM Professor of in their field. Clinical Tropical Medicine, Bertie Squire. 32 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 33

COCHRANE INFECTIOUS COUNTRY PARTNERSHIPS A recent study by MLW showed a positive LHP is one of only a handful of Academic PARTNERING Having access to the screening compounds DISEASE GROUP MALAWI-LIVERPOOL WELLCOME uptake of HIV self-testing in Blantyre, Health Science Systems in the UK, leading WITH INDUSTRY will allow A·WOL to determine if they Malawi. Allowing people to self-test within developments in the rapid translation are effective in killing Wolbachia – a Over the past 20 years the Cochrane TRUST CLINICAL RESEARCH A·WOL AND ASTRAZENECA their own homes was shown to provide of research into healthcare practice. bacterium that lives inside the parasitic Collaboration has helped policy makers, PROGRAMME (MLW) more and better privacy and convenience The partners are working to position The Anti-Wolbachia Consortium (A·WOL) worms that cause both river blindness and patients and health care practitioners Based in Blantyre, Malawi, MLW is a than testing in public health facilities. Liverpool as a leading centre nationally is an LSTM led consortium working to elephantiasis. Drugs can then be developed make informed and evidence-based partnership that conducts biomedical Of almost 13,000 people recruited to the and globally for the uptake of innovative develop new drugs against onchocerciasis that are potentially suitable for mass drug decisions. The Cochrane Reviews provide research relating to tropical health and study, an uptake of 78 percent self-testing applied health research and education. (river blindness) and lymphatic filariasis administration programmes, as some such systematic reviews of primary research provides research training for clinical and was demonstrated. One of the risks (elephantiasis). In order to identify those programmes are experiencing problems in human healthcare and policy and are laboratory scientists from Malawi and associated with self-testing was a perceived Clinical research is growing within the new medicines, in June 2013 A·WOL with resistance to new drug treatments. internationally recognised as the highest across the world. MLW is affiliated to the lack of support for those who tested NHS and some of the research done at established a partnership with global standard in evidence-based healthcare. University of Malawi’s College of Medicine positive. But Trial Coordinator Augustine Liverpool’s NHS trusts is informed by innovation-driven biopharmaceutical The new UK-based HTS Centre, which (COM); the national medical school for Choko did not find a single case of suicide research conducted by LSTM in research company AstraZeneca. opened early 2013, has access to leading Malawi. The partnership consists of COM; or serious adverse events, thanks to a poor countries. The work of LSTM’s automation and screening technology the University of Liverpool (UoL); LSTM “The Cochrane Review process strong network of local counsellors. A low Respiratory Infection Control Group in A shared commitment to the World with a capacity for up to 50 HTS per and the Wellcome Trust, who are the major uptake of regular HIV testing throughout sub-Saharan Africa is directly benefiting Intellectual Property Organization (WIPO) year. It combines this with a carefully is widely recognised as the funder of MLW. The latter renewed its the world is one of the major barriers to work with Royal Liverpool and Broadgreen and the fight against neglected tropical curated chemical library of 1.8 million most rigorous way of collating support by announcing in the summer of HIV control. University Hospital NHS Trust, Aintree diseases (NTDs) has allowed access to drug-like and lead-like compounds which the evidence to provide the 2013 a donation of around £14 million for Hospital and the University of Liverpool intellectual property for pharmaceutical will create a leading infrastructure for hit the next 5 years. necessary information to LSTM and MLW Clinical Research Fellow to improve outcomes for community compounds; technologies and data discovery. This type of infrastructure has assist policy making.” Dr Peter MacPherson, principal investigator acquired pneumonia. This area of research available for research and development. long been carefully guarded by industry, Overseen by MLW Director and LSTM In this case AstraZeneca has committed The Cochrane Collaboration on the study, said: “This is an approach will undertake clinical trials at the Royal with chemical libraries of this nature Professor of Tropical Medicine Rob that could be rapidly scaled-up as part of Liverpool University Hospital’s Clinical to allow access to its High Throughput being referred to as the ‘crown jewels’ of Heyderman, LSTM provides support to community HIV testing programmes to Trials Unit (CTU), which has become Screening (HTS) Centre and compound drug discovery. It is very rare for academic MLW’s expanding translational research improve access to Antiretroviral Treatment the first NHS facility in England to be collection, which has not previously been institutions working on NTDs to have portfolio; state of the art research and The Cochrane Infectious Diseases Group (ART). Importantly, our results suggest that granted Medicines and Healthcare freely accessible to academic institutions. access to diverse collections of this scale teaching facilities and active hospital (CIDG) is one of 53 review groups that most people who have self-tested positive products Regulatory Agency standard for their research. Manos Perros, Head of and community-based teams. Its make up the Cochrane Collaboration. do need extra help to get them into HIV and supplementary Phase I Accreditation. AstraZeneca’s Infection iMED commented: research focuses on malaria; TB; HIV; CIDG is a partnership of over 300 reviewers care in a timely fashion – so that this type Likewise, this Liverpool-based research “Over 100 million people suffer from non-communicable diseases; microbes; “This project marks a from over 40 countries. LSTM provides the of additional intervention may need to be activity informs the treatment of patients river blindness, lymphatic filariasis and immunity and vaccines. Six LSTM PhD paradigm shift in the way editorial base, led by Professor Paul Garner. factored in from the start.” in countries where respiratory infections, loaiasis and most do not have access to students are based in Malawi, contributing Each of the reviews conducted looks at the including TB, kill over a million people knowledge is being shared treatment. This collaboration is part of our to this research portfolio. benefits and risks a particular healthcare LOCAL PARTNERSHIPS each year. (…) As a result; partnerships commitment to develop novel treatments intervention poses, particularly in relation of this kind – between for the most neglected diseases. We are to malaria; TB; diarrhoea and neglected A LOCAL ACADEMIC HEALTH SCIENCE SYSTEM At a showcase event in June 2013 at pharmaceutical companies very pleased that A·WOL is accessing this tropical diseases. Liverpool’s Town Hall, LHP Chief Executive novel offering that is available via WIPO.” “The Malawi-Liverpool- Launched in 2012, Liverpool Health and academic groups – Professor Ian Greer commended LSTM’s Wellcome programme has Partners (LHP) is a Liverpool-based In the past academic year CIDG presented unique relationship with the University are an essential component academic health science system bringing a number of reviews, one of them in July an excellent track record of Liverpool. It illustrates a partnership of of translational research together the expertise form within the 2013 showing that a diagnostic test for not just for its research, organisations that add up to far more than for NTDs.” University of Liverpool (UoL); LSTM tuberculosis (TB) can accurately and quickly but for investing in the the sum of its world-class parts: LHP will (represented by Professor David Lalloo) AstraZeneca statement, 27 June 2013 detect both TB and drug-resistant strains. build a reputation as a national model for next generation of African and seven local NHS trusts, to help ensure The findings can provide timely advice for collaboration between the NHS, academic researchers.” that medical research breakthroughs clinicians and policy makers in countries and research institutions and industry. where TB is a major public health problem. Dr Jimmy Whitworth, Head of International lead to direct clinical benefits for High Throughput Screening at AstraZeneca The World Health Organization (WHO) Activities at the Wellcome Trust patients. LHP is organised around clinical has recognised the contribution made by academic programmes that demonstrate Professor Garner and the Group’s wide international excellence in research, commitment to evidence-based medicine supported by clinical services that can be by designating LSTM a Collaborating Centre developed in a coordinated way across LHP. for Evidence Synthesis for Infectious and Tropical Diseases. “The University of Liverpool’s long standing relationship with LSTM underpins Liverpool’s reputation as a leader in Infection and Global Health” Professor Ian Greer, LHP Chief Executive 34 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 35

