GB-EDU-133784-EquiTrauma130036 University of Birmingham This is a qualitative and priority setting study done in one rural and one urban area in three countries; Ghana, South Africa, and Rwanda. Amongst trauma patients, timely access to quality care remains inequitable with gaps in health services leading to barriers to care seen amongst those who are the poorest or otherwise vulnerable. Unfortunately, very little evidence exists of the identity and extent of these barriers, solutions to overcome them, and their priority in lower and middle income countries (LMICs.). This study aimed to identify barriers to access to quality care for people who have been injured in Ghana, South Africa, and Rwanda. In each country we have; 1. Conducted a two day workshop with policy makers, infrastructure providers, service users, and healthcare workers to identify barriers to access to quality injury care and prioritise solutions to overcome these barriers; 2. Conducted focus group discussions with persons who have accessed care for injury to further explore barriers to access to care from the service user perspective; 3. Conducted in-depth interviews with persons who have required injury care for themselves or their relatives to explore lived experiences of accessing healthcare for people who have been injured; 4. Conducted a survey of experiences of healthcare for those who have been injured using a standardised questionnaire; 5. Conducted focus group discussions with community leaders to explore their experiences with or observations of barriers to accessing care amongst their community members; 6. Done a governance assessment of trauma care in each country; 7. Created pathways to care maps from discussions with health workers in each country; 8. Convened a meeting of investigators, policy makers, and service user representatives at the end to discuss findings and outline future direction. UK - Department of Health and Social Care (DHSC) 2870 Ethical fee 196082.11 Milestone payment 2650 Milestone payment 6655 Milestone payment 2650 Milestone payment 6980 Milestone payment 49617 Operational delivery of project 6655 Milestone payment 6980 Milestone payment 8905 Milestone payment GB-EDU-133784-203062 University of Birmingham Research question Can a novel electronic system, Rwanda912, which uses an ambulance Destination Decision Support Algorithm (DDSA), improve transport time of injured patients to a facility that can treat them, in two areas (urban-Kigali and rural-Musanze), in Rwanda? Background In Rwanda, injury causes substantial disability and 9% of all deaths, 47% of which occur before-hospital. Many of these injury-related deaths and disabilities would be avoidable if delays getting to hospital were reduced. Rwanda has a country-wide free ambulance system. However, inefficiencies in communication and coordination between the ambulance and facilities cause delays in getting the right patient to the right hospital at the right time. In this multidisciplinary project, involving academics, the Ministry of Health (see letter from The Honourable Minister of Health), ambulance services, and a local not-for-profit software company (Rwanda Build Program [RWBuild]), we propose to test the efficacy and implementation of a novel, award winning, electronic system, Rwanda912, to reduce delays in transport to hospital for injured patients. Methods Our primary effectiveness outcome is time from injury to arrival at an appropriate facility. Secondary outcomes are clinical or process (e.g. death, need for ITU, length of stay). We will use an Interrupted Time Series (ITS) approach to assess effectiveness of the intervention – Rwanda912. ITS is known to be a robust method to assess effectiveness in real-world situations where a randomised controlled trial cannot be done. We will study implementation outcomes using the RE-AIM QuEST framework, which combines qualitative and quantitative measures to understand the intervention’s Reach, Effectiveness, Adoption, Implementation, and Maintenance. These outcomes will facilitate understanding of the reasons for the primary and secondary effectiveness outcomes and aid in the transferability of findings elsewhere. Costs, resource use, and cost-consequences will be captured. Timelines for Delivery The project will run for 60 months. The first 3 months are for set-up. Pre-intervention data collection will be University of Rwanda University of Global Health Equity Ministry of Health Rwanda Build Platform University of Aberdeen University of York University of Utah Start date of grant End of grant Rwanda partners MoH, UGHE, UoR University of Utah Universities of Birmingham, Aberdeen, York 687279 687279 687279 687279 687279 GB-EDU-133784-TWPCoP University of Birmingham The Thinking and Working Politically Community of Practice