Clinical Group

Liverpool, United Kingdom

Clinical Group

Liverpool, United Kingdom
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Wall E.C.,Clinical group | Cartwright K.,University of Leicester | Scarborough M.,John Radcliffe Hospital | Ajdukiewicz K.M.,North Manchester General Hospital | And 7 more authors.
PLoS ONE | Year: 2013

Mortality from bacterial meningitis in African adults is significantly higher than those in better resourced settings and adjunctive therapeutic interventions such as dexamethasone and glycerol have been shown to be ineffective. We conducted a study analysing data from clinical trials of bacterial meningitis in Blantyre, Malawi to investigate the clinical parameters associated with this high mortality.Methods:We searched for all clinical trials undertaken in Blantyre investigating bacterial meningitis from 1990 to the current time and combined the data from all included trial datasets into one database. We used logistic regression to relate individual clinical parameters to mortality. Adults with community acquired bacterial meningitis were included if the CSF culture isolate was consistent with meningitis or if the CSF white cell count was >100 cells/mm3 (>50% neutrophils) in HIV negative participants and >5 cells/mm3 in HIV positive participants. Outcome was measured by mortality at discharge from hospital (after 10 days of antibiotic therapy) and community follow up (day 40).Results:Seven hundred and fifteen episodes of bacterial meningitis were evaluated. The mortality rate was 45% at day 10 and 54% at day 40. The most common pathogens were S.pneumoniae (84% of positive CSF isolates) and N.meningitidis (4%). 607/694 (87%) participants tested were HIV antibody positive. Treatment delays within the hospital system were marked. The median presenting GCS was 12/15, 17% had GCS<8 and 44.9% had a seizure during the illness. Coma, seizures, tachycardia and anaemia were all significantly associated with mortality on multivariate analysis. HIV status and pneumococcal culture positivity in the CSF were not associated with mortality. Adults with community acquired bacterial meningitis in Malawi present with a severe clinical phenotype. Predictors of high mortality are different to those seen in Western settings. Optimising in-hospital care and minimising treatment delays presents an opportunity to improve outcomes considerably. © 2013 Wall et al.


Sloan D.J.,Malawi Liverpool Wellcome Trust | Sloan D.J.,University of Liverpool | Van Oosterhout J.J.,University of Malawi | Malisita K.,University of Malawi | And 4 more authors.
BMC Public Health | Year: 2013

Background: Impressive achievements have been made towards achieving universal coverage of antiretroviral therapy (ART) in sub-Saharan Africa. However, the effects of rapid ART scale-up on delays between HIV diagnosis and treatment initiation have not been well described. Methods. A retrospective cohort study covering eight years of ART initiators (2004-2011) was conducted at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. The time between most recent positive HIV test and ART initiation was calculated and temporal trends in delay to initiation were described. Factors associated with time to initiation were investigated using multivariate regression analysis. Results: From 2004-2011, there were 15,949 ART initiations at QECH (56% female; 8% children [0-10 years] and 5% adolescents [10-20 years]). Male initiators were likely to have more advanced HIV infection at initiation than female initiators (70% vs. 64% in WHO stage 3 or 4). Over the eight years studied, there were declines in treatment delay, with 2011 having the shortest delay at 36.5 days. On multivariate analysis CD4 count <50 cells/μl (adjusted geometric mean ratio [aGMR]: aGMR: 0.53, bias-corrected accelerated [BCA] 95% CI: 0.42-0.68) was associated with shorter ART treatment delay. Women (aGMR: 1.12, BCA 95% CI: 1.03-1.22) and patients diagnosed with HIV at another facility outside QECH (aGMR: 1.61, BCA 95% CI: 1.47-1.77) had significantly longer treatment delay. Conclusions: Continued improvements in treatment delays provide evidence that universal access to ART can be achieved using the public health approach adopted by Malawi However, the longer delays for women and patients diagnosed at outlying sites emphasises the need for targeted interventions to support equitable access for these groups. © 2013 Sloan et al.; licensee BioMed Central Ltd.


