Global Challenges Research Fund Research Articles

Factors associated with medical consumable availability in level 1 facilities in Malawi: a secondary analysis of a facility census.

Medical consumable stock-outs negatively affect health outcomes not only by impeding or delaying the effective delivery of services but also by discouraging patients from seeking care. Consequently, supply chain strengthening is being adopted as a key component of national health strategies. However, evidence on the factors associated with increased consumable availability is limited. In this study, we used the 2018-19 Harmonised Health Facility Assessment data from Malawi to identify the factors associated with the availability of consumables in level 1 facilities, ie, rural hospitals or health centres with a small number of beds and a sparsely equipped operating room for minor procedures. We estimate a multilevel logistic regression model with a binary outcome variable representing consumable availability (of 130 consumables across 940 facilities) and explanatory variables chosen based on current evidence. Further subgroup analyses are carried out to assess the presence of effect modification by level of care, facility ownership, and a categorisation of consumables by public health or disease programme, Malawi's Essential Medicine List classification, whether the consumable is a drug or not, and level of average national availability. Our results suggest that the following characteristics had a positive association with consumable availability-level 1b facilities or community hospitals had 64% (odds ratio [OR] 1·64, 95% CI 1·37-1·97) higher odds of consumable availability than level 1a facilities or health centres, Christian Health Association of Malawi and private-for-profit ownership had 63% (1·63, 1·40-1·89) and 49% (1·49, 1·24-1·80) higher odds respectively than government-owned facilities, the availability of a computer had 46% (1·46, 1·32-1·62) higher odds than in its absence, pharmacists managing drug orders had 85% (1·85, 1·40-2·44) higher odds than a drug store clerk, proximity to the corresponding regional administrative office (facilities greater than 75 km away had 21% lower odds [0·79, 0·63-0·98] than facilities within 10 km of the district health office), and having three drug order fulfilments in the 3 months before the survey had 14% (1·14, 1·02-1·27) higher odds than one fulfilment in 3 months. Further, consumables categorised as vital in Malawi's Essential Medicine List performed considerably better with 235% (OR 3·35, 95% CI 1·60-7·05) higher odds than other essential or non-essential consumables and drugs performed worse with 79% (0·21, 0·08-0·51) lower odds than other medical consumables in terms of availability across facilities. Our results provide evidence on the areas of intervention with potential to improve consumable availability. Further exploration of the health and resource consequences of the strategies discussed will be useful in guiding investments into supply chain strengthening. UK Research and Innovation as part of the Global Challenges Research Fund (Thanzi La Onse; reference MR/P028004/1), the Wellcome Trust (Thanzi La Mawa; reference 223120/Z/21/Z), the UK Medical Research Council, the UK Department for International Development, and the EU (reference MR/R015600/1).

Developing Heritage Preservation on Ilha de Moçambique Using a Historic Urban Landscape Approach

In 2011, a new approach was introduced into the management of heritage on Ilha de Moçambique by the UNESCO World Heritage Centre. Known as the Historic Urban Landscape (HUL) approach, this seeks to expand current understanding of the island’s historic urban heritage, recognising that ‘heritage’ is not limited solely to monuments or the built environment. Importantly, HUL incorporates urban sustainable development within the scope of heritage preservation. Given this, the adoption of the HUL approach has the potential to contribute to ensuring the authenticity and integrity of the built heritage, as prescribed by the 1972 UNESCO Convention, of Ilha de Moçambique, and effectively maintaining the Outstanding Universal Values that resulted in the declaration of the island as a UNESCO World Heritage Site in 1991. This paper discusses how local communities use the resources and heritage available to them and the central role of commerce, and the marketplace, in the heritage landscape of the island. A critical aspect of this is the sale of antiquities, including archaeological items, to tourists. Perspectives developed within the Rising from the Depths (RftD) network recently supported by the Arts and Humanities Research Council (AHRC) UK, with funding from the Global Challenges Research Fund (GCRF), offer positive alternative solutions to overcome this challenging situation. In particular, the network sought to identify how the tangible submerged and coastal Marine Cultural Heritage (MCH) of Kenya, Tanzania, Mozambique, and Madagascar, and its associated intangible aspects, can be utilised to stimulate ethical, inclusive, and sustainable economic growth in the region. Our paper demonstrates how the implementation of the RftD initiative when combined with the HUL approach can help to increase awareness among communities on Ilha de Moçambique about the relevance of their heritage and the need for preserving it while meeting everyday needs.