Department of Clinical Sciences

During its first year, the Department has brought together staff working across ACE cookstove in Lesotho

the spectrum of clinical science: experimental medicine, evidence synthesis, Our TB studies in Ethiopia and Nigeria, clinical trials, implementation and evaluation, teaching and clinical practice. lead by the clinical epidemiology group and funded by WHO, EDCTP and Grand The strategy has been defined, research successes achieved, new studies started Challenges, aim to increase access to diagnosis and treatment. Our work was and significant grants won. highlighted by the WHO, the UN Assembly and the UK parliament. Our group is evaluating new TB diagnostic platforms in studies funded by the EDCTP and Grand Experimental medicine studies using Evidence synthesis team outputs We have ongoing work on the neglected Challenges Canada. Together with KIT controlled human infection with have impacted in several policy areas. needs of adolescent schoolgirls through an Amsterdam we have identified markers pneumococcus have led to significant The Cochrane Infectious Diseases Group MRC/DfID/Wellcome Trust clinical trials that confirm TB in smear-negative patients. publications and advancement towards (CIDG) review of primaquine for reducing grant with collaborative partners in western an understanding of mucosal vaccination. malaria transmission raised questions in Kenya. This year has seen considerable Department projects: The portfolio of We collaborate with the Butantan Institute the World Health Organization about international interest in our work around Teaching and clinical practice: We clinical trials has expanded considerably in Brazil with MRC-FAPESP funding awarded evidence of true impact of this on malaria menstruation and the effect of health link research strategy with capacity and we have responded to the growing We have ongoing work on the to Dr Daniela Ferreira to promote joint transmission; the committee advising practices on education. development by innovative teaching. need for large multi-site trials by work using controlled human infection on global vaccines used the Cochrane neglected needs of adolescent For example, we teach Methods in developing a tropical Clinical Trials Unit to develop new pneumococcal vaccines. rotavirus vaccine review extensively when The department also hosts the secretariat schoolgirls through an MRC/ Epidemiologic, Clinical and Operational (tCTU). It will provide research advice, We have developed a new collaboration recommending the vaccine in Africa and of the global Malaria in Pregnancy Research (MECOR) to active physicians support and training and act as resource DfID/Wellcome Trust clinical with the Centres for Disease Control and the Group’s re-analysis of the deworming Consortium undertaking 8 multicentre in Africa and host the LSTM Diploma in investigators can access to develop ideas; trials grant with collaborative Prevention in Atlanta and University of for schoolchildren continued to impact trials to evaluate new drugs, regimens and Humanitarian Assistance. This year, the 7th protocol and grant application writing; Liverpool to advance a strategy for treating on the policy debate. strategies for the treatment and prevention partners in western Kenya. Annual MECOR course took place outside project management; evaluation and sepsis using augmentation of the natural of malaria in pregnancy, to prevent and Nairobi just after the attack on Westgate finally preparing papers/reports. immune response to infection. Clinical trials work has expanded with the reduce the negative consequences of Shopping Mall. The students and Faculty Joint Global Health Trials grant to fund malaria in pregnancy. Multidisciplinary decided to go ahead with the course in an advanced cookstove intervention to economic and implementation research solidarity with the Kenya Lung Conference prevent pneumonia among young children studies to assess the acceptability, and research colleagues in Kenya. in Malawi. The Cooking and Pneumonia feasibility and cost effectiveness of these Study (CAPS) will study an advanced stove interventions are also being done. Cookstove as used in the CAPS study International links: These remain strong, intervention that is expected to reduce particularly with Malawi. Professor Feiko smoke exposure by up to 90% potentially Implementation and evaluation: In the ter Kuile and Dr Penny Phillips-Howard improving health by reducing infection and field of applied health research, we are have moved to Kenya to work with the other smoke related lung damage. (See collaborating with Kenyan colleagues Kenyan Medical Research Institute/Centers page xx) Studies to measure the effects to determine the causes of mortality in for Disease Control (KEMRI/CDC) to on adult lung health have been added to 240,000 rural poor. Further, interventional develop research activities around malaria the CAPS study, funded by an MRC New studies to address the needs of rural elimination, adolescent health and public Investigator Research Grant awarded to people with chronic lung disease are being health priorities. Dr Kevin Mortimer. established. They build on work recently completed in collaboration with Epi-Lab in Sudan and REACH Trust in Malawi on engagement of informal providers in improving access to HIV and TB treatment.

Professor Stephen Gordon Head of Clinical Sciences SPECIAL REPORT LSTM ANNUAL REPORT 2012/13 | 37 LSTM’s Research Trajectory | 2012 – 2013

this model is reflected in World Health LSTM study leads WHO Organization (WHO) policy, the Ministry to update its malaria of Health HTC guidelines in numerous prevention policy countries in Africa, the continuing work of The impact of LSTM’s an indigenous Kenyan Non-Governmental A study led by LSTM has been a critical Organisation and expansion of HTC element in informing the new WHO through community outreach in the UK. policy recommendation on intermittent preventive treatment for malaria in research on policy pregnant women (IPTp) who live in While Kenya continues to scale up services, the principles established in the early malaria-endemic regions of sub-Saharan research have enabled its rapid scale-up Africa. Study results show that when and practice through a variety of approaches including pregnant women received three or more mobile, outreach and home-based doses of preventive therapy instead of the testing. LSTM Senior Clinical Lecturer, standard two-dose regimen the newborns LSTM strives to translate its research outcomes into policy and practice. It does Dr Miriam Taegtmeyer recently led the had higher birth weights. development of a practical handbook on so by providing a coordinated and multi-disciplinary approach to strengthening planning, implementing and monitoring capacity and delivering large scale operational research. home-based HTC. LSTM also convened “This updated policy the first international symposium on HIV will benefit pregnant self-testing in April 2013 where evidence WHO believes that the new guidelines, women in the 36 malaria A woman in Mozambique receives malaria medication on social and public health issues was entitled “Consolidated guidelines on the endemic countries in To measure its impact LSTM develops presented and ethics, human rights and use of antiretroviral drugs for treating and and provides monitoring and evaluation scale-up debated. preventing HIV infection”, could avert an sub-Saharan Africa which methodologies and systems and operates as additional 3 million deaths and prevent have adopted IPTp with SP a centre of excellence in research synthesis New WHO guidelines 3.5 million new HIV infections between as national policy.” for evidence-informed policy. The resulting now and 2025. for HIV treatment Dr. Robert Newman, Director of the WHO outcomes will be used to advocate for Global Malaria Programme scale-up of effective interventions in areas At the 2013 International Aids Society LSTM provides the editorial base for such as maternal and child health; respiratory, Conference in Kuala Lumpur, Malaysia, CIDG, which is part of the Cochrane neglected tropical and other vector borne the WHO released new HIV treatment Collaboration, the not-for-profit, global Results of this study were published in diseases. To illustrate this scale-up, the highly guidelines recommending offering health research review network of the Journal of the American Medical successful Making it Happen programme antiretroviral therapy (ART) earlier than approximately 28,000 reviewers across Association (JAMA) in February 2013. from LSTM’s Centre for Maternal and was recommended by previous guidelines. 120 countries. CIDG has contributed LSTM Professor of Tropical Epidemiology Newborn Health (CMNH) will build the These new guidelines were produced by hundreds of systematic reviews, many of and senior author of the study, Feiko capacity of over 17,000 healthcare workers the development group for the operational which have directly led to changes in ter Kuile said that the team was to provide evidence based, woman friendly, and service delivery section of WHO health policy or guidelines. pleasantly surprised by the consistency high quality care. By training of a cadre of recognising the importance of expanding and magnitude of the beneficial effect 1,000 national facilitators or ‘Master Trainers’, access to treatment. that can be achieved by providing these providing training equipment, influencing additional doses during the last 10 weeks pre-service training and introducing Dr Miriam Taegtmeyer, a core member “These guidelines represent of pregnancy, which is a critical period for additional quality improvement of the guideline development group another leap ahead in a trend foetal growth. methodology, the benefits of the programme said: “Unlike previous HIV guidelines, of ever-higher goals and ever- will be sustained beyond the immediate the new update goes beyond clinical greater achievements,” The updated malaria prevention policy funding period and original facilities. recommendations (What to do?) to could contribute to increased uptake and include operational (How to do?) and WHO Director-General Dr Margaret Chan quality of antenatal care services in Africa. Building a replicable model for programmatic (How to decide what to do The adapted protocol is now more closely HIV Testing and Counselling and where) recommendations to provide comprehensive guidance to national aligned to WHO’s Focussed Antenatal LSTM has developed a successful approach programme managers and policymakers. Care (FANC) schedule, ensuring that to the rapid scale-up of HIV testing and Another key feature of the guidelines intermittent preventive treatment can counselling (HTC) services in high prevalence target all age groups and populations.” be given to pregnant women during each countries, a vital component of the global scheduled Antenatal Care (ANC) visit, HIV response. The model combines The guidelines were also informed by a improving outcomes for the mother comprehensive quality assurance with Cochrane Review, authored by the LSTM- and child. operational research and has led to HTC based Cochrane Infectious Diseases Group expansion in mobile, home and facility- (CIDG) and authors from the Cochrane based settings. It has also allowed for HIV/AIDS Review Group. The study found responsiveness to local needs leading to post that fewer patients were lost to care when sexual violence care services linked to HTC, they continued on antiretroviral therapy at services for the deaf and HTC for men who a health centre or in community settings, have sex with men (MSM) and other hidden rather than in hospitals. populations in Africa. The global impact of 38 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 39