promotes awareness and adoption of TWP approaches, and provides evidence-based insights to stimulate further innovation. The impetus behind the formation of the CoP was to translate the insights of political economy thinking into operationally relevant guidance. The CoP does this by engaging with development practitioners, publishing information and advice, providing training workshops, and promoting new studies and research. United Kingdom Department for International Development (DFID) University of Birmingham First round of DFID funding DFID funding ended 150000 GB-EDU-133784-TWPCoP2 University of Birmingham The Thinking and Working Politically Community of Practice promotes awareness and adoption of TWP approaches, and provides evidence-based insights to stimulate further innovation. The impetus behind the formation of the CoP was to translate the insights of political economy thinking into operationally relevant guidance. The CoP does this by engaging with development practitioners, publishing information and advice, providing training workshops, and promoting new studies and research. UK - Foreign, Commonwealth and Development Office University of Birmingham The TWP CoP Secretariat received funding from FCDO to reinvigorate the work of the Community of Practice. The funding is allocated until 31st March 2023. The TWP CoP is a global network of practitioners and researchers in development and global affairs committed to promoting more effective development policy and practice. The TWP CoP works to promote more politically aware approaches to development, encourage their adaptation, translate findings and implications emerging from political economy analysis into operationally relevant guidance, and provide evidence-based insights that can stimulate innovation, sharing and learning. The programme therefore doesn't target specific regions or countries, but instead aims to bring more politically aware approaches to development worldwide. 12048 160000 33406.32 31135.58 111000 GB-EDU-133784-133135 University of Birmingham Improving equitable access to quality care after injury in low or middle income countries Each year 5 million people die due to injuries like road traffic accidents, burns, falls, or violence. Of these deaths, 90% occur in low- or middle-income countries (LMICs) and 40-50% of people who survive are disabled or unable to work. Delays that occur in accessing quality healthcare contribute substantially to death or disability after injury. The World Health Organisation has stated that strong health systems that provide quality care for injured people are needed to prevent death and disability. Evidence is urgently required to understand how best to improve health systems to provide quality care after injury. In this project, we will partner with colleagues from Ghana, South Africa, Rwanda, and Pakistan, to collect and analyse data from injured persons to understand what the delays to equitable access of quality care after injury are and how can these be overcome to reduce death or disability. We will also collect information on costs of care. These data will be used to develop an injury pathway map to show where it is most beneficial to intervene to reduce delays in accessing quality care after injury. In partnership with stakeholders in each country, we will develop solutions for future study in these, and other similar countries. Additionally, we will research how to bring multiple different stakeholder groups together to influence policy to improve access to quality care after injury and embed research findings into policy. Our project has the following overarching objectives In each country to: 1. Collect data to inform whether post-injury care is of high quality and equitable. 2. Develop an injury pathway map to show points of intervention to improve equitable access to quality healthcare after injury. 3. Develop a road map to bring stakeholders together to improve policy for improving equitable access to quality healthcare after injury. 4. Work with multiple stakeholders to co-develop solutions to test in future studies to improve equitable access to quality healthcare after injury. 