We are the Public Health Research Group, based at MLW in Blantyre, Malawi. Adult HIV prevalence in Blantyre is about 17% and TB is very common (1,000 per 100,000 in 2013 Malawi National TB Programme prevalence survey and 214 per 100,000 in a Blantyre prevalence survey by our team in 2019).
This group handbook gives a bit of information about who we are. It is primarily for people in the group or joining the group, but we hope it might also be a useful overview for our partners and collaborators.
If you have recently jointed the group, we are really glad to have you here, and will do what we can to make sure that your time with the group is rewarding. We hope that you will learn a lot about public health and epidemiology, develop new skills (coding, data analysis, writing, giving talks), make new friends and collaborations, and have lots of fun along the way.
This Group Handbook is licensed under a Creative Commons Attribution - NonCommercial 4.0 International License.
Group Head: Peter MacPherson
Deputy Group Heads: Titus Divala & Rachael Burke
Associate Groups: Marc Henrion (Biostatistics), Marriott Nliwasa (Helse Nord TB Initiative); Augustine Choko (Implementation Research in Health)
We are a team of researchers and professional services staff and students who are committed to doing scientific research to contribute to ending the HIV and TB epidemics in Malawi and worldwide. Our team comprises the “core” Public Health group, and our Associate Groups and key partners.
The MLW Public Health Group is led by Dr Peter MacPherson. Peter is a Reader in Population Health at the Liverpool School of Tropical Medicine and a Public Health Physician. He has worked at MLW since 2009.
The MLW Public Health Group hosts three Associate Groups. These are the Biostatistics Research Group at MLW (led by Dr Marc Henrion), the Implementation Research in Health Group at MLW (led by Dr Augustine Choko) and the Helse Nord TB Initative at Kamuzu University of Health Science (KUHES) (led by Dr Marriott Nliwasa).
We have a team of researchers working with us, many of whom are registered for Doctoral and Masters degrees at universities in Malawi or UK. We work together to learn and develop new skills, apply our knowledge to important public health problems, and strive to work in meaningful partnership with people affected by TB and HIV and with colleagues in government and the Ministry of Health in order to contribute to our mission to end the HIV and TB epidemics.
We work with communities to end the HIV and TB epidemics, which are the leading adult infectious killers worldwide.
To achieve this, we conduct research to improve the health of three populations: people in the community with undiagnosed HIV and TB, or who are at risk of infection; people attending primary health facilities with symptoms of disease; and people admitted to hospital with a high risk of death.
We use high-resolution data (epidemiology, surveillance, genomic, behavioural) and community engagement to prioritise populations that will benefit most from HIV/TB interventions.
Using randomised trials, we evaluate HIV and TB interventions (screening approaches, diagnostics, new approaches to treatment) to provide evidence for policymakers and improve the health of communities.
Key research questions:
In communities, can HIV/TB interventions be more effectively and efficiently targeted through better understanding of transmission networks, disease burden, and access to care?
In primary health care facilities, can screening for TB and HIV be improved to maximize health benefits and sustainability, while minimizing harms and costs?
In hospitals, can mortality from advanced HIV and TB be reduced?
Specific objectives:
To use high-resolution data (epidemiology, surveillance, genomic, behavioural) to identify populations with high prevalence of undiagnosed HIV and TB disease and transmission and poor access to care to better direct interventions
Through randomised trials, evaluate interventions that can rapidly end the HIV and TB epidemics, providing high-quality evidence that is relevant to national, regional and global policymakers
To work with communities to identify key priorities and advocate for research and policies that are responsive to local needs
The most important people that we work on behalf of are people and communities affected by TB and HIV in Malawi. We have formed a Community Scientific Advisory Board to engage with our neighbors so that as far as possible we do research “with” rather than “for” communities. We also endeavour to work closely with Malawi Department of Health, in particular the National TB and Leprosy Programme, the Department of HIV/AIDS and the Blantyre District Health Office.