Dihydroartemisinin- Close-to-Community Health Through its multi-country and systematic The breakthrough of anti-Wolbachia Informing other WHO policy piperaquine added as a Providers boost community- approach to researching close-to- therapy is of major global importance. and guidelines community providers REACHOUT has The antibiotic treatment is already tried treatment option for malaria based healthcare WHO regularly reviews policies and the potential to provide valuable insights and tested for other bacterial diseases In the WHO malaria guidelines LSTM Close-to-community providers, including guidelines for international healthcare on how countries that are grappling with and therefore does not need to undergo a and the Cochrane Collaboration were midwives, traditional birth attendants, or re-enforces existing ones such as the human resource constraints can scale series of safety trials. The drugs are readily commissioned to assess new Artemisinin- community health workers, and lay one on a diagnostic test for tuberculosis, up to universal coverage, particularly available to people with filariasis and are based combination therapies (ACT) counsellors form the backbone of the following the publication of research amongst the poor and the marginalised. cheap as well which is very important treatment options. In the Cochrane review health system in many settings. Working from LSTM and global partners. The Importantly it will also lend support in countries where these diseases prepared for the WHO Guidelines panel, Finger prick being undertaken on pupil as part of directly with individuals and families, organisation has also improved the way it blood donation drive at school in Zimbabwe to close-to-community providers, who are endemic. This approach has been the analysis clearly showed that this drug often in their homes and workplaces, develops global guidelines, with the help often work as volunteers in very recognised by donor agencies, such as the consistently performed as well as and they are in a unique position to observe of researchers from LSTM and the South The CRU’s Diploma in Project Design and challenging circumstances. Bill & Melinda Gates Foundation, through often better than other ACTs, and led the and understand the factors that influence African Cochrane Centre, who were invited Management is a work based part-time a $34 million investment in the Anti- panel to recommend this as a new option good health. Health programmes that to re-evaluate WHO guidelines. course, for which graduates receive an REACHOUT has already conducted Wolbachia (A·WOL) consortium and has for treating malaria. This drug is likely to employ close-to-community providers LSTM Professional Diploma award. an in-depth situation analysis of what been adopted by elimination programmes become one of the most important ACTs show a great deal of promise in extending The course has been extended from is happening in close-to-community for onchocerciasis (OEPA) and lymphatic in the next five years. access to quality services. But they also “WHO recognizes the Kumasi in Ghana to Accra and also to programmes. This is helping to uncover filariasis (GPELF) as new strategies for face challenges. Loss of staff motivation; Harare in Zimbabwe. The popularity of what kind of systems and structures elimination and morbidity management. importance of high-quality Building an evidence-based problems with health worker retention; this course has increased substantially. are in place, any weaknesses in the guidelines when making blood transfusion service for inadequate resource management; multiple It is already self-sustaining in Kumasi and implementation of programmes and the sub-Saharan Africa workloads; a lack of quality assurance and recommendations in public staff is currently working to ensure that the opinions of communities on potentially poor monitoring and evaluation systems health. The Organization LSTM’s Capacity Research Unit (CRU) is Diploma can run independently of T-REC beneficial changes. can mean that they fail to have the impact leading an EU funded project to build in the two additional sites after 2015. therefore values both the that they should. research capacity for blood transfusion Development of effective recognition of the current services in Africa (T-REC). Led by LSTM’s T-REC also provides student bursaries: The REACHOUT programme, launched in cures for Neglected gains and welcomes Professor Imelda Bates, this consortium supplementary research funds provided March 2013 and funded by the European Tropical Diseases the encouragement for has partners in the Universities of to undergraduate and postgraduate Commission’s Seventh Framework In recent years, more attention has been Copenhagen (Denmark) and Groningen students in Ghana and Zimbabwe to continuous improvement.” Programme for Research and Technological brought to bear on eliminating neglected (Netherlands), and blood transfusion undertake research on a blood transfusion Development, is working in Bangladesh, tropical diseases (NTDs), of which Dr Charles Penn, Chair of Guidelines Review services in Ghana and Zimbabwe. Their related project. This initiative is working Ethiopia, Indonesia, Kenya, Malawi, and lymphatic filariasis and onchocerciasis Drug distribution against Onchocerciasis Committee, WHO recent achievements include a successful well for encouraging students from local Mozambique to address these challenges. are two. Millions of people are at risk or PhD programme with four students in universities to conduct research related to REACHOUT is using action research to are infected with NTDs. Zimbabwe and Ghana who are all blood transfusion in a range of disciplines Anti-Wolbachia therapy delivers safe test different interventions to strengthen Published in the medical online journal progressing well. Their projects include including medicine, science and media macrofilaricidal activity with superior close-to-community programmes through Scientists at LSTM have found a cure PLOS One, the researchers found that changing HIV patterns, the economics of studies, and for forging new collaborations therapeutic outcomes (92-98% cure ‘improvement cycles’. for filarial parasitic worms, targeting an the procedures put in place to assure infection screening, donor motivation and rate) compared to all standard anti-filarial between the transfusion services and their essential bacterial organism (Wolbachia) quality could still be derailed by WHO rationalising syphilis screening. treatments, with the added benefit of local universities. with a course of antibiotics, which cures departments wanting to do things their substantial improvements in clinical patients of their worms and improves own way. Researchers found substantial pathology (improvement in lymphedema disease outcomes. This discovery offers resistance to change, however LSTM A health worker measures a newborn in a Bangladeshi village stage in 44% of patients cf. 5% with superior results compared to existing and partners have continued to inform standard therapy). These outcomes can be anti-filarial drugs by permanently blocking WHO policies and guidelines, producing achieved with existing registered drugs, disease transmission and improving case real change. e.g. doxycycline, that are affordable, management therapy. available to endemic communities and have well known safety profiles.

