Potential research project topics

Theme 1 – Confronting the global challenges of drug resistance

Adherence and HIV drug resistance – HIV infected children in sub-Saharan Africa

To monitor paediatric HIV drug resistance, its emergence, and identifying its determinants and patterns in Nigeria and Uganda. Observational cohorts of HIV-infected children that initiated 1st  or 2nd  line ART are currently ongoing. Clinical and laboratory data are collected in the field. Qualitative studies with respect to specific paediatric adherence challenges and operational and programmatic determinants will be performed amongst parents, caregivers and health workers.

Host institution: Academic Medical Centre of the University of Amsterdam

TB in Africa, genotype, drug resistance and multiple infections

Recent developments in molecular epidemiology are fundamentally changing our understanding of the natural history of tuberculosis (TB). Different genotype families of M. tuberculosis appear to differ with respect to some of their clinical characteristics (e.g. relapse rates), their risk of acquiring drug resistance and their transmission potential. At the population level HIV infection probably affects these differences by exerting reduced immunological pressure on M. tuberculosis populations while at the same time HIV co-infection appears to increase the potential for mixed infections within single human hosts. The project seeks to study the natural history of TB in Africa in relation to genotype, drug resistance and HIV infection.

Host institution: Academic Medical Centre of the University of Amsterdam

Over-expression of efflux pumps in MDR Acinetobacter baumannii and M. tuberculosis

Role of the over-expression of efflux pumps in multidrug resistant Acinetobacter baumannii and Mycobacterium tuberculosis: design of efflux pumps inhibitors.

Objectives:

  1. To identify and characterize the main efflux pumps which play a role in multidrug resistance of A. baumannii and M. tuberculosis.
  2. To investigate the prevalence of these efflux pumps in a well defined collection of both microorganisms and in isolates from different geographical areas
  3. To clone, express and purify the most clinically relevant efflux pumps
  4. To crystallize the purified efflux pumps
  5. To search for potential efflux pumps inhibitors
  6. Epidemiologycal surveillance of Acinetobacterbaumannii(environmental and human carriers) in two different clinical settings (implemented by a partner institution).

Host institution: University of Barcelona

Active case finding strategy of TB in urban slums, Cambodia

The main focus of the project is how to improve the diagnosis (and management) of tuberculosis and drug-resistant tuberculosis in low socio-economic communities of Phnom Penh, Cambodia. This project’s key features are community involvement (village-health-volunteers and TB-officers performing a house-to-house survey), collection of sputum at home, health system strengthening by improving sputum smear, access to rapid diagnostic tests, and use of mobile phone technology.

Host institution: Institute of Tropical Medicine, Antwerp

TB drug resistance in multiple endemic countries

Although the incidence of MDR TB is slowly increasing, this increase is not as dramatic as one may expect given the large numbers of untreated infectious MDR TB cases. This illustrates how we have insufficient understanding on the dynamics of drug resistance following introduction of drugs in the management of TB. The project seeks to study the occurrence of TB resistance to first line anti-mycobacterial drugs in multiple endemic countries in relation to programmatic use of these drugs from both the ITM database and published surveys.

Host institution: Institute of Tropical Medicine, Antwerp

Drug resistance to antileishmanial drugs

In the absence of an effective vaccine, the control of leishmaniasis is essentially dependent on chemotherapy and vector control. However, the arsenal of drugs currently available is limited and their efficacy is sooner or later jeopardised by drug resistance. This project aims to study the molecular and phenotypic adaptations of Leishmania parasites, during follow-up of visceral leishmaniasis cases (human and animal) treated with miltefosine.

Host institution: Institute of Tropical Medicine, Antwerp

Leishmania populations and molecular diversity

Whole Genome Sequencing (WGS) is rapidly becoming an important tool in support for clinics and epidemiology. This project aims to characterise the whole genome diversity of natural populations of L. donovani and L. braziliensis in patients treated with antimonials, in order to understand their recent evolution, their mobility and their clinical polymorphism. A particular attention will be given to the understanding of emergence and spreading of drug resistance among the respective populations.