MacPherson P.,Clinical Group | MacPherson P.,HIV and TB Group | Corbett E.L.,HIV and TB Group | Corbett E.L.,London School of Hygiene and Tropical Medicine | And 8 more authors.
PLoS ONE | Year: 2012

Background: Poor rates of linkage from HIV diagnosis to ART initiation are a major barrier to universal coverage of ART in sub-Saharan Africa, with reasons for failure poorly understood. In the first study of this kind at primary care level, we investigated the pathway to care in the Malawian National Programme, one of the strongest in Africa. Methods and Findings: A prospective cohort study was undertaken at two primary care clinics in Blantyre, Malawi. Newly diagnosed HIV-positive adults (>15 years) were followed for 6-months to assess completion of eligibility assessments, initiation of ART and death. Two hundred and eighty participants were followed for 82.6 patient-years. ART eligibility assessments were problematic: only 134 (47.9%) received same day WHO staging and 121 (53.2%) completed assessments by 6-months. Completion of CD4 measurement (stage 1/2 only) was 81/153 (52.9%). By 6-months, 87/280 (31.1%) had initiated ART with higher uptake in participants who were ART eligible (68/91, 74.7%), and among participants who received same-day staging (52/134 [38.8%] vs. 35/146 [24.0%] p = 0.007). Non-completion of ART eligibility assessments (adjusted hazard ratio: 0.11, 95% CI: 0.06-0.21) was associated with failure to initiate ART. Retention in pre-ART care for non-ART initiators was low (55/193 [28.5%]). Of the 15 (5.4%) deaths, 11 (73.3%) occurred after ART initiation. Conclusions: Although uptake of ART was high and prompt for patients with known eligibility, there was frequent failure to complete eligibility assessment and poor retention in pre-ART care. HIV care programmes should urgently evaluate the way patients are linked to ART. In particular, there is a critical need for simplified, same-day ART eligibility assessments, reduced requirements for hospital visits, and active defaulter follow-up. © 2012 MacPherson et al.


Taegtmeyer M.,Clinical Group | Martineau T.,International Health Group | Namwebya J.H.,Family Health International | Ikahu A.,Liverpool VCT | And 4 more authors.
BMC Public Health | Year: 2011

Background: Kenya experienced rapid scale up of HIV testing and counselling services in government health services from 2001. We set out to examine the human resource policy implications of scaling up HIV testing and counselling in Kenya and to analyse the resultant policy against a recognised theoretical framework of health policy reform (policy analysis triangle). Methods. Qualitative methods were used to gain in-depth insights from policy makers who shaped scale up. This included 22 in-depth interviews with Voluntary Counselling and Testing (VCT) task force members, critical analysis of 53 sets of minutes and diary notes. We explore points of consensus and conflict amongst policymakers in Kenya and analyse this content to assess who favoured and resisted new policies, how scale up was achieved and the importance of the local context in which scale up occurred. Results: The scale up of VCT in Kenya had a number of human resource policy implications resulting from the introduction of lay counsellors and their authorisation to conduct rapid HIV testing using newly introduced rapid testing technologies. Our findings indicate that three key groups of actors were critical: laboratory professionals, counselling associations and the Ministry of Health. Strategic alliances between donors, NGOs and these three key groups underpinned the process. The process of reaching consensus required compromise and time commitment but was critical to a unified nationwide approach. Policies around quality assurance were integral in ensuring standardisation of content and approach. Conclusion: The introduction and scale up of new health service initiatives such as HIV voluntary counselling and testing necessitates changes to existing health systems and modification of entrenched interests around professional counselling and laboratory testing. Our methodological approach enabled exploration of complexities of scale up of HIV testing and counselling in Kenya. We argue that a better understanding of the diverse actors, the context and the process, is required to mitigate risks and maximise impact. © 2011Taegtmeyer et al; licensee BioMed Central Ltd.