5. Conduct community engagement and involvement work to ensure that communities are informed about and inform our work. 6. Deliver capacity building to build research capacity in partner countries. Stellenbosch University Aga Khan university University of Global Health Equity University of Developmental Studies Eagle Research Centre University of York University of Aberdeen University of Rwanda en en Stellenbosch University UGHE University of Rwanda Eagle Research Centre UDS Aga Khan University Universities of York, Aberdeen and Birmingham en https://iatistandard.org/en/iati-standard/203/codelists/SectorCategory/ 738571 1073126 902005 705801 GB-EDU-133784-BactiVac-MR/R005974/1 University of Birmingham BactiVac is a global bacterial vaccinology network bringing together members based in academic, industry and policy sectors to accelerate the development of vaccines against bacterial infections relevant to low and middle-income countries (LMICs). The BactiVac Network delivers this through catalyst project and training awards to encourage cross-collaboration between academic and industrial partners in developed and developing nations. UKRI Medical Research Council (MRC) Department of Health and Social Care (DHSC) Bill & Melinda Gates Foundation (BMGF) Industry Strategy Challenge Fund (ISCF) Institute for Global Innovation, University of Birmingham University of Birmingham Wellcome Trust GB 546541 546541 546541 546541 400000 600000 -23673 600000 -44900 41993.00 Milestone 1 payment London School of Hygiene and Tropical Medicine, UK 25195.8 Milestone 2 payment London School of Hygiene and Tropical Medicine, UK 24906 Milestone 1 payment University of Stirling, UK 14943.6 Milestone 2 payment University of Stirling, UK 8367.38 Milestone 3 payment University of Stirling, UK 25000 Milestone 1 payment University College London, School of Pharmacy, UK 15000 Milestone 2 payment University College London, School of Pharmacy, UK 10000 Milestone 3 payment University College London, School of Pharmacy, UK 25000 Milestone 1 payment University of Liverpool, UK 15000 Milestone 2 payment University of Liverpool, UK 7057.37 Milestone 3 payment University of Liverpool, UK 24532 Milestone 1 payment University of Bath, UK 14719 Milestone 2 payment University of Bath, UK 9047.21 Milestone 3 payment University of Bath, UK 24924.8 Milestone 1 payment University of North Carolina at Chapel Hill, USA 14954.88 Milestone 2 payment University of North Carolina at Chapel Hill, USA 39998.27 Milestone 1 payment Disease Control & Elimination, MRC Unit The Gambia at LSHTM 23998.96 Milestone 2 payment Disease Control & Elimination, MRC Unit The Gambia at LSHTM 15999.3 Milestone 3 payment Disease Control & Elimination, MRC Unit The Gambia at LSHTM 32431.77 Milestone 1 payment Jenner Institute, University of Oxford, UK 19459.06 Milestone 2 payment Jenner Institute, University of Oxford, UK 24537.07 Milestone 1 payment University of Leicester, UK 14722.24 Milestone 2 payment University of Leicester, UK 9814.83 Milestone 3 payment University of Leicester, UK 18658.29 Milestone 1 payment Imperial College London, UK 11194.97 Milestone 2 payment Imperial College London, UK 15000 Milestone 2 payment Bio-Manguinhos, Brazil 23190.01 Milestone 1 payment University of Oxford, UK 13914 Milestone 2 payment University of Oxford, UK 7035.54 Milestone 3 payment University of Oxford, UK 31437.76 Milestone 1 payment University of Cape Town, SA 18862.66 Milestone 2 payment University of Cape Town, SA 17620.87 Milestone 1 payment University of Antwerp, Belgium 10572.52 Milestone 2 payment University of Antwerp, Belgium -7238.27 Return of underspend University of Antwerp, Belgium 24343.17 Milestone 1 payment Imperial College London, UK 14605.9 Milestone 2 payment Imperial College London, UK 8094.57 Milestone 3 payment Imperial College London, UK 23302.5 Milestone 1 payment University of Strathclyde, UK 13981.5 Milestone 2 payment University of Strathclyde, UK 7668.29 Milestone 3 payment University of Strathclyde, UK 30630.86 Milestone 1 payment University of Birmingham, UK 18378.52 Milestone 2 payment University of Birmingham, UK 12252.35 Milestone 3 payment University of Birmingham, UK 9969.92 Milestone 3 payment University of North Carolina at Chapel Hill, USA 8311.28 Milestone 3 payment Jenner Institute, University of Oxford, UK -7835.98 Milestone 3 payment - reimbursement due to underspend on project Imperial College London, UK 0 Milestone 3 payment - no further payment due to underspend on project Bio-Manguinhos, Brazil 12575.10 Milestone 3 payment University of Cape Town, SA 11214 BactiVac admin expenditure for year 1, 2018/19 51078 BactiVac admin expenditure for year 2, 2019/20 30897 BactiVac admin expenditure for year 3, 2020/21 25000 Milestone 1 payment Bio-Manguinhos, Brazil 38463.92 full amount at project completion 47904.84 full project payment at the end of the project 49095.85 50000 full project payment at the end of the project 35374.05 full payment at end of project 50599.00 49964.00 42996.47 42413.92 46359.70 41175.90 46942.78 45061.62 48975.20 82228.53 39839.18 49987.00 56000.00 52660.35 30724.74 47440.93 62655.18 69745.82 49943.36 65945.78 40000 147522.88 72523.89 197625.14 -65111.81 156310.45 215362.26 222090.59 85350.00 138641.23 49756.95 -4980.35 Return of underspend London School of Hygiene and Tropical Medicine, UK 44251.73 45389.00 39977.62 49710.87 34149.10 43396.86 48040.52 19596.50 38362.87 