In terms of the impact on policy, in 2012 the Onchocerciasis Elimination Programme of the Americas (OEPA) adopted doxycycline for the treatment of residual cases in the North-Eastern focus in Venezuela. In 2012 the Global Alliance for the Elimination of Lymphatic Filariasis (GAELF) endorsed the use of doxycycline as a new tool for morbidity management Onchocerca larvae of elephantiasis. A woman on TB treatment at a hospital in India 40 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 41

Department of Striving for global International equality in maternal Public Health and newborn health Lab technician in Kenya

Our department brings together diverse, highly skilled professionals and Almost 300,000 women die each year from complications during pregnancy supports a range of research models from individual fellowships and project and childbirth. This equates to a woman dying every 2 minutes. For each death, grants to large, multi-partner consortia. We focus particularly on health systems 30 women live but suffer lifelong morbidity. In addition, 3 million babies per research and the use of research to guide policies and programming. year across the world are stillborn and an additional 3 million babies die in the first week of life.

Each unit is led by highly experienced Our academics convened the first ever LSTM’s Centre for Maternal and Newborn CMNH has worked with international academics and supported by effective global meeting on HIV self-testing at Health (CMNH) has continued to position partners to define non-severe maternal managerial and administrative staff. the Brocher Foundation in Geneva and a itself as a global centre of excellence in morbidity as an outcome indicator, and has new cross-departmental post has been implementation research. The Centre’s designed an assessment tool, which will be This year there has been a significant established in social science and NTDs. work falls into 3 main categories: design, piloted in Pakistan and Malawi in 2014. expansion in the number of projects and implementation and evaluation. staff in the Department of International In the PERFORM action research A leadership and management package Public Health (DIPH). REACHOUT, a new programme District Health Management Design for Maternal and Newborn Health (MNH) EU funded project was launched and Teams in Ghana, Tanzania and Uganda is being developed, which aims to improve This year CMNH has redesigned its works closely with deprived communities have developed and begun implementing the capabilities of managers from the Emergency Obstetric Care and Newborn in low income countries. Fieldwork for strategies to improve health workforce facility level right up to the Ministry Care (EOC&NC) “skills and drills” training REACHOUT is now underway in six performance. Our Improving post- of Health. package, which is based on extensive countries. One of our well-established EU abortion family planning in China (INPAC) evaluation of the effectiveness of projects, ReBUILD was represented at the project has completed analysis of current Community health workers oversee drug distribution implementation across African and Health Systems Research (HSR) symposium post-abortion family planning services in “LSTM has a proud tradition Asian countries. The Centre has been in Beijing late 2012. At HSR the ReBUILD China and is designing improved services. Our Capacity Research Unit uses approached by global and national of leading the way in research, team led a Thematic Working Group on DIPH’s Monitoring, Evaluation, Technical multi-disciplinary participatory and organisations to deliver and franchise it with Maternal & Newborn health systems in Fragile and Conflict assistance, and Research Team (METRe) developmental research to design and track in additional settings. Affected States and early evaluations of unit has been supporting UNICEF to capacity strengthening projects in health Health an example of an area financing schemes for delivery care in India establish decentralised monitoring systems and non-health contexts. The Making it Happen with Data package of excellence and strategic under Maternal health in India (MATIND) and develop online M&E tools. In South was piloted this summer with excellent importance. The Centre were presented. Sudan METRe is establishing national Examples of our current projects include results, building the capacity of healthcare for Maternal and Newborn information systems to improve clinical strengthening laboratory systems for providers in collecting and using data for healthcare services and in Uganda they neglected tropical diseases, evaluating a monitoring and evaluation of practice as Health has developed are supporting mother/child HIV services national health research capacity part of the wider Making it Happen a unique reputation for Training participant in Somaliland and supporting DFID’s evaluation of its strengthening programme in Malawi, (MiH) project. designing, implementing performance based financing policy. In and helping the Royal Society to maximise and measuring intervention Odisha, India METRe is assisting national the potential for enhancing research A new Quality Improvement (QI) package Vector Programme in its fight against capacity across multi-national non-health was designed, peer-reviewed, and piloted packages” Design in Zimbabwe, Kenya, Sierra Leone and malaria. DIPH’s Centre for Maternal and research consortia. Baroness Helene Hayman, Newborn Health continues to expand as Malawi. Quality of Care is about delivering External Advisory Group to CMNH a global centre of research excellence. DIPH staff provides a significant input as effective health services consistent with the leaders and tutors for LSTM’s teaching best evidence, i.e. healthcare which is safe, programme. Because our course tutors are Evaluate effective, patient-centred, timely, efficient and equitable. QI teams in 150 healthcare at the forefront of generating research and Implement guiding policy, their teaching is strongly facilities will use this package in the next research driven and is highly valued by our 2 years. New indicators for measuring QI were also developed. Professor Imelda Bates all of our students. Head of International Public Health 42 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 43

Evaluation Building on the success of the monitoring and evaluation framework Working with the NHS used under Phase 1 of MiH, the Centre expanded the framework which includes measurement of healthcare provider reaction to the training; the change in LSTM works with several UK National Health Service (NHS) Trusts across knowledge and skills health care facility functionality and indicators of Quality Merseyside and the North West to deliver clinical services; conduct clinical of Care. In addition the availability, An obstetrical emergency survivor and research and promote public health. healthy baby in a Bangladesh hospital uptake and effect of care packages are being measured.