Capita Conferences Announce Details of Their Ending Violence Against Women and Girls Conference – 14th December, Central London London, United Kingdom, November 18, 2016 --( Following the Government’s announcement that an £80 million VAWG Service Transformation Fund will come into effect in 2017 as part of the new strategy, this conference enables organisations to develop a cost-effective, and multi-agency approach to tackling VAWG. Speakers include: · Keynote Address: Diana Barran, Chief Executive, SafeLives · Sarah Green, Co-Director, End Violence Against Women Coalition · Alison Byrne, Specialist FGM Midwife and Member, FGM National Clinical Group · Kelly Henderson, Domestic Abuse Lead, Gentoo and Co-Founder, Domestic Abuse Housing Alliance (DAHA) · Natalie Wood, Independent Domestic Violence Advocate, London Borough of Bexley · Richard Welch, Borough Commander, London Fire Brigade Attendees will gain transferable knowledge on engaging with men and boys about the VAWG agenda and hear from best practice examples on recognising high risk situations. Further Information: Website: http://www.capitaconferences.co.uk/public-sector-conferences/detail/article/ending-violence-against-women-and-girls-conference.html?code=SMMK Brochure: http://www.capitaconferences.co.uk/pdfgen.html?filename=EndingViolenceAgainstWomenAndGirls.pdf&code=SMMK Contact: Naomi Wood – naomi.wood@capita.co.uk Follow us on Twitter @capitaconf #VAWGconf London, United Kingdom, November 18, 2016 --( PR.com )-- With the Ending Violence Against Women and Girls (VAWG) 2016-2020 strategy setting out an ambitious vision to shift focus from crisis response to early intervention and prevention, there has never been a better time for organisations to enhance their strategy for tackling domestic abuse and sexual violence.Following the Government’s announcement that an £80 million VAWG Service Transformation Fund will come into effect in 2017 as part of the new strategy, this conference enables organisations to develop a cost-effective, and multi-agency approach to tackling VAWG.Speakers include:· Keynote Address: Diana Barran, Chief Executive, SafeLives· Sarah Green, Co-Director, End Violence Against Women Coalition· Alison Byrne, Specialist FGM Midwife and Member, FGM National Clinical Group· Kelly Henderson, Domestic Abuse Lead, Gentoo and Co-Founder, Domestic Abuse Housing Alliance (DAHA)· Natalie Wood, Independent Domestic Violence Advocate, London Borough of Bexley· Richard Welch, Borough Commander, London Fire BrigadeAttendees will gain transferable knowledge on engaging with men and boys about the VAWG agenda and hear from best practice examples on recognising high risk situations.Further Information:Website: http://www.capitaconferences.co.uk/public-sector-conferences/detail/article/ending-violence-against-women-and-girls-conference.html?code=SMMKBrochure: http://www.capitaconferences.co.uk/pdfgen.html?filename=EndingViolenceAgainstWomenAndGirls.pdf&code=SMMKContact: Naomi Wood – naomi.wood@capita.co.ukFollow us on Twitter @capitaconf #VAWGconf Click here to view the list of recent Press Releases from Capita Conferences


Langley I.,Clinical Group | Doulla B.,Ministry of Health and Social Welfare | Lin H.-H.,National Taiwan University | Millington K.,Clinical Group | Squire B.,Clinical Group
Health Care Management Science | Year: 2012

The introduction and scale-up of new tools for the diagnosis of Tuberculosis (TB) in developing countries has the potential to make a huge difference to the lives of millions of people living in poverty. To achieve this, policy makers need the information to make the right decisions about which new tools to implement and where in the diagnostic algorithm to apply them most effectively. These decisions are difficult as the new tools are often expensive to implement and use, and the health system and patient impacts uncertain, particularly in developing countries where there is a high burden of TB. The authors demonstrate that a discrete event simulation model could play a significant part in improving and informing these decisions. The feasibility of linking the discrete event simulation to a dynamic epidemiology model is also explored in order to take account of longer term impacts on the incidence of TB. Results from two diagnostic districts in Tanzania are used to illustrate how the approach could be used to improve decisions. © 2012 The Author(s).


Beeching N.J.,University of Liverpool | Beeching N.J.,Clinical Group | Fletcher T.E.,University of Liverpool | Hill D.R.,National Travel Health Network and Center | And 3 more authors.
International Journal of Antimicrobial Agents | Year: 2010

Viral haemorrhagic fevers (VHF) are caused by zoonotic viral infections transmitted to humans directly or by ticks or mosquitoes. The overall risk to travellers is conservatively estimated at <1 in 1 million travel episodes to African countries where infection is present, and febrile patients returning from these countries are at least 1000 times more likely to have malaria than Lassa fever or another VHF. No cases have been reported in fellow travellers exposed to a travelling case and only one asymptomatic seroconversion (to Lassa) has been reported in over 2000 contacts following care of VHF cases in modern Western hospital settings. However, healthcare-associated transmission of infection has been a major problem in some endemic settings. The potential for healthcare-associated infection and the threats posed by unrecognised or new agents necessitate a high index of suspicion and a standardised risk assessment approach to febrile travellers. Travel-related hantavirus infections are increasingly being reported from Europe and the Americas. This article summarises the epidemiology and reports of travel-related VHF cases in the past 40 years, together with strategies for their recognition, management and prevention. © 2010 Elsevier B.V. and the International Society of Chemotherapy.


MacPherson P.,Clinical Group | MacPherson P.,TB and HIV Group | MacPherson E.E.,TB and HIV Group | MacPherson E.E.,International Health Group | And 8 more authors.
Journal of the International AIDS Society | Year: 2012

Introduction: Linkage from HIV testing and counselling (HTC) to initiation of antiretroviral therapy (ART) is suboptimal in many national programmes in sub-Saharan Africa, leading to delayed initiation of ART and increased risk of death. Reasons for failure of linkage are poorly understood. Methods: Semi-structured qualitative interviews were undertaken with health providers and HIV positive primary care patients as part of a prospective cohort study at primary health centres in Blantyre, Malawi. Patients successful and unsuccessful in linking to ART were included. Results: Progression through the HIV care pathway was strongly influenced by socio-cultural norms, particularly around the perceived need to regain respect lost during a period of visibly declining health. Capacity to call upon the support of networks of families, friends and employers was a key determinant of successful progression. Over-busy clinics, non-functioning laboratories and unsuitable tools used for ART eligibility assessment (WHO clinical staging system and centralized CD4 count measurement) were important health systems determinants of drop-out. Conclusions: Key interventions that could rapidly improve linkage include guarantee of same-day, same-clinic ART eligibility assessments; utilization of the support offered by peer-groups and community health workers; and integration of HTC and ART programmes. © 2012 McDougal L et al; licensee International AIDS Society.