Host institution: Institute of Tropical Medicine, Antwerp

Malaria transmission and control

Outdoor and early biting malaria vectors are of particular importance in Southeast Asia and present a major challenge in eliminating malaria and especially artemisinin-resistant malaria at the Thai-Cambodian border. The main objective of this anthropological study is to assess the acceptability, the adherence and the use of the topical repellents as a malaria preventive measure in addition to the nationally distributed Long Lasting Insecticidal Nets.

Host institution: Institute of Tropical Medicine, Antwerp

Counterfeit antimicrobial drugs and the development of drug resistance

The size of the market for counterfeit drugs throughout the world is considerable. Among other hazards, counterfeit antimicrobial drugs could constitute a threat to public health by increasing the development of drug resistance. If counterfeit drugs represent a worldwide issue, the latter has a specific extent in regions where regulations and systems for drug supervision are less rigid. Following pharmaco-epidemiology and applied economy of innovation approaches, we would like to study the link between IP regimen, quantitative importance of counterfeit use, drug resistance development, and measure its impact on global public health at the economic level.

Host institution: Université Victor Segalen Bordeaux 2

Tackling antimicrobial resistance in the context of hospitals (France and other countries)

Antimicrobial resistance (AMR) is increasing worldwide. This worrisome problem is associated with high and irrational use of antibiotics (AB). National programmes developed in France to improve and reduce AB use in hospitals showed contrasting results with recent increase in both antibiotic use and resistance in Enterobacteriaceae. To tackle this problem and improve the French situation in the European context, new approaches would be useful to define the best strategies to implement AB policies. Besides the use of evidence based medicine and expert consensus, better knowledge on prescribers’ perception socio-cultural factors is needed. The tools and methods designed in this project should be useful for other countries willing to develop their own approach.

Host institution: Université Victor Segalen Bordeaux 2

Effective interventions to reduce the problem of antibiotic resistance at the EU level

Although antibiotics have revolutionized the treatment of infectious diseases, their (mis)use has resulted in the development and spread of antibiotic resistance. This is now a significant health problem: each year in the European Union alone, over 25 000 people die from infections caused by antibiotic-resistant bacteria. This study conducts an in-depth problem analysis and assesses the different intervention strategies and policies applied in European countries to combat antibiotic resistance. The ultimate aim is to formulate policy recommendations to mitigate antibiotics resistance (and thereby improve health).

Host institution: VU University Amsterdam

 

Theme 2 – Towards more sustainable and better quality health care in order to achieve HIV and maternal and reproductive health related MDGs 

Provider initiated testing for HIV, sub-Saharan Africa

As Provider Initiating Testing and Counseling programmes implementation expands in SSA, there is a need of evaluation of its performance in order to identify the main achievements and challenges, and to inform the timely adaptation of existing programmes. This requires of a trans-disciplinary approach that brings together complementary disciplines (clinical, epidemiology, anthropology and sociology) as a variety of actors (community organisations, academia, health providers, users of services and policy makers).

Host institution: University of Barcelona

Acceptability of self testing for HIV, South African youth

This study investigate the acceptability of self-testing for HIV amongst South African youth. We will explore the possible interactions between structural, programmatic, community and individual factors as well as the pathways through which these affect HIV testing uptake. Our results will inform policy recommendations on how to ensure the degree of “acceptance and cooperation” from populations required for universal “test and treat” strategies to succeed

Host institution: Institute of Tropical Medicine, Antwerp

Autopsy tool for investigating infectious causes of death

This project aims to design and assess the performance of minimally invasive autopsy (MIA) for investigation of infectious causes of death and to evaluate the acceptability and feasibility of using such tools in different cultural, religious and geographical backgrounds. This projects includes a validation study to assess the performance of MIA compared to complete diagnostic autopsy to investigate infectious causes of death in patients of four different age groups: 1) Stillbirths and newborns (<28 days of life); 2) Children aged 1month-<15 years of age; 3) Women of child-bearing age (including pregnant ones); and 4) Other adults.

