Epidemiological and statistical research on health problems of low and middle-income countries: MRC Tropical Epidemiology Group (TEG)

MRC热带流行病学小组（TEG）的使命是通过开展确定和评估有效干预措施的研究，帮助改善低收入和中等收入国家的健康。包括疟疾、艾滋病毒、结核病和被忽视的热带病在内的传染病仍然是我们研究的主要焦点，因为它们是非洲健康状况不佳的主要原因。在下一个赠款期内，我们将扩大对新发疾病、青少年健康和非传染性疾病的研究，特别是高血压、糖尿病和慢性阻塞性肺病，这些都是中低收入国家的主要疾病问题。我们的研究重点是导致健康状况不佳的主要原因，改善预防或治疗可以直接改善经济和社会结果。这些问题对英国的重要性在2015年政府海外援助战略中得到了强调，该战略旨在应对符合国家利益的全球挑战。自2000年以来，疟疾控制工具（主要是长效驱虫蚊帐）和有效的联合疗法的推广，在撒哈拉以南非洲预防了约6.63亿临床疟疾病例，并使消除疟疾成为一些国家可以实现的目标。然而，这些成果可能受到杀虫剂耐药性、耐药性和资源限制的威胁。在下一个拨款期内，我们的重点将是评估新工具，结合新的和现有的控制策略，并研究这些策略的可持续和更有效的部署。对于艾滋病毒，我们的重点目标是使90%的艾滋病毒感染者了解自己的状况，90%的已知艾滋病毒阳性个体持续接受抗逆转录病毒治疗，90%接受抗逆转录病毒治疗的个体能够持久抑制病毒。例如，我们正在南非和赞比亚领导一项重大试验，以评估综合预防干预对社区新发艾滋病毒病例的影响。干预措施包括以家庭为基础的艾滋病毒检测和社区保健提供者与保健服务的联系，以及通过常规保健服务立即开始治疗。TEG关于结核病的研究包括评估改进的结核病治疗战略、改进的耐药结核病诊断、预防和控制、改进的结核病病例发现和预防以及评估控制结核病的结构性干预措施（社会支持和金钱激励）的研究。例如，我们正在开展一项试验，评估用于结核病患者的改进电子药物设备，以减少治疗失败和在没有直接观察治疗的情况下随后的复发/再治疗。我们将继续就控制和消除被忽视热带病的干预战略开展长期工作，并继续最近参与控制埃博拉和寨卡病毒等疫情。我们还将继续开展工作，研究非专业卫生工作者在治疗常见精神障碍（抑郁和焦虑）方面的干预措施的有效性，特别注重对青少年的这些疾病的治疗，半数以上的精神健康障碍都是从青少年开始的。通过MRC计划拨款，我们为研究项目筹集额外资金，并为LSHTM的约30名统计学家和流行病学家提供工资支持。这笔赠款对于我们能够招募和留住这些科学家至关重要，他们在设计和分析中低收入国家的流行病学研究方面具有疾病和方法方面的专业知识。我们与冈比亚和乌干达的MRC单位以及其他50多个中低收入国家的研究机构合作。我们将继续采取行动，提高撒哈拉以南非洲地区的医学统计能力，例如扩大MRC TEG奖学金计划，该计划迄今已通过LSHTM的医学统计硕士学位培训了17名医学统计学家，随后进行了实习年。他们现在都在非洲从事医疗统计工作。

The mission of the MRC Tropical Epidemiology Group (TEG) is to help improve health in low- and middle-income countries (LMICs), by conducting research that identifies and evaluates effective interventions. Infectious diseases, including malaria, HIV, tuberculosis (TB) and neglected tropical diseases (NTDs), remain a main focus of our research, as they are the leading causes of ill-health in Africa. In the next grant period, we will expand our research on emerging diseases, adolescent health and non-communicable diseases - particularly hypertension, diabetes and chronic obstructive pulmonary disease, which are major disease problems in LMICs. Our research focuses on conditions that are major causes of ill-health, and for which improved prevention or treatment leads directly to improved economic and social outcomes. The importance of these issues to the UK is highlighted in the 2015 Government strategy for overseas aid, on tackling global challenges in the national interest.The scale-up of malaria control tools, primarily long-lasting insecticidal nets, and effective combination therapies, has prevented an estimated 663 million clinical malaria cases in sub-Saharan Africa since 2000, and has made malaria elimination an achievable goal in some countries. However, these gains may be threatened by insecticide resistance, drug-resistance, and resource-constraints. Within the next grant period, our focus will be on evaluating new tools, combining new and existing control strategies, and investigating sustainable and more effective deployment of these strategies. For HIV, we focus on the goal that 90% of those living with HIV know their status, 90% of known HIV-positive individuals receive sustained ART, and 90% of individuals on ART have durable viral suppression. For example, we are leading a major trial in South Africa and Zambia to evaluate the impact of a combination prevention intervention on new cases of HIV in the community. The intervention includes household-based HIV testing and linkage-to-health services by community care providers, and immediate initiation of treatment delivered through routine healthcare services.TEG research on TB includes studies to evaluate improved TB treatment strategies, improved diagnosis, prevention and control of drug-resistant TB, improved TB case finding and prevention, and evaluation of structural interventions (social support and monetary incentives) to control TB. For example, we are working on a trial to evaluate an improved electronic medication device for TB patients to reduce treatment failure and subsequent recurrence/retreatment in the absence of directly observed treatment.We will continue our long-standing work on intervention strategies for the control and elimination of NTDs, and our more recent involvement in the control of outbreaks such as the Ebola and Zika virus outbreaks. We will also continue our work on the effectiveness of lay-health worker interventions to treat common mental disorders (depression and anxiety), focusing particularly on treatment of these conditions among adolescents, in whom over half of mental health disorders start. Through the MRC Programme Grant, we leverage additional funding for research projects and support salaries for around 30 statisticians and epidemiologists, based at LSHTM. The grant is critical to enable us to recruit and retain these scientists, who have disease and methodological expertise in the design and analysis of epidemiological studies in LMICs. We collaborate with the MRC Units in The Gambia and Uganda, and over 50 other research institutes in LMICs. We will continue our initiatives to increase capacity in medical statistics in sub-Saharan Africa, for example by expanding the MRC TEG Fellowship scheme, which to date has trained 17 medical statisticians through a Masters in Medical Statistics at LSHTM, followed by a placement year. All are now working as medical statisticians in Africa.