Profile: MLW optimises community engagement in research

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Malawi has an enviable record for medical research from the laboratory to implementation in the field. In fact, when research output was compared with gross domestic product, Malawi came out on top according to a 2010 Reuters pan-Africa survey. This result is in no small part due the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MLW), one of the country's leading medical research centres.<br />Capitalising on its robust north-south connections, MLW is a collaboration between the University of Malawi College of Medicine and the UK's Liverpool School of Tropical Medicine, University of Liverpool, and Wellcome Trust. Based in Blantyre, the commercial capital, it formally started in 1995 and a mere 8 years later, was granted major overseas programme status by the Wellcome Trust, one of only five in the world.<br />Malaria, HIV/AIDS, tuberculosis, and vaccines have long been the focus of MLW research, but reflecting regional trends, non-communicable diseases including diabetes, stroke, and epilepsy are gaining a foothold on the research agenda.<br />Notably, Malawi was one of the first countries in Africa to introduce the Haemophilus influenzae type b (Hib) vaccine in 2002 and the pneumococcal vaccine in 2011. MLW has been monitoring the direct effects of the vaccines on the incidence of pneumonia and meningitis in people vaccinated as well as their indirect preventive effects of herd immunity. “We've demonstrated the high efficacy of the Hib vaccine in Malawi and hope to show the success of the pneumococcal vaccine over the next few years”, reports Rob Heyderman, who has been MLW's director for the past 5 years.<br />He adds that this autumn, they will begin monitoring the introduction of the rotavirus vaccine aimed at preventing 30—40% of cases of severe diarrhoea in children. Heyderman says they want to know whether the pneumococcal and rotavirus vaccines together have an additive effect.<br />Much of this research strength lies in MLW's strong laboratory base, but their reach extends well beyond the bench. MLW established the Anadkat-Wellcome Trust Adult Emergency and Trauma Centre in 2011, which is markedly improving the care of critically ill adults. Such community engagement is integral to MLW's mission. “The last thing we want to be is an isolated ivory tower but rather a research institution responsive to local needs”, emphasises Heyderman.<br />As testament to MLW's effort to strengthen community engagement with health and medicine, they have recently started a cluster randomised intervention trial investigating the effect of community-level access to HIV self-testing and its association with tuberculosis prevention and mortality.<br />The trial uses the HIV home-testing kit recently approved by the US Food and Drug Administration, making MLW the only programme in the world using self-testing kits for HIV in the general community. “We want to know whether you can better control HIV/TB by promoting HIV testing linked to TB prevention in populations with this dual epidemic”, says Liz Corbett, study lead, who started the trial in February this year.<br />In addition to evaluating the self-testing kits for acceptability and convenience, they are also looking at any potential harms. “Will people come forward to access care after self-testing positive for HIV, or do people feel they have been forced into testing, by their partner or parents?” she adds.<br />Douglas Young, professor of microbiology at Imperial College London, UK, says that Corbett's work addresses a core problem in tuberculosis control: that of individuals actively spreading Mycobacterium tuberculosis but who do not experience sufficient clinical symptoms to seek medical attention. “Dr Corbett uses HIV community-engagement networks to extend the reach of TB diagnosis beyond the limitations of conventional health services and formal clinics.”<br />The programme integrates clinical and public health aims, he adds. “It involves extending responsibility for disease control from the sole province of health-care professionals to communities and individuals.”<br />Working so closely with local people in this way, requires participants and community leaders to take responsibility as partners in research and for their own health. As part of a wider public engagement strategy, MLW will shortly launch a national radio show called Umoyo Nkukambirana, which is Chichewa for Health Talk. It is aimed at encouraging public discussion of local health issues.<br />Tamara Chipasula, MLW science communication officer, says that since MLW has promoted public engagement, communities who were previously reluctant to participate in medical research work due to misconceptions, have transformed. “Now people are more inquisitive about their health and medical research, with greater willingness to help and participate in our work, and fewer misinformed rumours”, she says.<br />Use of the home-testing HIV kit reflects this. “We use trained volunteers, nominated by their own communities to provide services from their own homes to their neighbours”, remarks Corbett. “This takes us close to the ideal of community-directed health interventions that have proved more readily sustainable elsewhere, as well as promoting a greater sense of ownership and responsibility for one's own health.”<br />




McCall, B. (2012). Profile: MLW optimises community engagement in research. The Lancet. Lancet Publishing Group.

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