Over the last two decades, our work at the Nuffield Centre for International Health & Development, University of Leeds has focused on developing and testing interventions that can be scaled up within national TB programmes (NTPs) in low income countries. Much of this work has been done in collaboration with research NGOs in Nepal, Pakistan, Bangladesh, China and Swaziland. One of our key principles is to engage service providers and NTPs throughout the research to ensure that our work influences policy and practice and that tested interventions are scaled-up nationally.
Understanding Stigma: A body of work to understand the effects of stigma associated with TB in LICs, and the causes of that stigma, which has influenced the delivery of TB care (DFID-funded, 2007-14).
Working with the private sector: A body of work to understand the scale and quality of participation of private medical practitioners (PMPs) in TB control in S Asia; development of an intervention to reduce the impact of poor quality care provided by PMPs; assessment of the effectiveness of the intervention; assessment of the longer-term impact of the scaled-up intervention. Work to understand and develop an intervention to introduce tuberculosis care in the workplace: developing partnerships with the garment industries in Bangladesh (DFID-funded, 2000-12).
Delivering DOTS: A body of work to assess the effectiveness of health facility directly observed treatment (DOT) compared with family member and community-based DOT for TB, leading to changes in WHO guidelines to encourage adoption of more patient-friendly approaches (DFID-funded, 2000-2005).
Psycho-social support for people with TB and MDR TB: In many LICs, poor mental health and limited social support underlie loss to follow-up and poor patient outcomes. Our research has improved understanding of problems faced by people with MDR-TB in completing treatment; developed and assessed interventions to providing counselling and financial support for people with TB, and led to the provision of financial support to patients in many countries (DFID-funded, 2012-14); our current research (DFID-funded, 2011-19) aims to develop psychosocial support for people with MDR TB that can be delivered as part of routine NTP services.
TB Diagnostics: A body of work assessing quality in TB control, relating to improving lab quality, and assessing the impact of decentralising tuberculosis microscopy services (DFID-funded, 2009-12).
TB & Tobacco: Evidence demonstrates that tobacco smoking increases the risk of acquiring TB infection and its progression to TB disease and continued smoking leads to poor disease outcomes. Our research focuses on the implementation of tobacco cessation services within routine NTP clinics. This has included the development of a brief intervention to improve TB management and support cessation in primary care in Nepal (DFID-funded, 2012-15). Following collaboration with University of York (EUH2020-funded, 2015-19) we are now working with partners in Nepal, Pakistan and Bangladesh to adapt the intervention and conduct implementation research to inform scale-up of the intervention within the NTPs in the three countries.