36313.20 University of Cambridge, UK 51395.49 56500.00 49015.35 46302.76 49983.27 50000.00 56915.32 38779.95 GB-EDU-133784-BWSA University of Birmingham This research programme addresses the problem of poor and inequitable access to quality primary healthcare for chronic obstructive pulmonary disease (COPD) patients in South America. COPD is the fourth leading cause of death in the continent, with high a hospital healthcare and societal burden, disproportionately affecting the poor. More than 75% of cases remain undiagnosed, therefore untreated. Building on a previous Global Health Group in Brazil, the aim of the programme is to develop primary care research capacity in South America (specifically Argentina, Brazil and Peru) to improve earlier identification and management of COPD. It is co-led by the University of Birmingham (UoB) and the Universidad Cientifica del Sur (UCSUR) in partnership with CRONICAS Centre of Excellence in Chronic Diseases in Peru. The co-leads work in an equitable partnership with the Institute for Clinical Effectiveness and Health Policy (IECS) in Argentina, the University of São Paulo (USP) in Brazil, the International Primary Care Respiratory Group (IPCRG) and University College London (UCL). The three South American partner Institutions (‘hubs’) will work with and build capacity amongst colleagues from 2-3 less-experienced institutions (‘spokes’), situated in contrasting geographical/economic areas which include the most disadvantaged populations. Over four years, starting in July 2024, Breathe Well partners will develop a set of COPD quality indicators, and an identification pathway for COPD patients in primary care. They will test the feasibility of these in different settings, and model the preliminary cost-effectiveness of the pathway and its potential impact on health inequalities. Based on the outcomes of the work, partners will then submit funding applications for full trials of the developed interventions. Building on a previous Global Health Group in Brazil, the aim of this programme is to develop primary care research capacity in South America (specifically Argentina, Brazil and Peru), to improve earlier identification and management of chronic obstructive pulmonary disease (COPD). The programme’s objectives are as follows. • Develop sustainable research infrastructure and research leaders, in order to deliver high quality COPD research in primary care in South America. This will involve training individuals on a range of generic, clinical and research skills and methods, and engaging with academic, clinical and funding institutions to sustain future research. • Develop sustainable engagement with community members, clinical leaders and policy stakeholders, to ensure research is rooted in local, national and regional needs with clear pathways to impact on health and healthcare. The core project partners will provide training and mentoring for local teams to identify, engage, influence and work with relevant stakeholders, in order to ensure sustainability of impact. • Assess the current quality of COPD primary care in Argentina, Brazil and Peru. This assessment will cover governance and the policy context, foundations, processes, quality and inequities, as well as the quality of electronic healthcare records (EHR). • Develop a set of COPD quality indicators. These indicators will be used to monitor and improve the quality of care. • Co-develop/adapt a pathway of identification and management of COPD patients in primary care, from early diagnosis through management and self-management. The pathway will be based on locally-appropriate, team-based, task-sharing implementation. • Test feasibility of implementation. The pathway will be tested, including a comparison of different settings to evaluate its potential impact in different segments of society. • Model preliminary cost-effectiveness of the pathway and potential impact on health inequalities. The pathway will be assessed using exploratory decision model-based health economic analyses from both healthcare and societal perspectives. • Submit funding applications for full trials of the developed interventions. Universidad Cientifica del Sur (UCSUR) University of Sao Paulo Institute for Clinical Effectiveness and Health Policy International Primary Care Respiratory Group (IPCRG) University College London The University of Birmingham manages the overall programme of work and acts as the host contracting institution. UoB research staff co-lead each of the research work packages, together with colleagues from Peru, Argentina and Brazil. University College London will advise on the clinical aspects of the study, working with local respiratory doctors from each country. IPCRG will lead the stakeholder engagement activities. UCSUR is the co-lead for the programme. All work packages will be implemented in Peru: - WP1: evaluate quality of COPD care, describe & explore quality of electronic healthcare records (EHR) - WP2: Co-develop, adapt & test feasibility of a COPD pathway - WP3: conduct preliminary cost-effectiveness analyses - WP4: train and mentor local teams to identify, engage, influence & work with relevant stakeholders to ensure sustainability of impact - WP5: build capacity by training individuals and engaging with academic/clinical/funding institutions to sustain future research. All work packages will be implemented in Brazil. All work packages will be implemented in Brazil. 