Implementation The past academic year saw the Over the last year the Centre forged ahead Centre win the contract with UNICEF Clinical treatment Research to improve Research into respiratory medicine with its mission of reducing maternal relates to pulmonary infection and to conduct a three-year programme The Tropical and Infectious Diseases Unit respiratory medicine and newborn mortality and morbidity evaluation of the Health Transition Fund non-communicable diseases, particularly (TIDU) at the Royal Liverpool Hospital LSTM’s Respiratory Infection Group, by supporting 169 healthcare facilities (HTF) in Zimbabwe, a national initiative pneumonia and tuberculosis, including the provides treatment for patients with led by Professor Stephen Gordon, conducts to increase the availability and quality of which aims to revitalise the public effect of inhaled air pollutants particularly infections including tuberculosis (TB) laboratory and clinical research aiming to Skilled Birth Attendance and Emergency health system with a particular focus on biomass smoke exposure. These research and HIV as well as a host of tropical understand susceptibility to respiratory Obstetric Care and Newborn Care. mothers and babies. themes are being explored in partnership diseases including malaria. TIDU is infection and to develop new preventative with the University of Liverpool, the Mother with baby in Pakistan the regional adult unit for tropical and and therapeutic strategies. LSTM CMNH is currently completing a Liverpool Wellcome Trust Tropical Centre, infectious diseases and offers a wide variety coordinates a cross-Merseyside respiratory mapping of MNH data collected in the NIHR Comprehensive Local Research “The concept of composing of inpatient and outpatient services. research strategy encompassing themes Emergency and Humanitarian settings, Looking Ahead Network, Liverpool Heart and Chest and utilising standards to The unit is supported by clinicians from of airways and physiology, infection for WHO. CMNH’s research grant total now Hospital (LHCH), Aintree University LSTM, whose international expertise and inflammation, cancer and global improve quality of care is stands at over £20 million with a Hospital (AUH), the Royal Liverpool The Centre has continued to increase ensures that patients receive the highest health. The NHS continues to be a crucial relatively new to me and my further £10 million worth of proposals University Hospital (RLUH) as well as the its publications over the year and its standard of treatment. TIDU was the focus partner in developing new diagnostics and awaiting approval. Malawi-Liverpool-Wellcome Programme in colleagues. Thank you paper on Emergency Obstetric Care in of a Discovery Channel documentary treatments in respiratory medicine. Clinical Tropical Medicine. to LSTM for emphasising Somaliland was selected by the Global To assist in the Centre’s future partly filmed in the hospital during 2012 the structure and process Emergency Medicine Review out of a development and provide external and broadcast over summer 2013. The A good example of collaboration across field of 5000 papers as one of the top series ‘Bugs Bites and Parasites: Tropical we should be using to critique of its work CMNH convened NHS, academia, primary and secondary global emergency medicine articles an External Advisory Group (EAG), Diseases Uncovered’ explored the diagnosis care in Merseyside is a £1,879,410 improve outcomes.” of 2012. chaired by Baroness Helene Hayman. and treatment of patients by LSTM and National Institute for Health Research NHS doctors. disseminate research findings QI Training Participant, Sierra Leone, May 2013 In the coming year it will also be The EAG comprises leading figures from grant, funding a study into ‘the clinical in four scientific presentations and three launching a Quality of Care supplement the world of Maternal and Newborn and cost-effectiveness of temporarily free communications sessions as well as for the British Journal of Obstetrics and health, and has supported the 5 year quadrupling the dose of inhaled steroid to hosting two pre-congress workshops on CMNH £18 million flagship project, Making Gynaecology (BJOG). Business Strategy and supporting prevent asthma exacerbations; a pragmatic, it Happen (MiH), is now operational across Communications Plan, which lays out EOC&NC and QI. randomised, normal care controlled, 11 countries in Africa and Asia, working in CMNH played a key role in the the Centre’s key objectives and priorities clinical trial: FAST’ with LSTM as the partnership with Ministries of Health, LSTM Royal College of Obstetricians and for growth. lead local academic institution. Arrival of cookstoves in Malawi offices and staff in-country, and leading Gynaecologist’s World Congress in June The CMNH has a team of over 60 local research partners. 2013, showcasing the Centre’s research Building upon the success of the first Exposure to smoke produced when by delivering 3 keynote scientific members of staff working in Liverpool joint respiratory medicine appointment biomass fuels are burned in open fires is a By September 2013, just over 3500 presentations and 2 pre-congress and overseas and this number of Dr Kevin Mortimer, LSTM and Aintree major avoidable risk factor for pneumonia. healthcare providers were trained in workshops. is expected to expand further in University Hospital jointly appointed A team from LSTM and AUH are leading EOC&NC; 152 attended Making it Happen 2013/2014. Dr John Blakey, who brings expertise on the development of the Cooking and In October 2013 staff attended with Data workshops; 82 were trained in QI in asthma and technology-enabled Pneumonia Study (CAPS), investigating FIGO’s (International Federation of Maternal conditions are the second workshops; 498 new Master Trainers were innovation for unscheduled medical care. how to reduce the effects of domestic Gynaecology and Obstetrics) first Africa most common cause of death in trained; 15 Skills Labs were established in A third joint appointment of a Senior smoke inhalation, which is a problem Regional Conference in Ethiopia to women of reproductive age in low and hospitals allowing staff to improve skills Academic (Clinical) in Respiratory Medicine in low and middle income countries disseminate research findings in four middle income countries. In contrast, with up-to-date equipment and 236 is now being made between LSTM and around the world. In June 2013, LSTM scientific presentations and three free maternal death does not feature in the training rooms were equipped. the Department of Respiratory Medicine hosted the first meeting of the CAPS Trial communications sessions as well as 10 most common causes of death in at the Liverpool Heart and Chest Hospital Steering Committee, where Co-Principal In 2013 a new programme started to build hosting two pre-congress workshops on high income countries. (LHCH). Investigator Dr Kevin Mortimer said: capacity of Maternal and Child Health EOC&NC and QI. As long as this disparity exists CMNH “the implications could be enormous (MCH) Aides, the biggest group of health will continue with its vision of ‘striving and benefit millions of people around care providers providing Skilled Birth for global equality in Maternal and the world.” Attendance (SBA) across Sierra Leone, Newborn health’. through support to and evaluation of an expanded scope of work including Family Planning. 44 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 45

Clinical Research Unit (CRU) A second CRU-based trial involves P4 Promoting public health peptide treatment in severe Community The Clinical Research Unit (CRU) at LSTM hosts the regional co-ordinator Acquired Pneumonia (CAP). This trial, the Royal Liverpool University Hospital of the North West TB Cohort Audit as Well Travelled ongoing in the Intensive Care Units of provides state of the art dedicated a secondment from Public Health England RLUH and Aintree University Hospital facilities to support high quality clinical (PHE). The cohort audit was pioneered in (AUH) and funded by Grifols and Liverpool research. The CRU is a resource open to developing countries to improve clinical Clinics Ltd Health Partners (LHP), aims to test a researchers from all disciplines encouraging outcomes of TB patients. It has been novel treatment ex vivo to determine if this collaboration with investigators in adapted and implemented by the North can benefit future patients in the Intensive Liverpool and beyond. In 2013 it became West TB Summit which is a joint initiative Care Unit (ICU) diagnosed with CAP. the first NHS facility in England to be between PHE, NHS Trusts and others. The Respiratory Medicine Group has granted Medicines and Healthcare products The regional co-ordinator works with Well Travelled Clinics had its strongest trading year ever in 2012-13 with previously demonstrated that this peptide Regulatory Agency (MHRA) standard and Professor Bertie Squire within the can up regulate the immune response to patient numbers up by 11.2% in Liverpool and by over 25% in Chester. supplementary Phase I Accreditation. Collaboration for Research on Equity & kill more bacteria in healthy adults. The aim This accreditation will allow the Royal, Systems in TB & HIV-AIDS (CRESTHA). Overall, income rose by 7.5% on the previous year. of the study is to determine if this can also together with the University of Liverpool, More than 200 health professionals are be observed in the ICU patient population LSTM and six other local NHS Trusts involved in audit of approximately 700 TB as this will be the intended patient group that comprise Liverpool Health Partners cases across the UK’s North West for the treatment. In October 2012 the Chester clinic In the year ahead, WTC is going to develop (LHP) to be at the forefront of clinical each year. The purpose of audit is to relocated to a more visible row-level a new four year business plan to grow sales developments and drug trials to prevent prevent TB transmission through improved property just below our original clinic. to secure profitability. We plan to extend 2012/13 illnesses; provide faster diagnoses and find Liverpool Health Partners TB case management. CRESTHA staff and The more commercial location of this our opening hours at the Chester clinic; new treatments. (LHP) the Regional Co-ordinator are working AT A GLANCE property has led to an increase in patient broaden our occupational health base in LHP facilitates many of LSTM’s joint on a qualitative evaluation of health numbers with more patients walking in to Liverpool and re-develop our on-line retail This year, Well The CRU is facilitating clinical trials of some clinical research projects with the NHS and professional perspectives on the process. book appointments and buy products. section of our website. We will continue of the newest treatments under evaluation. showcases Liverpool as a hub for funders, Because of its track record of using Travelled Clinics: to extend and expand our clinical services LSTM’s Respiratory Medicine Group is industry and academic institutions to multi-disciplinary applied health research In Liverpool, a number of key new to ensure that we meet the needs of our conducting two clinical trials at the CRU, collaborate with the NHS. Representing to promote quality of care in TB control in corporate contracts have been developed corporate clients to ensure the health of • Saw 10,554 patients both led by Professor Stephen Gordon. LSTM within the partnership, Professor developing countries and its link, through this year and our income from business their workforce in the UK and overseas. David Lalloo said: Professor Squire, to TIDU (see above), • Answered 22,323 travel has grown. In addition, we have The first trial is part of a larger project CRESTHA is hosting the TB Cohort Audit also started providing some occupational phonecalls aiming at developing novel pneumococcal and contributing to the efforts of the health services to both LSTM and our vaccines for the future. Pneumococcus North West TB Summit towards making • Gave 12,008 vaccines external clients. is a bacterium that is the leading cause “By working together, the North West TB-free. of pneumonia and is responsible for the • Dispensed 91,150 death of 500,000 children each year. the partnership malaria tablets The Pneumococcal conjugate vaccine aims to enhance and and experimental human pneumococcal improve research, • Sold 2775 bottles carriage (PCV and EHPC) is a randomised clinical education and of DEET repellent. controlled trial at the Clinical Research WTC Services Facility (CRF) at the RLUH, investigating healthcare delivery Pre-travel the effects of the PCV vaccine upon throughout Liverpool risk assessment nasal carriage of pneumococcal bacteria and the wider region. and advice compared with Hepatitis A vaccine as Membership of the Occupational Pre-deployment Travel a control. Healthy volunteers are randomly health medical allocated to receive either PCV or Hepatitis partnership will surveillance screening Services A vaccination and following vaccination facilitate the NHS they are inoculated with live pneumococcal research undertaken bacteria in the nose. Volunteers are closely by LSTM.” monitored for 4 weeks to determine if they Pre-employment Pre-deployment develop pneumococcal carriage. Professor David Lalloo, LSTM screening visa medicals