We have a close and very important partnership with Kamuzu University of Health Sciences (KUHES)**, principally through our “sister” group there - the Helse Nord Tuberculosis Initiative. We also work closely with the TB Research Laboratory, which is run jointly between MLW and KUHES.
We work with several key international scientific collaborators:
The Liverpool School of Tropical Medicine is one of the “parent” institutions of MLW and where Peter holds his substantive post. We work with lots of groups at LSTM (including other groups at MLW).
Several group members work at the London School of Hygiene and Tropical Medicine and/or are registered for research degrees at the London School. We work very closely with Professor Liz Corbett - Peter and Liz supervise many PhD students and the Public Health Group collaborates on several large studies led by Liz.
We have worked closely with Foundation for Innovative Diagnostics (FIND), Kenya National TB Program, STOP-TB and have contributed to World Health Organization (WHO) Committees and Guideline Development Processes.
We also have active collaborations with Sheffield University, Yale University, University College London and - through the Helse Nord Tuberculosis Group - with Ludwig Maximillian University, Swiss Tropical Public Health Institute and University of St Andrews.
We are grateful to receive funding from several sources, the most important of which is Wellcome. Wellcome provide core support to MLW which enables MLW and it’s constituent groups to thrive. Wellcome also fund Peter’s Clinical Research Career Development Fellowship (including the PROSPECT trial), Liz’s Senior Fellowship (including SCALE study), and Clinical PhD fellowships for several of our PhD students (including the CASTLE trial).
Key projects
We are delighted to work on lots of interesting projects, furthering our aims of contributing to ending the HIV and TB epidemics. We can’t list everything here, but to give a flavour of our work, these are some of the bigger projects we work on:
PROSPECT (2018-2019)
The PROSPECT trial was a randomised trial of TB screening and HIV testing in Primary Care. We showed that digitial Chest X-ray with computer aided diagnosis and universal HIV screening significantly increased the timeliness and completeness of HIV and TB diagnosis. The paper is published in PLOS Medicine here.
HitTB, SCALE and Enhanced TB Surveillance (2011 - )
Sustainable Community Action on Lung hEalth (SCALE) is a randomised trial of Community Based Active Case Finding for TB in Blantyre. As part of SCALE (and it’s predecesor HitTB), and in partnership with the Blantyre District Health Office, we have an enhanced electronic TB surveillance system for all people starting TB in Blantyre including geolocation (ePAL).
We have used information about geographic location and microbiological status of people starting TB treatment to investigate spatial determinants of tuberculosis risk, the impact of COVID-19 on TB diagnosis and treatment and have an ongoing project (BLAST TB) to use genomics to research transmission of TB in Blantyre.
We are in the process of rolling out an improved electronic Patient Locator (ePAL2).
STAMP trial (2015-2017) and CASTLE trial (2019 - )
STAMP was a two site trial run in Malawi and South Africa, it showed that among adults living with HIV admitted to hosptial, testing for TB using urine LAM reduced mortality in at-risk groups. CASTLE is an ongoing trial evaluating the effectiveness of screening for TB using FujiLAM and digital chest Xray with computer aided diagnosis.
TB Diagnostics
In addition to PROSPECT and CASTLE trials, we work or have worked with collaborators on several studies of TB diagnostics including the FujiLAM Multicountry Prospective Evaluation and the RADIO+ study, designed to evaluate the use of Cepheid Host Response Gene Signature for tuberculosis. Previously, we conducted the CHEPETSA trial, which evaluated the roll out of Xpert for TB diagnosis in Malawi.
We are also part of the LIGHT consortium which seeks to research ways in which TB diagnostic and treatment pathways can be optimised to ensure that no-one is left behind or misses out of TB diagnosis.
HIV Testing and Self-Testing
We are part of the STAR consortium (co-led by Liz Corbett), evaluating the effectiveness of community based and community delivered HIV self testing, and including novel HIV self-test secondary distribution strategies.