579828 847008 785567 786233 GB-EDU-133784-200132 University of Birmingham A UK and low-and-middle-income-country (LMIC) partnership that aims to improve the treatment and prevention of Leprosy and Buruli ulcers in Nepal, India and Nigeria. The project has three main aims: 1. To improve self-care in the community for patients who are at risk of recurring leprosy ulcers. 2. To better understand the needs of patients with Buruli Ulcers and the barriers to meeting those needs. 3. To evaluate new methods of clinical care for leprosy patients. The first aim – supporting self-care / self-help for people in the community who are at risk of recurring leprosy ulcers – is based on an ‘implementation science’ approach where we will work across all three countries to: 1. Agree and share a set of guidelines to support the set and management of self-care in the community. 2. Build on these principles to support the design and evaluate local interventions in collaboration with communities, patients, clinicians and policy-makers. The second aim is to conduct a health needs assessment for Buruli ulcer patients in Nigeria to identify barriers and facilitators to meeting those needs. The third aim – developing new methods of clinical care – will ‘translate’ knowledge by selecting and conducting preliminary evaluations of treatments that have a good chance of being effective and cost-effective in improving care for leprosy patients. These may be: 1. Ideas that have been tried but not proven in leprosy. 2. Treatments that are effective in other ulcer conditions and hold promise for leprosy or BU. 3. New ideas emanating from the ‘science base’. The project is designed to create, as an additional key output, an international ‘Community of Practice’ involving researchers, community and public contributors, clinicians, and policy makers. This community will be ideally prepared and situated to build on the accomplishments of this grant and continue to collaborate, share best practice, and innovate in care so that fewer people will be stigmatised by deformities and disabilities resulting from the two highly stigmatising diseases. University of Warwick German Leprosy & TB Relief Association The Leprosy Mission England & Wales The Leprosy Mission Trust India The Leprosy Mission International The Leprosy Mission Nepal Dhulikhel Hospital - Kathmandu University Hospital The Leprosy Mission Nigeria University of Michigan University of York University of Ibadan The George Institute for Global Health India In South East Nigeria, we are working with the German Leprosy and TB Relief Association (DAHW) in the following projects. 1) We aim to support self-care for people in the community who are at risk of recurring leprosy ulcers, based on an ‘implementation science’ approach. We aim to Identify people at risk of ulcers from registers held in our study centres; carry out baseline assessment in ulcer prevalence and severity, and quality of life and wellbeing; build on our internationally agreed principles to design local interventions in collaboration with communities, patients, clinicians and policy-makers; pilot, refine, roll out and evaluate intervention. 2) We will conduct a cohort study to better understand the needs of Buruli Ulcer patients and the barriers to meeting those needs 3) This is one of four studies on sustainability of Self-Help Groups (SHG) once funding ceases. The aim is to evaluate post-implementation of SHG projects that were implemented in SE Nigeria in order to identify barriers and facilitators to SHG implementation/effectiveness, and the feasibility of sustaining SHG in Southern Nigeria. 