Occupational vaccination on Post-travel and blood tests NHS clinics Post-travel screening (corporate clients) Occupational Services 46 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 47 Social mission Fundraising

LSTM has been working for 115 years to save lives in resource poor countries Being both a charity and a higher education institution means that LSTM is through providing high quality, scientifically robust and relevant research facing an increasingly restricted UK funding environment, with individuals evidence, education and capacity strengthening. Our staff aims to reduce having less disposable income, charitable trusts reducing the levels of support the burden of sickness and mortality in disease endemic countries through they can offer and government cutbacks hitting education and health budgets. the delivery of effective interventions which improve human health and are The requirement to create a broad funding mix is stronger than ever. relevant to the poorest countries. To achieve this mission, we need to have the right people, with the right skills working together to achieve our Diversity of support LSTM’s Centre for Neglected Tropical Attracting the world’s best students to Diseases hosts the secretariat for the become some of the world’s best scientists, organisational goals. Online donations have risen by almost global alliance responsible driving researchers and doctors requires your 200% in 2013 thanks to a documentary the elimination of lymphatic filariasis support, so that LSTM is in a position to featuring LSTM shown on the Discovery (LF), a parasitic disease also known as offer scholarships. Channel. The ‘Bugs Bites and Parasites: Our values underpin the core behaviours As LSTM continues to grow, the Human The review particularly praised the elephantiasis. One anonymous supporter Tropical Diseases Uncovered’ programme, for LSTM staff and support us in achieving Resources Team has been working hard School’s exemplary equality and diversity has for many years given a monthly There are many ways to support LSTM, highlighted the work of LSTM clinicians our mission. These values are: to ensure that staff embeds these values, practices, the introduction of coaching to donation to help the Centre support from corporate sponsorship to leaving a and researchers both in the local Royal recognising the importance of developing support the leadership and management NTD control programmes. Regular giving gift in your will. Liverpool Hospital and overseas. Donors • Making a difference to health not just the organisation but its people. of our organisation, our investment in can help to drive forward research that left encouraging messages alongside and wellbeing In 2013 we were happy to announce the communications, the introduction of a provides health professionals with the right their donations praising the efforts of renewal of our Investors in People (IiP) salary review process, the investment in knowledge, skills and resources to meet If you would like more information on • Excellence in innovation, LSTM doctors. Standard, an accreditation that we are growth through new premises, and the how to support LSTM please contact: leadership and science disease elimination targets and, in doing so, proud to have maintained. The findings introduction of a new HR management relieve suffering. Training to boost the skills of sexual and Billy Dean, Development Officer, • Achieving and delivering from the IiP review showed that people information system in-house. LSTM has reproductive health professionals requires Liverpool School of Tropical Medicine, through partnership at LSTM enjoy their roles and that we improved considerably since the 2010 The expansion of LSTM’s estate is only the support of scholarships to attract Pembroke Place, Liverpool, L3 5QA. continue to encourage a diverse and review and hopes to see this approach possible with the support of major public • An ethical ethos founded students from low-resource countries. talented workforce willing to share ideas continue as we begin our time as a higher and private sector funders. The Wolfson Or alternatively you can email: on respect, accountability The Oglesby Charitable Trust is a long- and promote an inclusive learning culture. education institution. Foundation, following an earlier grant for [email protected] and honesty standing supporter of the Diploma in the construction of the CTID building, or phone 0151 705 3272 Reproductive Health in Developing • Creating a great place to work Christine Greenway, Director of Human Our senior management team also awarded in 2013 another grant of £1,5 Countries (DRH) education programme, and study Resources said: “I would like to thank recognises the importance of continued million towards the Anson House project A full list of donors during this period can funding scholarships that allow students all staff for their support in achieving development for all of our staff and is opposite CTID that will house the Centre be found in the LSTM Financial Statements to reduce reproductive mortality and the reaccreditation status under the now working towards the Bronze Standard for Maternal and Newborn Health. This 2012 – 2013 publication. morbidity. Trustees of the Trust take an IiP award. Part of the work underpins for the Athena Swan Award. This Award commitment has been echoed by the active interest in the students, meeting our ambition in achieving the Athena recognises commitment to advancing UK Regional Growth Fund, which has with them in person to learn first-hand Swan Award and informs the Equal women’s careers in academia for science, contributed a further £1.5 million and about improving reproductive health within Opportunities Committee in areas for technology, engineering, mathematics the European Regional Development Fund low-resource communities, hospitals and future development.” and medicine. with a grant of £2 million. health centres.

Christine Greenway Director of Human Resources 48 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 49