Host institution: University of Barcelona

Opportunistic infections (e.g. IRIS, TB) with HIV

The Immune Reconstitution Inflammatory Syndrome (IRIS) has been defined as an immunopathological syndrome affecting 10-40% of HIV-infected patients who start antiretroviral therapy (ART) and is characterized by paradoxical deterioration in clinical status. A number of mechanisms, which may underpin the development of IRIS, have been identified but their true roles have not been established. So far even the clinical spectrum of IRIS remains to be better documented. This project aims to further document the clinical spectrum of IRIS, improve knowledge about the pathogenesis of IRIS and investigate the role of corticosteroids to prevent TB IRIS.

Host institution: Institute of Tropical Medicine, Antwerp

Developing sustainable community health resources in poor settings in Uganda (CoHeRe)

This project aims to contribute to the development of sustainable interventions that will mitigate the effects of the human resource deficit in healthcare and contribute to the achievement of the health-related MDGs. It has been argued that the practical knowledge and effective interventions needed to reduce priority health problems in low-income countries are available, but that they do not adequately reach poor and vulnerable populations. One solution is the use of community health workers. So far, however, the development of sustainable reward systems for CHWs has failed. In response to this, this project seeks to answer the question: Can social roles, networks and groups be identified in poor and vulnerable communities in Uganda that could serve as a source of basic health information, skills and behaviours, and link vulnerable community members to existing health resources?

Host institution: University of Amsterdam

Improved responsiveness of maternal health services

Reducing maternal mortality ratios and morbidity rates requires among others that maternal health services are responsive to citizens’ needs. Citizen engagement in decision-making processes for health services and policies can improve responsiveness. One way to achieve this is through the establishment of social accountability mechanisms, which intend to assess performance in relation to civil society’s stated needs and demands of health services. This research assesses whether, and how, political accountability mechanisms increase responsiveness and performance of maternal health services (in order to improve maternal health) in selected countries in sub-Sahara Africa.

Host institution: VU University Amsterdam

The health of pregnant women and human rights

Maternal death and perinatal mortality are major problems in Africa. Both are targets for improvement within the UN MDGs 4 and 5. There is often a lack of access to health care and health information services, including prenatal checks and postnatal care that are vital for the prevention and early detection of problems. Human rights issues, and in particular the realization of basic women’s rights often plays a major role in the actual access to health care. This project investigates in-depth the relation between lack of women’s rights and maternal health problems and the use of new approaches in which innovative technologies play a central role in combination with empowerment of African women.

Host institution: VU University Amsterdam 

Early antiretroviral treatment initiation for truck drivers in Southern Africa

The empirical evidence supporting early treatment for prevention (T4P) approaches is promising with respect to reductions in HIV and TB mortality and morbidity and HIV transmission. However, questions remain as to how best to translate this evidence into successful programmes. In particular, for T4P strategies to substantially increase the proportion of people living with HIV who have undetectable viral loads, thereby reducing onward HIV transmission, improvements in patients’ engagement in the entire continuum of HIV care are needed. This continuum starts with HIV testing and includes counselling and receipt of results, linkage to care, clinical staging, retention in care, and subsequent adherence to antiretroviral treatment. This study will aim to determine whether the early start of antiretroviral therapy plus an enhanced HIV care and prevention model to support it (including SMS and/or u-boxes) represents an affordable, effective, and feasible intervention compared to standard of care for truck drivers in Southern Africa.

Host institution: Academic Medical Centre of the University of Amsterdam

 

Theme 3 – Generating understanding of health syndemics

Immunity, parasitic infections and reproductive health

The burden of reproductive tract infections in Africa is enormous with a prevalence of 30-50% in women of reproductive age. While many anti-microbial drugs already exist, they are currently often ineffective in preventing or curing these conditions, can exacerbate microbiome imbalances, or cause drug resistance. An improved understanding of the balance between parasitic helminth infections, the human microbiome and the host immune system is important as it will enhance our knowledge of disease etiology and pathogenesis, and generate hypotheses regarding better use of existing interventions or the design of new intervention tools.