4) Scoping study of traditional healers in prevention and management of leprosy and buruli ulcer. This study aims to explore the literature to determine the scope of practice and involvement of traditional healers in the prevention and management of Leprosy and Buruli ulcers. In North Central Nigeria, we are working with the Leprosy Mission Nigeria. This is one of four studies on sustainability of Self-Help Groups (SHG) once funding ceases. We will interview different groups of people who were involved or have knowledge of the community-based self-care/self-help interventions in North Central Nigeria. The interviews will aim to explore the impact of the community-based interventions on the targeted communities. We are also undertaking a clinical trial to evaluate the use of honey in leprosy ulcer healing. The SHERPA study aims to evaluate a service intervention called Integrated Mobilization of People for Active Community Transformation (IMPACT). This is a programme funded by the government of Australia to encourage self-care and self-help. We plan to evaluate the IMPACT intervention by following a cohort of 18 self-help clusters from around the time of inception to 24 months. The study is a prospective, cluster-based, non-randomised controlled study. The IMPACT intervention will be rolled-out to 36 clusters in total, of which we will study the final 18 clusters. We are running a clinical trial titled ‘Trial of Autologous Blood products to promote ulcer Healing in LEprosy (TABLE)'. This is a randomised clinical trial (RCT) to evaluate the efficacy of Leukocyte and Platelet-Rich Fibrin (L-PRF) on healing rates for leprosy ulcers and on duration of hospital stay. Sustainability of Self-Help Groups: This is one of four studies on sustainability of Self-Help Groups (SHG) once funding ceases. The broad aim of the Nepal study is to evaluate the sustainability of program activities of PACED (Participatory Action for Community Empowerment and Development) and CEDAR (Community Empowerment, Development, Disability & Rehabilitation), projects run by TLMN and of perceptions any short-term benefits. The Leprosy Mission Trust India (TLMTI) recently proposed the replicable model project (intervention) to enhance leprosy care within the existing government health system, with the goal of reducing the rate of leprosy related disability (WHO classifications Grade I and II) below 5% in newly diagnosed children and adults in Janjgir Champa, Chhattisgarh by 2024. We will also evaluate this intervention. Sustainability of Self-Help Groups: This is one of four studies on sustainability of Self-Help Groups (SHG) once funding ceases. We aim to evaluate the sustainability of program activities of the Self-Help Community Development Project (SHCDP) and perceptions of any short-term benefits. Review on customised protective footwear in prevention of recurrence of ulcer in insensitive feet due to leprosy This study aims to review the literature on customised footwear and answer the following question: Does footwear with customised insole reduce the recurrence of ulcer in person affected by leprosy and diabetes at risk of ulcer as compared current standard Micro-Cellular Rubber (MCR) footwear? The University of Birmingham manages the overall programme of work and acts as the host contracting institution. The University of York leads health economics and the University of Warwick leads the qualitative research components across the programme. The Leprosy Mission International and The Leprosy Mission England and Wales provides support for the research, impact and dissemination activities. The University of Michigan provides scientific advice and guidance across the projects. 1 - OECD DAC 297268 1210180 1165571 1289368 1036512 GB-EDU-133784-GREENSURG University of Birmingham Climate change is an emergency with communities worried about effects on their health. World leaders have pledged to introduce Net Zero healthcare and the NIHR has identified carbon reduction as a research priority. This Group will explore how to reduce the carbon footprint of operating theatres in low and middle income countries and apply these lessons to the wider hospital. We will provide a sustainable approach to addressing the current research deficient, addressing 7 Sustainable Development Goals, with direct impact on SDG3 (Good Health) and 13 (Climate Action). University of Warwick University of Edinburgh University of Rwanda Christian Medical College, Ludhiana, India University of Lagos, Nigeria University for Development Studies, Ghana Aga Khan University, Pakistan Partners in the UK: University of Birmingham University of Edinburgh University of Warwick The University of Birmingham is the lead institution and provides overall oversight for the grant. The research team based at Aga Khan University in Pakistan will lead on the policy implementation work package. The research team based at the University of Development Studies in Ghana will participate in all work packages. The research team based at Christian Medical College in Ludhiana, India will participate in all work packages. The research team based at the Obafemi Awolowo University in Nigeria will participate in all work packages. The research team based at the University of Rwanda will participate in all work packages. GB-EDU-133784-158242 