Comparing one dose of HPV vaccine in girls aged 9–14 years in Tanzania (DoRIS) with one dose in young women aged 15–20 years in Kenya (KEN SHE): an immunobridging analysis of randomised controlled trials

The first randomised controlled trial of single-dose human papillomavirus (HPV) vaccine efficacy, the Kenya single-dose HPV-vaccine efficacy (KEN SHE) trial, showed greater than 97% efficacy against persistent HPV16 and HPV18 infection at 36 months among women in Kenya. We compared antibody responses after one dose of HPV vaccine in the Dose Reduction Immunobridging and Safety Study (DoRIS), the first randomised trial of the single- dose regimen in girls aged 9-14 years, the target age range for vaccination, with those after one dose of the same vaccine in KEN SHE. In the DoRIS trial, 930 girls aged 9-14 years in Tanzania were randomly assigned to one, two, or three doses of the 2-valent vaccine (Cervarix) or the 9-valent vaccine (Gardasil-9). The proportion seroconverting and geometric mean concentrations (GMCs) at month 24 after one dose were compared with those in women aged 15-20 years who were randomly assigned to one dose of the same vaccines at the same timepoint in KEN SHE. Batched samples were tested together by virus-like particle ELISA for HPV16 and HPV18 IgG antibodies. Non-inferiority of GMC ratios (DoRIS trial:KEN SHE) was predefined as a lower bound of the 95% CI less than 0·50. Month 24 HPV16 and HPV18 antibody GMCs in DoRIS were similar or higher than those in KEN SHE. 2-valent GMC ratios were 0·90 (95% CI 0·72-1·14) for HPV16 and 1·02 (0·78-1·33) for HPV18. 9-valent GMC ratios were 1·44 (95% CI 1·14-1·82) and 1·47 (1·13-1·90), respectively. Non-inferiority of antibody GMCs and seropositivity was met for HPV16 and HPV18 for both vaccines. HPV16 and HPV18 immune responses in young girls 24 months after a single dose of 2-valent or 9-valent HPV vaccine were comparable to those in young women who were randomly assigned to a single dose of the same vaccines and in whom efficacy had been shown. A single dose of HPV vaccine, when given to girls in the target age range for vaccination, induces immune responses that could be effective against persistent HPV16 and HPV18 infection at least two years after vaccination. The UK Department of Health and Social Care, the Foreign, Commonwealth, & Development Office, the Global Challenges Research Fund, the UK Medical Research Council and Wellcome Trust Joint Global Health Trials scheme, the Bill and Melinda Gates Foundation, the US National Cancer Institute; the US National Institutes of Health, and the Francis and Dorothea Reed Endowed Chair in Infectious Diseases. For the KiSwahili translation of the abstract see Supplementary Materials section.

Statistical modelling of determinants of child stunting using secondary data and Bayesian networks: a UKRI Global Challenges Research Fund (GCRF) Action Against Stunting Hub protocol paper

IntroductionSeveral factors have been implicated in child stunting, but the precise determinants, mechanisms of action and causal pathways remain poorly understood. The objective of this study is to explore causal...

Sociocultural environmental factors and childhood stunting: qualitative studies – a protocol for the Shared Values theme of the UKRI GCRF Action Against Stunting Hub

IntroductionStunting is a significant and growing global problem that is resisting scientific attempts to understand it in terms of direct nutrition-related determinants. In recent years, research included more complex, indirect...

Compromise and complicity: partnership and interdependence in a global challenges research collaboration

This article contributes to debates on international collaborations by examining contradictions between the decolonial turn and the UK’s Global Challenges Research Fund which imposed Global North leadership on Global South partners. Through the lenses of compromise and complicity, the article explores how collaborators strive to work together equitably within the constraints of a UK government Official Development Assistance funding scheme. Drawing on focus group discussions with members of a research team, the article traces, first, their engagement with political and institutional constraints and, second, their articulation of collaborative compromise and productive complicity. The article foregrounds the generative potential of complicity as a productive concept that can help partners to navigate the challenges of interdependence and partnership entailed in North–South, South–South, cross-sector and interdisciplinary collaboration.