We are always interesting in hearing from people who would like to work with us. If you think your would be a good match for our group and you have ideas for a collaboration or to develop a grant together (including fellowships) please reach out.
You are probably reading this website because you have already come across someone who is part of the Public Health Team - please feel free to reach out to them! If you’re not sure, a good first point of call is Peter (peterdotmacphersonatlstmeddotacdotuk), or Rachael Burke (rachaeldotburkeatlshtmdotacdotuk).
We are also very happy to host MSc students and interns, usually from Malawi but occasionally from overseas. MLW periodically advertises fellowships which provide stipends for students to come and work with us. These will be advertised on MLW webpage here.
This section is likely to be most relevant for those are working with us, or about to start working with us.
Everyone
Science is hard. But it’s also fun. In the Public Health Group, we want to make sure that everyone experiences a positive, engaging, hostility-free, challenging, and rewarding environment. To maintain that environment, we all have to do a few things.
There are a few day-to-day things to keep in mind to keep the Group running smoothly.
Group Head
In addition to the above, I promise to…
Post-docs
In addition to the above, you are expected to…
PhD Students and Masters Students
In addition to the above, you will be expected to…
Interns and volunteers
In addition to the above, you will also be expected to…
Code of Conduct
The Public Health Group, and MLW, is an environment that must be free of harassment and discrimination. All Group members are expected to abide by the MLW on discrimination and harassment, which you can (and must) read about here.
The Public Health Group is committed to ensuring a safe, friendly, and accepting environment for everybody. We will not tolerate any verbal or physical harassment or discrimination on the basis of gender, gender identity and expression, sexual orientation, disability, physical appearance, body size, race, or religion. We will not tolerate intimidation, stalking, following, unwanted photography or video recording, sustained disruption of talks or other events, inappropriate physical contact, and unwelcome sexual attention. Finally, it should go without saying that lewd language and behaviour have no place in the Group.
If you notice someone being harassed, or are harassed yourself, tell Peter immediately. If Peter is the cause of your concern, then reach out to any of the MLW safeguarding champions, or a senior member of MLW Senior Management Team (e.g. MLW Deputy Director or Director).
MLW has a safeguarding policy and a list of safeguarding champions. Please ask Peter or someone else in the group for a copy when you start.
Scientific Integrity
The Public Health Group, and MLW, is committed to ensuring research integrity, and we take a hard line on research misconduct. We will not tolerate fabrication, falsification, or plagiarism.
A big problem is why people feel the need to engage in misconduct in the first place, and that’s a discussion that we can have. If you are feeling pressured to succeed (publish a lot, publish in high impact journals), you should reach out to Peter and we can talk about it – but this pressure is something we all face and is never an excuse to fabricate, falsify, or plagiarise. Also, think about the goal of science and why you are here: you’re here to arrive at the truth, and to improve the health of the people of Malawi. Not only is research misconduct doing you a disservice, it’s also a disservice to the people of Malawi. And it risks your entire career. It is never right and never worth it.
The MLW Public Health Group is reasonably diverse and most of us are Malawian, but we are largely funded by institutions based in Europe, at an institution that is partly European and led by someone who is male and white. We acknowledge that there is a legacy of “colonialism” in Global Health and that against a backdrop of injustice and privilege it is not appropriate to conduct “business as usual”, as that just maintains the status quo.
We seek to work with communities most affected by TB and HIV and listen to what they tell us about public health problems they face. We seek to provide excellent scientific training, working environment and opportunities to achieve professional aims to all our group members, whatever their background - acknowledging that all of us experience various forms of privilege and discrimination in different amounts and in different ways.
We are not perfect, but we are striving to learn and continue to do better.
If you are joining the group we recommend that you please read and reflect on the following articles:
Abimbola S. The uses of knowledge in global health BMJ Global Health 2021;6:e005802.
