Every year at least six million people die from TB, malaria or HIV. Leeds researchers will play a major role in the fight against the world’s three biggest killers in a £5m programme spanning countries from China to Nepal and Bangladesh to Uganda.

The five-year project will help ensure that the best treatments reach those in most need as quickly as possible, and that effective healthcare systems are established to prevent the spread of disease.

“Our vision is to contribute at a global level to a better understanding of ways to combat communicable diseases,” said Dr John Walley, co-director of COMDIS. Dr Walley and co-director Dr James Newell will work with research partners, national TB, AIDS and malaria programmes, patients, doctors and policy makers across Asia and Africa to develop practical and affordable improvements - or ‘interventions’ - to save lives from these devastating diseases. “An ‘intervention’ can both cure patients and prevent the spread of disease,” said Dr Walley.

“Take for example, improving the way people take their TB medication. If they take it properly, they’ll be cured and won’t pass it on to other people. The intervention could be better communication, better education or improving the way health systems pick up and care for people with health problems.”

Effective healthcare, with timely and high quality interventions, needs efficient and integrated healthcare systems. But in many overburdened countries these do not exist - the challenge for the Nuffield team is to design research leading to solutions that are practical in real-life situations. “Although solutions are out there for disease control, the major problem is being able to use these in ways that are responsive to patient needs, cost-effective and sustainable,” said Dr Walley.

The COMDIS programme will test ways to improve the quality and coverage of healthcare for the poor and vulnerable, which could include anything from community based TB care in remote areas or insecticide-treated plastic for displaced people, to interactive theatre exploring the causes of stigma and discrimination associated with TB, which deter people with the disease from coming forward for treatment.

The group prioritise situations where resources exist from national and international agencies to help improve healthcare, and focus on the ‘bottlenecks’ - what is preventing it being successfully carried out. Solutions are trialled and monitored for effectiveness, and best practice is promoted in both research publications and to the people who will need to use them.

“If we can demonstrate the effectiveness of new strategies in reducing health equalities in a cost-neutral way, they are more likely to be taken up by communicable disease programmes,” said Dr Newell. “Improving quality by addressing access, efficiency, equity and effectiveness can help programmes achieve their goals without heavy investment. We believe that the quality, relevance and timeliness of our evidence can dramatically alter the approach and results of reaching the poor.”

Their successful approach to development is based on ten years of public health programme design and implementation experience, ensuring that the interventions are sustainable, affordable and acceptable to patients, health workers and managers. “Our strength is the longstanding relationship and track record we have with in-country disease control programmes,” said Dr Newell. “Rather than lip service, national control programmes are involved throughout.”

Many of their most fruitful relationships on the ground began during the Nuffield centre for international health and development’s tuberculosis research programme, which ends the day that COMDIS begins. The group worked closely with the Pakistan national tuberculosis programme providing guidance on how best to roll out DOTS, the World Health Organization TB control strategy. Following pilot projects and a Lancet-published trial, they worked with the TB programme to improve strategic planning, care guidelines and training materials.

The case management guidelines and materials were used in training 100,000 doctors and other health workers involved in TB treatment in Pakistan. As a result the successful treatment rate has since risen from 30 per cent to an average of 82 per cent, curing at least 22,000 more people, who would otherwise have infected another 220,000. Similar work was completed in other countries including China, where their TB diagnosis and care guidelines will be used to train 11,000 doctors.

COMDIS will take a ‘cross-cutting’ approach to develop similar systems for different diseases across different countries - for example, they will apply their experience in TB to HIV care, effectively delivering anti-retroviral treatment in Uganda and Swaziland.

Their embedded approach to research and development means the COMDIS consortium can make the £5m, funded by the department for international development, go a long way. Partners in COMDIS include the Beijing National and Guangxi provincial centres for disease control, the Malaria Consortium in the UK and Africa and BRAC - which provides community healthcare across two-thirds of Bangladesh. Dr Newell stressed: “The involvement of policy makers from the beginning is crucial for researchers to address key operational constraints, and for rapid knowledge dissemination.”

“At first sight there are plenty of solutions to healthcare problems in these countries but the challenge is finding ones that can really work under the difficult conditions seen in developing countries,” said Dr Walley. “COMDIS will make sure that research makes a real difference to a huge number of people.”

Photo 1: On the ground - Dr James Newell with Nepalian people
Photo 2: Making a difference - the co-directors at the Nuffield centre
Photo 3: Policy into practice - Dr John Walley