Doing harm: the impact of UK’s GCRF cuts on research ethics, partnerships and governance

In spring 2021, during the COVID-19 pandemic, research projects funded by the UK’s Global Challenges Research Fund (GCRF) were subjected to budget cuts. The cuts were the result of UK government’s decision to reduce its Official Development Assistance (ODA), which had devastating effects for humanitarian, development and research work. This article draws on focus group discussions with project teams working on three large GCRF-funded projects to explore the effects of these cuts. The article documents how the cuts curtailed project aspirations and impact, had a negative toll on the mental health of researchers, and imperilled the trusting relationships upon which international research collaborations are built. The article argues that the cuts expose the shallow commitments to research ethics and equitable partnerships of powerful actors in the UK research ecosystem, including research councils and government. In ‘doing harm’ via these cuts, the article explores the failure of research governance structures and the continued coloniality underpinning the UK’s approach to researching ‘global challenges’.

RNA-Seq of untreated wastewater to assess COVID-19 and emerging and endemic viruses for public health surveillance.

The COVID-19 pandemic showcased the power of genomic sequencing to tackle the emergence and spread of infectious diseases. However, metagenomic sequencing of total microbial RNAs in wastewater has the potential to assess multiple infectious diseases simultaneously and has yet to be explored. A retrospective RNA-Seq epidemiological survey of 140 untreated composite wastewater samples was performed across urban (n=112) and rural (n=28) areas of Nagpur, Central India. Composite wastewater samples were prepared by pooling 422 individual grab samples collected prospectively from sewer lines of urban municipality zones and open drains of rural areas from 3rd February to 3rd April 2021, during the second COVID-19 wave in India. Samples were pre-processed and total RNA was extracted prior to genomic sequencing. This is the first study that has utilised culture and/or probe-independent unbiased RNA-Seq to examine Indian wastewater samples. Our findings reveal the detection of zoonotic viruses including chikungunya, Jingmen tick and rabies viruses, which have not previously been reported in wastewater. SARS-CoV-2 was detectable in 83 locations (59%), with stark abundance variations observed between sampling sites. Hepatitis C virus was the most frequently detected infectious virus, identified in 113 locations and co-occurring 77 times with SARS-CoV-2; and both were more abundantly detected in rural areas than urban zones. Concurrent identification of segmented virus genomic fragments of influenza A virus, norovirus, and rotavirus was observed. Geographical differences were also observed for astrovirus, saffold virus, husavirus, and aichi virus that were more prevalent in urban samples, while the zoonotic viruses chikungunya and rabies, were more abundant in rural environments. RNA-Seq can effectively detect multiple infectious diseases simultaneously, facilitating geographical and epidemiological surveys of endemic viruses that could help direct healthcare interventions against emergent and pre-existent infectious diseases as well as cost-effectively and qualitatively characterising the health status of the population over time. UK Research and Innovation (UKRI) Global Challenges Research Fund (GCRF) grant number H54810, as supported by Research England.

Reframing skills ecosystems for sustainable and just futures

The current dominant approach to vocational education and training (VET) does not work in theory, policy or practice in current contexts of unsustainability and global inequality. Nor is it fit for future purpose. Drawing on a large-scale research collaboration between four universities, funded by the UK’s Global Challenges Research Fund, with co-funding and funding in-kind from global south partners, this paper is a contribution to imagining new VET futures. It looks iteratively, reflexively and expansively at how our experience of VET system development involving boundary crossing between formal and informal VET systems interfaces with recent Northern work on the conceptualisation of social skills ecosystems, and how this concept can be expanded to address the challenge of skills for just transitions in the global South. We advance the skills ecosystems approach ontologically by drawing on critical realism (a growing trend in VET and development research). This allows us both to move beyond the structure-agency divide that has bedeviled the field, and with it the tendency to monoscalar analysis. Rather, we argue that accounts of VET and development must address both structure and agency, and their interplay, and must be multiscalar. This reading allows us to focus on the central importance of relationality. We argue that it is through networks and relationships that the precarious worlds of learning and work are brought together.