Tamarozzi F.,Molecular and Biochemical Parasitology | Tendongfor N.,University of Buea | Tendongfor N.,Research Foundation for Tropical Diseases and Environment | Enyong P.A.,Research Foundation for Tropical Diseases and Environment | And 6 more authors.
Parasites and Vectors | Year: 2012

Background: Anti-Wolbachia treatment with doxycycline is effective in sterilising and killing adult Onchocerca volvulus nematodes, proving superior to ivermectin and of great potential as an alternative approach for the treatment and control of onchocerciasis, particularly in areas of Loa loa co-endemicity. Nevertheless, the length of the required treatment poses potential logistical problems and risk of poor compliance, raising a barrier to the use of doxycycline in Mass Drug Administration (MDA) strategies. In 2007 and 2008 a feasibility trial of community-directed treatment with doxycycline was carried out in two health districts in Cameroon, co-endemic for O. volvulus and L. loa. With 17,519 eligible subjects, the therapeutic coverage was 73.8% with 97.5% compliance, encouraging the feasibility of using doxycycline community-directed delivery in restricted populations of this size. The current study evaluated the effectiveness of this community-directed delivery of doxycycline four years after delivery. Findings. Infection with O. volvulus was evaluated by skin biopsy and nodule palpation. Of the 507 subjects recruited, 375 had completed the treatment with doxycycline followed by one or two rounds of annual ivermectin MDA and 132 received one or two rounds of annual ivermectin MDA alone. Statistically significant lower microfilarial prevalence (17.0% [doxycycline plus ivermectin group], 27.0% [ivermectin only group], p = 0.014) and load (p = 0.012) were found in people that had received doxycycline followed by ivermectin compared to those who received ivermectin only. Conclusions: This study demonstrates the long-term effectiveness of doxycycline treatment delivered with a community-directed strategy even when evaluated four years after delivery in an area of ongoing transmission. This finding shows that a multi-week course of treatment is not a barrier to community-delivery of MDA in restricted populations of this size and supports its implementation to compliment existing control strategies for onchocerciasis, where needed. © 2012 Tamarozzi et al; licensee BioMed Central Ltd.


Wijaya L.,Singapore General Hospital | Ford L.,Clinical Group | Lalloo D.,Clinical Group
Journal of Travel Medicine | Year: 2011

Background. In 2009, 58.6 million UK residents traveled abroad. Of these, 49.5 million (84.5%) visits were to Europe and North America and 9.1 million (15.5%) were to other parts of the world. Rabies is widely distributed and continues to be a major public health issue in many developing countries. The UK is free of rabies in carnivore host species, although cases of rabies in bats have been reported. This study examined the rabies postexposure prophylaxis (PEP) service from 2000 to July 2009 at the Liverpool School of Tropical Medicine. Methods. Medical records of patients who attended the clinic for rabies PEP were reviewed. Results. During the study period, 139 patients were treated for possible rabies exposure. The mean age was 35 years. Thailand and Turkey each accounted for 31 (22.3%) cases. Sixty-nine (49.6%) of those seen were due to dog bites. Most injuries involved a lower limb (n = 67, 48.2%) or hands (n = 26, 18.7%). Eighty-six (61.9%) cases had initiated rabies PEP overseas, but only 3 of the 78 (3.8%) meeting UK criteria for rabies immunoglobulin (RIG) received it while overseas. Only an additional 11 patients received RIG on return to the UK; most were seen more than 7 days after initiation of PEP. The median time from exposure to receiving rabies PEP was 1 day (range: 0-1,720). Only 14 (10.1%) had received preexposure rabies vaccination. Conclusions. The majority of travelers seeking PEP at this clinic initiated treatment overseas. Most had not received RIG abroad, when it would have been appropriate. Initiation of appropriate treatment is often delayed and is a concern to those without preexposure rabies immunization. In view of the scarcity of RIG, travelers need to be aware of the risks, consider preexposure immunization, and present early for PEP. © 2011 International Society of Travel Medicine.

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