GB-UKPRN-10007794-ACROSS University of Glasgow The combination of heart disease alongside depression and anxiety is a common and profound unmet need for global health systems, especially in low and middle-income country settings. It affects people of working age causing them major financial loss (& other long-term conditions) that further adds to their ill-health. Rehabilitation, ‘the action of restoring someone to health or normal life after illness’ is recommended by the WHO as a core component of health services. Rehabilitation includes exercise, education, and psychological support. It has proved to reduce death rate and hospital admissions and improve the quality of life and mental well-being. However, due to financial limitations and lack of appropriately trained health care personnel, the availability of rehabilitation services in low- and middle-income countries is virtually absent. Therefore, there is an urgent need to develop an affordable model of rehabilitation that can meet the huge unmet health and socioeconomic needs of people with multiple long term conditions that include both heart disease and mental health disorders. Working with partners in Bangladesh and Pakistan, the ‘Affordable Cardiac Rehabilitation: an outreach Inter-disciplinary Strategic Study’ (ACROSS) programme seeks to develop and evaluate the implementation of a clinically effective, affordable, and culturally and contextually appropriate model of home-based rehabilitation. ACROSS has four work packages: (1)Engagement events with those with lived disease experience, their families, healthcare staff, and service providers will assist us to co-develop a culturally and contextually adapted home-based rehabilitation ('ACROSS') programme and training materials for providers; (2) A pilot study will allow us to understand if the ACROSS programme is acceptable and practical for patients and staff and whether a full scale trial is doable; (3) A trial in 2000 patients with multiple long-term conditions that include heart disease and depression and anxiety across several sites in each country will tell us whether the programme improves their health outcomes at 12-months and what is its affordability; and (4) Develop a sustainable model of workforce training and implementation to enable long-term programme delivery as well as build partner future research capacity. University of Manchester University of Leicester Ishrat Husain Pakistan Institute of Living and Learning (PILL) Bangladesh University of Health Sciences UK - Department of Health and Social Care (DHSC) University of Glasgow Official start date when contract was signed with NIHR University of Glasgow School of Health and Wellbeing David Innes Global ACROSS Project Manager David.Innes@glasgow.ac.uk 505043 1001061 879561 847913 808565 43264.00 101292.02 199999.99 99999.98 2798.40 ACROSS University of Leicester expenditure July 2025 - December 2025 43867.66 ACROSS PILL expenditure October 2025 - December 2025 27508.39 ACROSS PILL expenditure July 2025 - September 2025 38934.00 ACROSS BUHS expenditure July 2025 - December 2025 72968 ACROSS programme running costs July 2025 - September 2025 59296 ACROSS programme running costs October 2025 - December 2025 59998 ACROSS programme running costs January 2026 - March 2026 GB-UKPRN-10007794-NIHR304295 University of Glasgow To strengthen health preparedness in Uganda by improving the detection, understanding, and early identification of viral infections of public health importance, using advanced genomic sequencing methods, and by building sustainable local research and surveillance capacity. 1. Improve detection of viral diseases: To identify viral causes of fever and other syndromes that are currently missed by routine diagnostics, using next-generation sequencing approaches. 2. Support early warning and outbreak preparedness: To generate population-level surveillance data (including clinical and environmental sampling) that can detect emerging or circulating viruses before large outbreaks occur. 3. Build long-term local capacity in Uganda: To strengthen Ugandan scientific, diagnostic, and analytical capability through training, technology transfer, and partnership with local institutions. Uganda Virus Research Institute UK - Department of Health and Social Care University of Glasgow MRC/UVRI & LSHTM Uganda Research Unit Official start date when contract was signed with NIHR University of Glasgow UVRI & MRC/UVRI & LSHTM Uganda Research Unit 110133 391929 394468 396274 395593 284404 110133 97444 97444 1070 278 97179 98259 98514 60281.49 University of Glasgow Project Running costs Mar25- May25 17918.42 University of Glasgow Project Running costs Jun25- Aug25 89817.61 University of Glasgow Project Running costs Sep25- Nov25 GB-UKPRN-10007794-SEDHI University of Glasgow Brazil and Ecuador manifest stark inequalities, including inequalities in health. These inequalities arise from the social determinants of health the conditions in which people are born, grow, work, live, age and die. Many environmental factors, including urbanisation and the climate emergency, are increasing priorities for individual and population health. These tend to have the most harmful impacts on the most deprived in society. The health system needs to respond to such social and environmental threats, but its organisation may mean that it is not protecting the most vulnerable in society. To try to reduce the impact of social conditions such as poverty, governments have introduced policies such as conditional cash transfers or housing programmes for the very poor. Similarly, governments may introduce environmental policies to protect the environment and mitigate any harmful effects on living conditions. While such policies may not be primarily aimed at improving health, they may still have large impacts on health and health inequalities, with much of the historical improvement in life expectancy attributable to them. Our Unit will focus on discovering which policies impact health, whether they had a bigger impact on disadvantaged groups (defined by axes such as income, ethnicity, race, sex, geography, migration, urbanicity and deprivation), and how the organisation and provision of the health system (particularly regarding coverage, access and quality) could optimise any positive health impacts. We will build on our existing GHR Group on Social Policy and Health Inequalities and the experiences and relationships that have been moulded by that Group. Over the next five years, we plan to be global leaders, focused on Latin America, in harnessing existing databases by integrating them to evaluate the impact of social and environmental policies on health and health