Rethinking North–South Research Partnerships Amidst Global Uncertainties: Leveraging Lessons Learned from UK GCRF Projects during COVID-19

International research and development projects (or grand challenge projects) consist of multicultural, multi-country, multi-sectoral, and multi-stakeholder initiatives aimed at poverty reduction. They are usually conceived as partnerships between actors in the global north–south. The COVID-19 pandemic was a major unexpected disruption to ongoing projects and challenged their already complex management. The aim of this paper is to present evidence on how international development projects were impacted by COVID-19 with a particular focus on the relationship between research institutions in the north and south. We conducted a mixed-methods research study, combining a reflective exercise with the co-author team and a survey with principal investigators, project managers, and capacity development leads drawn from 31 Global Challenges Research Fund (GCRF) projects funded through the UK government’s Official Development Assistance (ODA) and focused on social–ecological system research. The survey contained closed- and open-ended questions in order to (i) demonstrate how those involved in managing projects adapted to risks, including both threats and opportunities, presented by the COVID-19 pandemic, and (ii) consider the implications for tailoring adaptive management approaches in international research projects amidst uncertainties, with a special focus on enhancing equities in global north–south partnerships. The paper offers the following recommendations on designing, planning, and implementing international research and development projects: (i) devolve project management in order to enhance project resilience and improve north–south equities; (ii) allocate dedicated resources to enable equitable north–south research partnerships; (iii) rely more on hybrid and agile approaches for managing a project’s life cycle; and (iv) improve resource flexibility, transparency, and communication through enhanced funder–implementer collaboration.

Theory of Change in Complex Research for Development Programmes: Challenges and Solutions from the Global Challenges Research Fund.

The United Kingdom Research and Innovation (UKRI) Global Challenges Research Fund (GCRF) aimed to address global challenges to achieve the United Nations (UN) Sustainable Development Goals through 12 interdisciplinary research hubs. This research documents key lessons learned around working with Theory of Change (ToC) to guide Monitoring, Evaluation and Learning (MEL) within these complex research for development hubs. Interviews and document reviews were conducted in ten of the research hubs. The results revealed that only one hub invested in an explicit visual system mapping approach, and that funder timelines, budget constraints and issues with capacity and expertise limited the application of these approaches across all hubs. In contrast, many hubs attempted to deal with visual complexity by means of ether constructing multiple, nested ToCs, or a conscious simplification of complexity through reducing their ToC towards a straightforward and uncomplicated chain model or spherical model. While the former approach had some value, most hubs struggled to find capacity to support the full articulation of nested ToCs. In contrast, the latter approach resulted in ToCs which lacked detail or mechanism articulation, but which nevertheless were often 'fit for purpose' in ensuring effective communication and coherence across diverse stakeholders and sub-projects. We conclude that in instances where the reporting, funding and management cycles of complex research for development programmes cannot be adapted to properly support learning-based approaches to ToC development, imposing simplicity in the ToC might be fit for purpose. This might also be preferable to more complex visual approaches that are only partially realised.

Revealing the Relational Mechanisms of Research for Development Through Social Network Analysis

Achieving impact through research for development programmes (R4D) requires engagement with diverse stakeholders across the research, development and policy divides. Understanding how such programmes support the emergence of outcomes, therefore, requires a focus on the relational aspects of engagement and collaboration. Increasingly, evaluation of large research collaborations is employing social network analysis (SNA), making use of its relational view of causation. In this paper, we use three applications of SNA within similar large R4D programmes, through our work within evaluation of three Interidsiplinary Hubs of the Global Challenges Research Fund, to explore its potential as an evaluation method. Our comparative analysis shows that SNA can uncover the structural dimensions of interactions within R4D programmes and enable learning about how networks evolve through time. We reflect on common challenges across the cases including navigating different forms of bias that result from incomplete network data, multiple interpretations across scales, and the challenges of making causal inference and related ethical dilemmas. We conclude with lessons on the methodological and operational dimensions of using SNA within monitoring, evaluation and learning (MEL) systems that aim to support both learning and accountability.