Host institution: Institute of Tropical Medicine, Antwerp

Exploring youth health syndemics in – Africa and Asia

Adolescents and youths all over the world are confronted with serious sexual and reproductive health problems. They are at major risk for HIV and other sexually transmitted infections, and for unwanted pregnancies leading to a high number of unsafe abortions and increased maternal health risk. Moreover they often engage in substance abuse, which limits their capacity to practice safe-sex. Those living with HIV have specific SRH needs. Poor sexual and reproductive health impacts adolescents socially and economically, for example, through reduced educational and employment opportunities. Although these problems are recognised by policy makers as serious, health systems are currently not mounting an adequate response. PhD candidates will work on existing databases to generate understanding on these Urban Youth Syndemics.

Host institution: University of Amsterdam

Crossing Borders – effects on migration on child health and development

The Crossing Borders project is a multicentre comparative study investigating the effects of migration on child health and development. Its aim is to determine the importance of host, environmental and social factors on child health by comparing children with a migrant background with children from their or their parents’ country of origin. The study population is a birth cohort of children from parents that migrated to the Netherlands from Ghana or Morocco (Group 1), native Dutch children (Group 2) and children born and living in Morocco and Ghana (Group 3). Research focuses on a number of health problems: allergy and asthma, autoimmune diseases, immunomodulating infections, and chronic helicobacter pylori infection. It also studies the access to health care and health seeking behaviour. The appointed PhD will analyse data on the socio-economic factors influencing access to health care and health seeking behaviour in relation to ethnicity and health outcomes.

Host institution: University of Amsterdam

Enteric vaccines, immunity and the microbiome

Oral enteric vaccines, such as the rotavirus vaccine, have a significantly lower efficacy in African and Asian countries when compared to wealthier industrialized countries.   Understanding the determinants of this decreased efficacy is critical to improving vaccine response in these vulnerable populations, which carry the highest burden of diarrheal disease morbidity and mortality.  The gut microbiome may be an important immune modulator of vaccine efficacy.  Understanding how factors such as maternal health, micronutrient deficiencies, urban and rural environments, other viral, bacterial and parasitic exposures influence the gut microbiome may lead to a deeper understanding of enteric immune vaccine responses.

Host institution: Academic Medical Centre of the University of Amsterdam

Tuberculosis and co-infections

Tuberculosis is among the leading causes of death in much of the world. Yet these cases represent only a minority of all tuberculosis infections, as most remain without symptoms for life. This suggests co-evolution of man and micro-organism, resulting in a symbiotic balance that is only rarely disrupted. Understanding the determinants of this balance may provide important clues for improved tuberculosis control. Recent clinical and immunological studies suggest it is partly defined by co-infections other than HIV, such as with helminths or Helicobacter pylori, possibly through effects on the granuloma response.  This project aims at defining the role of co-infections in the epidemiology of tuberculosis by secondary analysis of large datasets from geographical settings and time periods.

Host institution: Academic Medical Centre of the University of Amsterdam

Syndemics between urbanisation and non-communicable diseases

Urbanisation is taking place in a rapid pace and already half of the global population lives in urban areas. A third of these urban dwellers live in resource-poor areas, often called slums. This trend of urbanization is associated with a transition away from the traditional to more unhealthy lifestyles, leading to an increase in risk factors for non-communicable diseases (NCDs), such as stroke, diabetes mellitus and cardiovascular diseases. It is projected that by 2020 these NCDs will cause 80% of the global burden of disease. Living in a resource-poor urban area is associated with an increase in risk factors for chronic diseases. This is not only the effect of a change in lifestyles, but is also due to the more broader determinants of health, such as the challenging social and physical conditions of these areas. This study uses a transdisciplinary approach to study the syndemics between the process of urbanisation and NCDs and their risk factors. It aims to collect qualitative as well as quantitative data on the prevalence, knowledge and perceptions on NCDs in resource-poor urban communities in the Western Cape Province, South Africa, which will be used to develop interventions.

Host: VU University Amsterdam