Abimbola S, Pai M. Will global health survive its decolonisation? Lancet. 2020 Nov 21;396(10263):1627-1628. (free, but annoyingly you do have sign into Lancet)
You might also enjoy reading:
Jumbam DT. How (not) to write about global health. BMJ Glob Health. 2020 Jul;5(7):e003164
Abimbola S. The foreign gaze: authorship in academic global health. BMJ Glob Health. 2019 Oct 18;4(5
We believe that science should be open, reproducible, and freely available so that it can have the greatest possible impact.
Reproducible science
If you gave someone else your raw data, they should be able to reproduce your results exactly. This is critical, because if they can’t reproduce your results, it suggests that one (or both) of you has made errors in the analysis, and the results can’t be trusted. Reproducible research is an essential part of science, and an expectation for all projects in the Group.
Reproducible research requires that each step of the research process is documented and organised and stored. To facilitate reproducible research, we do the following:
usethis
package automates much of this process.Some examples of where we have shared code openly:
Open science MLW receives substantial core funding for research from Wellcome. Additionally, many group members and projects will receive funding from charities, governments and research institutes. For science to progress, it is essential that all of our research is available freely, and as soon as possible. We follow Wellcome’s Open Access Policy in our approach to publication:
Authorship
We follow ICMJE guidelines for authorship.
Authorship is based on four criteria:
Authorship should usually be defined at the start of a project, before any data collection or analysis has taken place, and recorded on the Project Concept Note form. At the start of a new project, the student or post-doc taking on the lead role (i.e. the person who is leading the analysis and writing) can expect to be first author (talk to Peter about it if you aren’t sure). Peter will typically be the last author, unless the project is primarily under the guidance of another PI and Peter is involved as a secondary PI – then Peter will be second to last and the main PI will be last. Students and post-docs who help over the course of the project may be added to the author list depending on their contribution, and their placement will be discussed with all parties involved in the paper. If a student or post-doc takes on a project but subsequently hands it over to another student or post-doc, they will most likely hand-over first-authorship to that student or post-doc, unless co-first-authorship is appropriate. All of these issues will be discussed openly, and you should feel free to bring them up if you are not sure of your authorship status or want to challenge it.
Writing manuscripts It can be hard to write when you are staring at a blank page. Make your life easier by starting writing a manuscript using the Public Health Group manuscript template.
To get started with writing, is is sometimes easiest to: - start with the Methods section - Then the Results section (including tables and figures) - Then the Introduction section - Then the Discussion section - Then the abstract section
Try to write using the active (rather than passive tense), and use personal pronouns. Check (and improve) your writing style using the Writer’s Diet tool.
Most journals will accept submissions in Microsoft Word, .pdf, or sometimes in latex. It is useful to check before you start writing.
For referencing, we use Zotero, which has a helpful plugin for Microsoft Word.
You can also try writing a manuscript as part of an R package, including the data, code, and output within a single RMarkdown document.
Be careful with your spelling, formatting and grammar; mistakes here make your manuscript look less professional.
Publication of manuscripts We aim to submit manuscripts as soon as possible to share results and facilitate open science. Before submission of a manuscript, the project lead should ensure that:
Increasingly, manuscripts are published as pre-prints, and we encourage this. Pre-print servers include:
Before selecting a journal to submit the manuscript to, make sure that:
Orphaned projects If a student or post-doc collects a dataset but does not completely analyse it or write it up within two years after the end of data collection, Peter will re-assign the project (if appropriate) to another person to expedite publication. If a student or post-doc voluntarily relinquishes their rights to the project prior to the two-year window, Peter will also re-assign the project to another individual. This policy is here to prevent data (especially expensive data, and data of public health importance) from remaining unpublished, but is meant to give priority to the person who collected the data initially.