inequalities, and the extent to which these can be affected by the health system. We will develop research capacity in data linkage and policy evaluation as a legacy for Brazil and Ecuador. We will achieve this by: 1. Building and developing high quality data resources in Brazil and Ecuador; 2. Conducting rigorous evaluations of the impacts of social and environmental policies, and the effects of large-scale population migration, on health and health inequalities; 3. Updating or creating small area deprivation indices for Brazil and Ecuador; 4. Determining how health systems are best organised to improve health for all social groups and interact with social and environmental policies; 5. Focusing on priority health outcomes with relevance to Brazil, Ecuador and Latin America, in which the research team have expertise: non-communicable diseases including mental health and asthma; maternal and child health; reproductive and sexual health; COVID-19 and emerging health threats; infectious diseases; and violence; 6. Monitoring progress towards the 2030 Agenda for Sustainable Development (particularly Goal 3, but also any impacting on health equity); 7. Working with stakeholders, communities and the public to develop our research agenda, set priorities, disseminate results targeted to specific audiences and in so doing influence regional and national policy; and 8. Building capacity in the relevant disciplines in global health research in Brazil, Ecuador, the UK and globally through the development of training programmes and the promotion of south-south learning. University of Birmingham Fundação Oswaldo Cruz (Fiocruz) London School of Hygiene and Tropical Medicine University College London Universidad Internacional del Ecuador City St George's, University of London DHSC University of Glasgow University of Glasgow School of Health and Wellbeing Claire Burke Project Manager claire.burke@glasgow.ac.uk 1479576 1599413 1434327 1309256 1177403 56912.06 81085.51 60787.08 62404.77 69996.01 72692.79 85535.60 80547.30 90761.33 107118.28 84982.33 74767.15 87771.80 63577.56 79075.12 8646.31 50175.48 15832.64 51257.24 28401.69 190214.62 24063.09 113689.30 49924.75 57650.10 57650.10 17739.34 35190.10 4112.09 23920.34 335817.41 194506.83 188691.03 23829 44778.60 90232.21 265375.77 111143.01 198128.46 107993.08 178955.04 27600.27 252704.46 33266.18 GB-UKPRN-10007794-GB-UKPRN-10007794 University of Glasgow Tuberculosis is now the leading infectious killer globally, with unacceptably slow progress being made towards elimination targets. Southern Africa has been the centre of the global TB pandemic for the last 30 years, driven by generalised HIV epidemics. In 2022, more than one third of people with TB were not diagnosed or treated, resulting in sustained ongoing transmission, and a high risk of severe illness and death. A major barrier to efforts to control TB is the suboptimal diagnostic tests available. The most-commonly used test is sputum examination by microscopy, culture, or molecular testing. But many people with TB are not able to produce sputum because of severe illness or weakness. Additionally, the importance of subclinical TB (where sputum tests are positive, but the patient has no symptoms) has recently been recognised. People with subclinical TB have lung changes on chest X-ray, meaning it is possible to detect disease earlier; however, doctors able to interpret chest X-rays for TB are extremely limited in most high TB-burden countries. Recently we have shown in a randomised trial in Malawi that highly-accurate computer-aided detection of TB by portable and affordable digital chest X-ray using artificial intelligence software (DCXR-CAD) can increase the number of people diagnosed with TB and speed up diagnosis from a median of 11 days to 1 day. DCXR-CAD uses deep-learning algorithms trained on hundreds-of-thousands of X-rays to identify abnormality patterns consistent with TB. A positive DCXR-CAD needs to be confirmed with a sputum test before treatment is started, with sputum testing being by far the largest cost component of this approach. However, we have recently shown that setting a single DCXR-CAD abnormality threshold for all patients is likely to be highly inefficient, resulting in considerable over-referral for sputum testing. This is because individual patient characteristics – including older age, severity of symptoms, HIV status, and history of previous TB – are strongly associated with the presence of TB. I hypothesise that by setting “adaptive thresholds” accounting for these characteristics, we could dramatically reduce the number of confirmatory sputum tests that are required to diagnose TB, without impacting detection or accuracy. If correct, this would have massive implications for costsaving for public health programmes in the Global South now rolling-out DCXR-CAD. Based at the University of Glasgow, I will establish a dynamic team of epidemiologists, public health modellers, and health economists with partners at Kamuzu University of Health Sciences, Malawi, The Robertson Centre for Biostatistics, and Health Economics and Health Technology Assessment Unit at University of Glasgow, and The Malawi National TB and Leprosy Elimination Programme. Through knowledge exchange with a high TB/HIV prevalence country in southern Africa (Malawi), we will firstly undertake an individual participant metaanalysis and epidemiological modelling of existing datasets identified through systematic review to identify optimal adaptive thresholds based on patient characteristics, and their potential impact and cost-benefit on TB diagnosis. Subsequently, we will undertake a trial, randomising adults to receive sputum TB testing based on either the fixed DCXR-CAD threshold, or the adaptive threshold, with the main outcome being the number of sputum tests required to confirm one TB case. We will embed community needs and voices throughout the project, and work with national, regional, and global policymakers and DCXR-CAD software developers to direct policy and guidelines to include adaptive chest X-ray screening for TB. This proposal is bold. If successful, it could prove transformative for global efforts to improve TB diagnosis and accelerate towards elimination. Moreover, we will provide compelling evidence of how the Global South is at the forefront of embedding effective and context-specific artificial intelligence tools within healthcare delivery. University of Glasgow UK - Department of Health and Social Care Kamuzu University of Health Sciences (KUHeS) University of Glasgow School of Health and Wellbeing Alison Purdie-Gore Project Co-ordinator alison.gore@glasgow.ac.uk 605310.00 90479.00 695789.00 592194.56