University of Birmingham A UK and low-middle-income country partnership (University of Ibadan, Bayero University, African Population and Health Research Center, Kenya Medical Research Institute, University of Birmingham, University of Edinburgh, University of Warwick, University of Exeter, Georgetown University) that aims to develop and then evaluate a service change to avoid delay in receiving cancer care. This study will take place over 54 months from November 2024 - April 2029. Cancer is the second largest cause of death in Sub-Saharan Africa (SSA) and the outlook for cancer is much worse in SSA than in high-income countries, mostly because people already have late-stage, and therefore incurable, disease by the time they are diagnosed. Approximately half of the delay arises after the person has been to a clinic: it is this delay within the health sector that we will study. We will build on our ongoing relationships with local governments in two countries: Oyo and Kano states in Nigeria, and Nairobi County in Kenya. These countries are increasingly using public messaging to encourage people with serious symptoms to attend health clinics, and they are upgrading specialist services. It is therefore crucial to close the gap and provide an effective, efficient, compassionate, and equitable pathway from presentation at a primary health clinic to receiving specialist treatment. We will study care for people with symptoms of seven ‘marker’ cancers; uterus (womb), colon, breast, stomach and gullet (oesophageal), lung, prostate/bladder/kidney, and head/neck. Working with patients, policymakers and civil society we will design interventions to reduce delay arising in primary health clinics by designing an educational programme and to reduce delays after referral by developing a programme of peer navigation assistance. To evaluate clinician education we will test knowledge through structured tests and then measure the knowledge practice gap based on observations. We will evaluate both interventions by monitoring referral rates, patient wellbeing and delay. To better understand factors that influence successes of our interventions, we will study the broader system, including workforce, collaboration between organisations, leadership and governance. Community members and policymakers will work with us to disseminate findings and engage people across SSA and beyond so that they can learn from what we have done and advocate for similar services locally. University of Ibadan Bayero University African Population Health Research Center University of Warwick University of Edinburgh University of Exeter Health Research Operations Kenya Limited - The Operating Vehicle for the KEMRI-Wellcome Trust Research Programme The University of Ibadan will provide overall leadership and management of the project with support of the University of Birmingham. The University of Ibadan will lead activities in Ibadan and will also provide expertise in intervention development, process evaluation, educational theory and research management. It will also lead training and capacity strengthening for the project. Bayero University will lead all activities in Kano and ensure input from the Federal Ministry of Health Nigeria. Bayero University will work with partners to lead on work packages 2, 4 and 5. Work packages 2 - 6 will take place in Nigerian sites (Ibadan and Kano). African Population Health Research Center (APHRC) will lead delivery of research activities in Kenya. APHRC, inter-agency non communicable diseases technical working group Kenya Ministry of Health, Kenya National Control Programmes and Kenya Network of Cancer Organisations will also provide health systems support. Kenyatta National Hospital will provide advice and support on intervention development and pilot. Cancer Café will lead CEI activities across the collaboration along with support from other collaborators. at KEMRI-Wellcome Trust Research Programme Kenya will provide expertise in health economics and co-lead work package 6. Work packages 1-6 will take place in Kenya. The University of Birmingham will provide overall leadership and management of the project with support of the University of Ibadan and it manages the overall programme of work and acts as the host contracting institution. University of Birmingham staff will provide expertise in priority setting, decision making in healthcare, intervention development and implementation studies. Collaborators will provide expertise in developing knowledge tests for medical education and medical schools assessment and to support work packages 2 and 5. The University of Birmingham will work with partners to lead on work package 5. The University of Warwick leads the qualitative research components across the programme. The University of Exeter provide advice across the whole research programme with primary support to work package 2 and the University of Edinburgh will provide scientific advice across the programme. Collaborators from Georgetown University, University of California, San Francisco and Harvard University will lead work package 3 and provide expertise on quality measurement. Collaborators from University of California, San Francisco will support the continuation of literature review and curation for work package 6. 