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.
The Global Health Research Group on Brain Infections (Brain Infections Global) was set up in 2018 with £2million from the UK National Institute of Health Research (NIHR) to improve the diagnosis and early hospital management of patients with suspected acute brain infections in low- and middle-income country settings. Its core study is identifying challenges in making a diagnosis and achieving optimal care, to inform a multi-component intervention to address these challenges in a variety of hospitals in Brazil, India and Malawi.
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. 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: Current practice in diagnosis and management of patients with suspected brain infection. To understand the factors contributing to suboptimal diagnosis and management we will observe the journeys of patients and their cerebrospinal fluid samples through the hospital, and conduct interviews with key people in hospitals and health systems. This will guide intervention development.
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 training, and online training modules, both generic and specific to brain infections, offered with our partner, The Global Health Network.