Governance Officers2012/13

LSTM was originally set up as a private, limited by guarantee, company PATRON Dame Jane Newell DBE JP Dr Ann Hoskins MB BAO BCH MCommH FFPH Her Royal Highness The Princess Royal that holds no share capital, and has registered charitable status. Private is Michael Oglesby CBE GCVO Professor Malcolm Jackson BSc PhD self-explanatory, and limited by guarantee is just what is described in that The Rt Hon The Lord Owen CH MRCPath FRCPath members act as guarantor of £1. As a registered charity, LSTM reinvests all PRESIDENT Sir Richard Evans CBE Sir Michael Perry GBE Professor James Keaton BSc surpluses into its core activities in support of its charitable objective. CHAIRMAN John E Roberts CBE Rt Hon Stephen O’Brien MP James Ross OBE Members elect a Board of not more than These minor amendments will include: In addition to the normative structure, James M Smith Prof Nigel Thrift FBA DIRECTOR fifteen trustees - on a three year rotation. • Incorporating the phrase “Higher the constitution offers an enhanced Sir Crispin Tickell GCMG KCVO Prof Stephen Ward BSc PhD The Board is responsible for the governance Education Institution” in the name. member role identified as vice president. Professor Janet Hemingway CBE FRS DSc of LSTM and empowering the senior There are currently twenty one vice PhD BSc FMedSci FRCP FRES (Hon) FAAM • Replacement of the two University of management to run the operations of presidents actively supporting LSTM in Foreign associated National Academy of Professor Sir David Weatherall DL MD Mr André CM Winter MA Liverpool nominated Trustees with an the organisation. addition to a president who presides over Sciences USA FRCP FRCPE FRS elected student representative as a the annual general meeting. The role Observer Trustee and another elected member On the 19th of July 2013, the Secretary of the vice presidents is predominantly Sir Leslie Young CBE LLD DL Dr Nicholas Banatvala MBBS MSC MD to the Board. VICE-PRESIDENTS of State, by an order of parliament, ambassadorial, but also advisory, and FFPH FRCP designated LSTM as a higher education reflects LSTM’s links with political notables Professor The Lord Alton of Liverpool LSTM’s Board is selected to provide BOARD OF TRUSTEES 2012/13 institution and consequently LSTM is now and multinational business leaders. Secretary & Clerk to the Board of assurance to the members that it has Chairman a public body. Some minor amendments It is crucial to recruit new contemporary Nicholas C F Barber CBE Trustees the skills, ability and experience to guide James Ross OBE will be introduced to the constitution after industry leaders and political policy R Einion Holland FCCA MBA senior management in all its activities. approval by the Privy Council who are makers but also essential to retain the Nicholas Baring CBE LLD The Board’s composition is organised by Vice-Chairman advised by the Department for Business, networking links and experience of our performing a skills audit to compare the Vacant Innovation and Skills [BIS] and the older ambassadors. A new category of Jenny Borden OBE specialities of the individual Trustees with Higher Education Funding Council for emeritus vice president has now been the governance demands of a leading Hon Treasurer England [HEFCE]. introduced, which will maintain continuity Sir Arnold Burgen FRCP FRS international organisation. When vacancies Ian M Jones ACIB and prolong the lifespan of these influential arise the skills gap is identified and new LSTM continues to be a registered charity individuals with LSTM. Baroness Cox of Queensbury recruits are selected to fill that gap, Deputy Hon Treasurer and will consider the consequences, both complementing the existing Board. Jonathan Schofield BA positive and negative of evolving to an It is LSTM’s intention to use the change William D Fulton JP DL FCA exempt charity over the next years. in status to modernise its governance It is important to note that LSTM places Director statements by integrating its memorandum Emeritus Professor Herbert M Gilles CMG high demands on its Trustees who Professor Janet Hemingway CBE and articles, incorporating values such as UOM KCSJ MSc DSc MD FRCP FFPH generously contribute many days of FRS DSc PhD BSc FMedSci FRCP academic freedom and reflecting the new DMedSc their time in the course of any year FRES (Hon) FAAM Foreign associated relationship with HEFCE. without remuneration. Jesper Kjaedegaard National Academy of Sciences USA

The Rt Hon The Lord McColl of Dulwich Mr Jonathan Brown LLB

Mr Stephen Mogford Dr Trevor Francis BSc

50 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 51

Facts and Figures Staff overview

UK 308 Funding bodies 2012 - 2013 Crete 1

Funding Bodies 2012 India 1 GATES 31% DFID 22% Cameroon Uganda WELLCOME 15% 1 3

EC 9% Kenya Ecuador 5 EDCTP 4% 1 DR Congo Tanzania MRC 3% 2 3

USAID 2% Malawi MoH Saudi 3% 15

NIH (USA) 2% Mozambique WHO 2% 1 UNICEF (Sierra Leone) 1% CDC (USA) 0% South Africa MSH 1% 1 GSK 0% UNICEF (New York) 1% TB REACH 1% Current number of staff LHL (Norway) 0% working overseas: GTZ (Germany) 0% 34

a further

Funding Bodies 2013 308 are based at LSTM and GATES 28% one offsite in the UK DFID 24% (as of 1 September 2013). WELLCOME 13% EC 9% Cameroon 1 EDCTP 2% Crete 1 MRC 6% USAID 3% D R Congo 2 MoH Saudi 2% Ecuador 1 NIH (USA) 2% India 1 WHO 1% Kenya 5 UNICEF (Sierra Leone) 1% CDC (USA) 1% Malawi 15 MSH 1% Mozambique 1 GSK 0% South Africa 1 UNICEF (New York) 1% Tanzania 3 TB REACH 1% LHL (Norway) 0% Uganda 3 GTZ (Germany) 0% 52 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 53

Publications List of honorary appointments

Name Title Department One of LSTM’s main objectives is Dr Mohammed Yassin Research Fellow Clinical Sciences “conducting first class Dr Terrie Taylor Research Fellow International Public Health and Clinical Sciences research and disseminating Dr Catherine Molyneux Research Fellow Clinical Sciences the results of that research”. The Online Archive is another step in Dr Saye Khoo Research Fellow International Public Health and Clinical Sciences fulfilment of that aim; helping to Professor Tom Solomon Ressearch Fellow International Public Health and Clinical Sciences ensure the accessibility of our published research outputs worldwide. Dr Melita Gordon Research Fellow International Public Health and Clinical Sciences Professor Peter Winstanley Research Fellow International Public Health and Clinical Sciences LSTM Online Archive is a digital Dr Gerry Davies Research Fellow International Public Health and Clinical Sciences archive of research output produced by Liverpool School of Tropical Medicine Dr Liz Joekes Teaching Fellow Education staff and can be accessed via: Dr Alexander Egyir-Yawson Research Fellow Vector Biology http://archive.lstmliverpool.ac.uk/ Dr Michael Chance Research Fellow Parasitology Dr Vittoria Lutje Research Fellow Clinical Sciences Dr Oliver Hassall Research Fellow International Public Health Dr Guy Barnish Teaching Fellow Education Professor S Tang Research Fellow Clinical Sciences Professor Mark Woodhead Research Fellow Clinical Sciences Dr Patricia Graves Research Fellow Clinical Sciences Professor Jimmy Volmink Research Fellow Clinical Sciences Dr Luc Djobenou Research Fellow Vector Biology Dr I Marshall Teaching Fellow Education Dr Tom Blanchard Fellow International Public Health and Clinical Sciences Dr Poliaro Research Fellow International Public Health Professor N Hall Research Fellow International Public Health and Clinical Sciences Professor D Hornby Visiting Professor Parasitology Dr Theresa Allain Research Fellow International Public Health and Clinical Sciences Dr Kondwani Charles Jambo Research Fellow Strategic Operations Christopher M Parry Research Fellow Clinical Sciences Christopher Alan Moxon Research Fellow Parasitology Dr Henrik Ullum Teaching Fellow International Public Health Dr Alastair Miller Teaching Fellow International Public Health and Clinical Sciences Professor J Gyapong Research Fellow Parasitology Dr L Savioli Research Fellow Parasitology Dr Seif Al-Abri Research Fellow Clinical Sciences Dr Prathap Tharyan Research Fellow Clinical Sciences Dr Victor Mwapasa Fellow International Public Health and Clinical Sciences Dr M Beadsworth Fellow International Public Health and Clinical Sciences Elaine Richardson Fellow Human Resources 54 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 55

Students and courses Awards and Honours

Research Students MSc in International Public Health: 16 Research students 2012 – 2013: 95 LSTM Director Janet Hemingway receives the Knowledge Leader Dr Charles Wondji of the Vector Biology Department is notified of the Year Award in November 2012. The award is part of a in July that he has been awarded the prestigious Wellcome Trust (38 UK/EU and 57 were from outside the EU, MSc in Humanitarian Studies: 13 Liverpool Post event to identify key leaders who play a pivotal Senior Research Fellowship for his research on the mechanisms of as per 1 December 2012) role in the Liverpool city region. resistance in Anopheles funestus. MSc in Humanitarian Health Programme Management: 4