564770.47 955568.34 1151185.50 952808.89 406194.61 GB-EDU-133784-DIGIPATHS University of Birmingham Our aim is to develop, implement and evaluate a digitally integrated care pathway (DICP) within electronic health records (EHRs) to manage primary care patients with multiple long-term conditions (MLTC) in Sri Lanka. Our focus will be on diabetes, hypertension and associated cardiometabolic, renal and mental health conditions. We will achieve our aims through the following objectives: 1. To establish a stakeholder consultation group (SCG) consisting of people living with MLTC, healthcare professionals, clinical informaticians, policy makers and researchers to provide expertise throughout the research lifecycle 2. To evaluate existing care pathways and clinical guidelines and identify stakeholder priorities for improvement 3. To develop and implement a stakeholder designed DICP 4. To evaluate the DICP through a cluster randomised controlled trial 5. To evaluate the contextual and organisational factors that may influence scalability and transferability of the DICP across Sri Lanka and countries with similar population and health systems 6. To carry out an economic evaluation of the DICP A UK and low- and middle-income country (LMIC) research partnership that aims to improve the management of multiple long-term conditions in primary care in Sri Lanka. Long-term health conditions are becoming increasingly more common in low-and-middle-income countries, leading to disability and early death. In Sri Lanka, many people suffer from diabetes, high blood pressure, heart disease, kidney disease, and mental health conditions. When someone has several long-term conditions, it becomes more difficult to manage their care, leading to poor health outcomes. The project plans to use electronic patient record systems in primary care centres to create an improved care plan for those with multiple long-term conditions. This plan is called a digitally integrated care pathway (DICP). It aims to standardise care and improve the patient experience using digital technologies. The research project has six parts, or "work-packages (WP)," which will lead to the development and evaluation of the DICP for patients with diabetes, high blood pressure, heart disease, chronic kidney disease, depression, and anxiety. In the first part (WP1), a group of people, including patients, doctors, and policymakers, will be brought together to help create the DICP. They will make sure it meets the needs of patients and healthcare providers and that it can be used across the country. In another part (WP2), we will understand the current healthcare pathways in Sri Lanka and get input from local patients and healthcare professionals to make improvements. They will choose the best guidelines for care, so doctors and nurses know how best to support the care of people with multiple long-term conditions. The DICP will have four key parts developed (WP3), that will connect to an electronic patient record system called OpenMRS. It will include digital guidelines, so doctors have the best information for treatment. There will be a digital referral system for communication and collaboration among healthcare providers. Automated feedback to clinicians will help improve the quality of care. Finally, there will be a digital patient-facing interface for patients to access their health information and take an active role in their care. To see how well the DICP works, we will test it in 50 primary care centres using a special study called a cluster randomised controlled trial (WP4). We will also see if it is worth using in other parts of the country. The project will train and support a group of local experts to lead the use of the DICP and improve the care of people with multiple long-term health conditions in Sri Lanka. The research ultimately aims to improve healthcare for these patients and the use of digital technologies to make it easier to provide the right care at the right time. University of Jaffna University of Leicester University of Edinburgh ArogyaLife NICS MORU ArogyaLIfe University of Birmingham Applied Health Research Fazla Fayaz Programme Manager f.f.ahamedfayaz@bham.ac.uk https://www.birmingham.ac.uk/research/applied-health/research/digipaths/project-team digipaths@contacts.bham.ac.uk 3874868 3874868