Communications with Group Head In addition to Group Meetings meetings (see below), you can find Peter in his office. He is usually available; feel free to ask for a chat. He will almost always say yes, though sometimes he can only spare a couple of minutes or might ask you to let him finish typing a sentence. If Peter is not at his desk, assume that he is either gone, in a meeting, or does not want to be disturbed – so please send a message (WhatsApp or e-mail) rather than waiting around.
Peter also holds Scientific Office Hours on Monday afternoons from 13:00pm to 15:30pm. Please book a meeting by emailing Peter and Thandie (usually max 30mins to allow as many appointments as possible). Come prepared to the meeting: if you want to discuss some analysis, bring your code and a short summary of where you are struggling; if you want to discuss a new project, bring a Project Concept Note; if you want to discuss career direction, make some notes to discuss beforehand. Scientific Office Hours should not be used to resolve administrative issues.
If you have a serious matter, need timely advice or need something knotty resolved, do not hesitate to ask Peter. If a brief conversation can resolve hours of headache for you, then great, that is what he is here for. However, Peter shouldn’t be the first port of call for administrative issues. Try to see if Luke or Thandie (or someone else) can resolve these first.
Email and other communication etiquette
We expect you to work hard and enjoy science whilst at work, but to be able to relax and enjoy your time away from work. Work communications out of hours can be intrusive and stressful - think twice before pressing send: nearly always, it can wait until tomorrow. Although some people work at the evenings or weekends, not everyone wants to, or is able to - please respect your colleagues home life by limiting work communications to work hours. If you receive a work communication outside of work, do not feel as though you have to respond until you are back at work.
Calendars
We have a shared calendar for Group Meetings. Please ask Thandie to add you to it.
If you receive a calendar invite, please respond to it, either by accepting or declining. This lets the organiser know who is able to attend.
Twitter can be an excellent medium for engaging with fellow scientists and the public.
Here is some advice about using Twitter in science.
We encourage you to:
#paperaday
hashtag.Be careful not to publish personally-identifying information about study participants (e.g. photos, names etc without consent). Speak to Peter or MLW SciComm Department if you want further help on using Twitter.
(This is a working document, so please add resources that you find to be helpful here).
In general, ask Peter to borrow hard copies if needed.
Statistics and Epidemiology
Scientific (and general) writing
Tuberculosis and HIV
Group Meetings
Public Health Group meetings are held every Thursday between 2pm and 3.30pm CAT. All group members are expected to attend and participate. Meetings rotate weekly between:
Please review the schedule regularly, and ensure that you are prepared to present when it is your turn. If you need help with a presentation or journal club, ask Peter.
Projects with a laboratory component (or any other Group Members who are interested) should attend the TB Lab Meeting, held at the College of Medicine on every second Wednesday morning. Ask Thandie or Doris for the schedule.
Peter, or his nominated deputy, will attend the monthly MLW Research Strategy Committee. If you have a project LOI that is being reviewed, please ensure that they are briefed in advance of the meeting.
Other meetings/seminars
Presenting your research at conference is a great way to share your results with the scientific community and the public, and to make new links with fellow scientists in the field.
Similar for publications, you should follow authorship guidelines for conference submissions
Generally, it is good to present new results that haven’t yet been published at conferences. This means you need to plan submission carefully to fit timelines for publication.
Make sure supervisors and authors are aware of the proposed submission, and have read and approved the abstract
Consider who is going to pay for the costs of the conference (there is generally no “pot” of money available, and you shouldn’t pay for these yourself). Think about:
Travel, including airplane flights if required
Visas
Hotels/accommodation
Travel/health insurance
Conference registration
Local expenses (travel, food, etc)
Remember that when you are at a conference, you are representing the Public Health Group and MLW - follow the Group Code of Conduct.
Essential Conferences
You should always submit abstracts to:
Other Conferences
If you have new results to report, consider submitting abstracts to:
There are other important conferences that you might consider submitting an abstract to. Discuss with Peter/your supervisors before submitting. This list is a helpful resource of conferences.
Presenting at conferences
If you are presenting a poster:
If you are giving an oral presentation