BACKGROUND

Acute brain infections, such as meningitis and encephalitis, are a major cause of death and disability globally. There is relatively little global research expertise in tackling them.

For more than twenty years researchers at the University of Liverpool have been studying brain infections in the UK and internationally. The Liverpool Brain Infections Group has been using a range of research disciplines including epidemiology, clinical and diagnostic studies, host response and therapeutic approaches to study brain infections in Asia, Africa and Latin America. The new Brain Infections Global programme comprises a new National Institute for Health Research (NIHR) Global Health Research Group on Brain Infections, working to improve the management of acute brain infections, at selected hospitals in Brazil, India and Malawi. In addition it provides a framework and networking space for all those interested in neurological infections research and training

For many brain infections appropriate therapies exist, but doctors fail to diagnose, and thus treat them properly. Often basic but critical investigations, such as a lumbar puncture and microbiology, to examine the cerebrospinal fluid, are performed poorly, or not at all. Doctors are therefore faced with the choice of blindly overtreating for all possibilities (risking side effects, and antimicrobial resistance) or guessing at the diagnosis and treatment (which risks getting it wrong). Newer technologies offer the promise of diagnosing brain infections more accurately, more rapidly, with less reliance on skilled technicians, and ultimately more cheaply.


AIMS & OBJECTIVES

Liverpool has an outstanding international reputation in brain infections research. Warwick has an internationally renowned Centre for Applied Health Research and Delivery. This GHRG will bring them together for the first time, along with leading research institutions in Malawi, India, and Brazil. The overall aim is to improve the diagnosis of acute brain infections in adults and children in these countries, to guide treatment and improve outcomes. We will also develop research capacity, and develop a broader network of hospitals interested in studying brain infections. This GHRG will thus establish the platform to generate follow on funding for further research projects, supporting long-term sustainability.

Our research programme will comprise a series of projects in interlinked themes: 

Theme 1: Understanding the behaviours, knowledge, attitudes and practice of patients, families and health care workers to suspected brain infection.

To understand the factors contributing to poor management we will examine social and structural barriers to care, through interviews, and focus group discussions. These studies will guide training, as well as intervention development.

Theme 2: Improving early management through development of a compound intervention.

Based on our findings in Theme 1, we will work with service users and providers to develop an intervention, made of different components, which improves patient management, and addresses underuse of lumber puncture, and inadequate laboratory methods.

Theme 3: Strengthening diagnosis through pathogen discovery and host genomic approaches.

Newer approaches to diagnosing brain infections are being developed in Liverpool and elsewhere. These include molecular methods to detect pathogens, and to look at human immune response patterns, which differ for different infections. We will develop such approaches to diagnose more patients.

Theme 4: Policy, health economics and implementation.

We will consider the funding impacts of any changes in care in advance of their development, to help determine if they are worth exploring, and the cost at which they might be implemented. Our patient and public involvement panel will ensure our research and its results has impact to reduce death and disability.

Theme 5. Training, capacity building and long-term sustainability.

This will include studentships on our Masters in Research, PhD exchange projects, short course staff training, and online research training modules, both generic and specific to brain infections, offered through our partner, the Global Health Research Network.