Taught Students PG Cert in Humanitarian Health Programme Management: 1 TB REACH project Ethiopia - LSTM wins a gold medal in Ethiopia In September it was announced that Professor Stephen Ward, Taught students 2012 – 2013: 533 at the 8th Annual Conference of the TB Research Advisory Deputy Director of LSTM, is to be awarded the Thai Sornchai (380 were from the UK/EU and 153 were from outside the EU) Committee of the Ethiopian Federal Ministry of Health in Looressuwan Medal, which is given to researchers whose efforts Professional Diplomas: March 2013. have been devoted to malaria. The breakdown for individual programmes was: Diploma in Humanitarian Assistance: 16 MScs: Diploma in Reproductive Health: 15 Professor Hilary Ranson receives the Royal Society Wolfson Professor David Molyneux receives the Manson Medal in MSc in Tropical & Infectious Diseases: 7 Research Merit Award for her research to develop and evaluate September, the Royal Society of Tropical Medicine and Hygiene’s new control tools in April 2013. highest mark of distinction, for his long standing contribution in Diploma in Tropical Nursing: 57 the field of tropical medicine. MSc in Tropical Paediatrics: 7

Diploma in Tropical Medicine & Hygiene: 181 Catrin Jones, an MSc student in Humanitarian Studies, wins in MSc in Biology & Control of Parasites & Disease Vectors: (credit bearing) 6 the same month the Royal Society of Medicine medical student Professor Richard Pleass wins the Universal Biotech Innovation essay prize in the category Catastrophes and Conflict. Prize in October. His project deals with the development MSc in Molecular Biology of Parasites & Disease Vectors: 9 Other short courses: 201 of Hexagard™, a biomimetic to replace intravenous immunoglobulin (IVIG) therapy for treating autoimmune diseases.

PhD student Ako Victorien is a prize winner at the University of Liverpool’s postgraduate research Online Poster Day in May 2013 for his poster on insecticide resistance.

Diploma of Tropical Medicine & Hygiene students April 2013 Dr Lucy Asamoah-Akuoko, a PhD student, receives the ‘Outstanding Female Doctor’ award in the Ghana Women’s Awards 2013 in June.

Professor David Molyneux (centre) 56 | LSTM ANNUAL REPORT 2012/13 LSTM ANNUAL REPORT 2012/13 | 57 Research consortia 115 years of excellence hosted by LSTM in Tropical Medicine and Global Health

AVECNET MiP LSTM’s long history started in 1898 when Sir Alfred AVECNET aims to develop and evaluate The Malaria in Pregnancy (MiP) consortium Lewis Jones, a prominent Liverpool ship owner, new tools for malaria control in Africa. improves the control of malaria in together with fellow businessmen and health pregnancy in Africa, Asia and Latin Funded by: European Union America by researching malaria treatment, pioneers, provided the funding and political influence www.avecnet.eu prevention and public health impact. to establish the Liverpool School of Tropical Diseases (later to be renamed Liverpool School of Tropical Funded by: Bill and Melinda Gates A-WOL Foundation, European Union and the Medicine), the first institution in the world dedicated A·WOL’s academic and industrial partners European and Developing Countries to research and teaching in tropical medicine. aim to develop new drugs against Clinical Trials Partnership onchocerciasis (river blindness) and www.mip-consortium.org Sir Alfred Lewis Jones lymphatic filariasis (elephantiasis).

Funded by: Bill and Melinda PERFORM Gates Foundation The PERFORM consortium uses an action A series of early expeditions culminated in www.a-wol.net research approach to support decentralised Sir Ronald Ross receiving the Nobel Prize for management to improve health workforce Physiology or Medicine in 1902 for demonstrating performance in Sub-Saharan Africa. CNTD the method by which mosquitoes transmit malaria CNTD supports national NTD Funded by: European Union to humans. Further breakthroughs in relation to sleeping programmes; provides technical www.performconsortium.com sickness (see below), river blindness, elephantiasis and assistance; strengthens the evidence malaria would follow as well as expansion into Global base to inform policy makers and Health issues, placing LSTM as a leading international identifies and prioritises interventions REACHOUT that will eliminate lymphatic filariasis The REACHOUT consortium supports and centre for research, health system capacity building and reduce the burden of other strengthens the vital work of close-to- Sir Ronald Ross and teaching. neglected tropical diseases. community providers of healthcare in Africa and Asia. Funded by: UK Department for International Development and Funded by: European Union LSTM undertook 34 expeditions between 1899 GlaxoSmithKline www.reachoutconsortium.org and the outbreak of the First World War in 1914. www.cntd.org Here, Joseph Everett Dutton is shown during an expedition to The Gambia 1902-3. He was ReBUILD EHCRC The ReBUILD consortium explores different responsible for the first demonstration of The Effective Health Care Research approaches to health system development sleeping sickness trypanosomes in human blood. Consortium (EHCRC) focuses on in countries that have been affected by reliable, relevant evidence in malaria social and political conflict / crisis in Africa and tuberculosis, child health, maternal and Asia. health and health systems. It prepares Funded by: UK Department for and updates Cochrane Reviews about Joseph Everett Dutton International Development the effects of health care relevant to www.rebuildconsortium.com low-income and middle-income countries. LSTM hosts the Cochrane Infectious The latest in a rich history of achievements came Disease Group. T-REC in 2013 with the awarding of the Manson Medal Funded by: UK Department for T-REC is a consortium of academics and to LSTM Emeritus Professor David Molyneux. International Development health practitioners who want to improve The medal is the Royal Society of Tropical Medicine www.evidence4health.org blood transfusion services across Africa. and Hygiene’s highest mark of distinction. http://cidg.cochrane.org Funded by: European Union www.t-rec.eu IntHEC IntHEC develops evidence-based strategies to increase equity, integration and effectiveness of reproductive health Professor David Molyneux services for poor communities in sub-Saharan Africa. Funded by: European Union www.inthec.org The 98-year old stained glass window in LSTM’s old school building featuring the original crest underwent much needed restoration work in 2013.

Designed by Scottish artist Herbert McNair in 1905, the exact meaning of LSTM’s original crest remains unclear. It has been suggested that the boat represents journeys to tropical destinations, with the eye in the sail referring to the Egyptian falcon god Horus, who was connected with healing and protection from evil.

The original crest was replaced by LSTM’s current one in 2008.

Editorial team: Billy Dean; Helen McFarlane; Tanith Palmer and Diderik van Halsema (Coordination). Contributors: Sue Assinder; Imelda Bates; Alister Craig; Stephen Gordon; Christine Greenway; Einion Holland; Hilary Ranson; Bertie Squire; Mark Taylor, Phil Tubb and Fred Yeomans. Images: AstraZeneca; Chris Barrett; BBC; Center for Communication Programs; Kim Burns Case, Johnson Ndungu, Charles Franzen, Farah Mateen, Arturo Sanabria and Jean Sack all courtesy of Photoshare; Djemba, courtesy of Dreamstime; James Gathany; Deborah Havens; Johns Hopkins Malaria Research Institute; HPA; David Malone; Mark McNulty; Dean Palmer; Sue Purnell; the University of Liverpool and Joe Turner. Pembroke Place Liverpool, L3 5QA United Kingdom Tel: +44 (0)151 705 3249/3261 Fax: +44 (0)151 705 3362 Email: [email protected] www.lstmliverpool.ac.uk

Company registration number: 83405 VAT registration number: 887125885 Registered charity number: 222655

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