RISK AND RETURNS: Large‐scale Funding for Urban Research

AbstractThe nature of research funding shapes knowledge outcomes, especially for urban research that is conducted in multiple sites and over multiple years. Recent unplanned cuts in the Global Challenges Research Fund (GCRF) grants, alongside the rupture caused by Covid‐19, created ethical and procedural issues for completing the PEAK Urban programme. Building on durable partnerships, setting principles for the reduced fund distribution and adjusting modes of working enabled PEAK Urban to navigate the fiscal disruption—but the difficult episode highlights lessons for the ethical organization of global urban research under conditions of uncertainty.

West Africa's moist convective environment as observed by the Atmospheric InfraRed Sounder (AIRS)

AbstractKnowledge of the seasonal positioning of the Intertropical Discontinuity (ITD) is critical to understanding seasonal moist convective processes and associated rainfall over West Africa. This study constitutes a new analysis of the seasonality of moist convection over West Africa, relative to the ITD, based on NASA's Atmospheric Infrared Sounder (AIRS) measurements from 2003 to 2018. Results show that AIRS resolves the seasonal march of the ITD, including its inherent diurnal‐scale variations. AIRS captures the north–south daytime skin temperature dipole around the ITD, with greater relative temperatures to the north, especially during March–August. In the vicinity of the nighttime ITD, AIRS profiles indicate increased instability that is characteristic of nocturnal thunderstorm propagation. For seven Ghana weather stations, we show that AIRS positive moisture and equivalent potential temperature anomalies coincide with observed thunderstorm days. On these thunderstorm days, the mean latitude of the AIRS‐derived ITD is displaced 3°, 0.2°, and 2° north of its DJF, MAM, and SON climatological positions, respectively, and 1.2° south in JJA. Among four common thunderstorm initiation indices considered, the K‐index is determined to be most skillful. The findings of this study contribute to the Global Challenges Research Fund, African Science for Weather Information and Forecasting Techniques project's mission to build local tropical weather forecasting capacity and capabilities in West Africa.

Guest Editorial: Ecological knowledge co‐production and the contested imaginaries of development in Southeast Asia

Guest Editorial: Ecological knowledge co‐production and the contested imaginaries of development in Southeast Asia

COVID-19 IMPACTS ON THE MENTAL HEALTH AND WELLBEING OF RESEARCHERS, PARTNERS, AND RESEARCH COMMUNITIES

BackgroundIn the United Kingdom, over five years, the Arts and Humanities Research Council (AHRC) and UK Research and Innovation (UKRI) have made more than to 300 awards under the Global Challenges Research Fund (GCRF) and the Newton portfolios. These awards have drawn on AHRC’s research base to address development challenges that are ultimately global challenges, including poverty reduction, global health, climate change, resilience, conflict, displacement, inclusive education, and rapid urbanization. ObjectiveThis paper focuses on data from a selection of projects from both the GCRF and Newton portfolios in order to evaluate the impact the COVID-19 pandemic has on the mental health and wellbeing of individuals and communities.  A focus of the study is on researchers and their families, on research partners and other affiliates as well as within the communities where these projects take place. A particular attention is paid on the impact of COVID-19 on different aspects of life and social practices as well as changes in the perceptions, attitudes and behaviors of researchers as part of and during the research process. MethodsThe data in this project comes from PRAXIS, a £1m research project from the University of Leeds, which covers four main areas of research; namely those of Heritage, Conflict and Displacement, COVID-19 and Climate Change, and Youth Engagement. In this paper, the data presented is only from the COVID-19 Strand that examined 248 projects from both the GCRF and Newton portfolios. The data was gathered via a desk-based assessment, two surveys, twenty-one interviews, as well as twelve case studies. ResultsThe COVID-19 pandemic increased pressure on already strained research systems highlighting some key challenges and issues.  With the pandemic impacts, the sense of isolation and loneliness increased as well as the need for additional mental health support. Mental health concerns were often reported in the context of deteriorating mental health for academics and practitioners involved in the projects. The trauma of the pandemic and its effects led to reports of frustration, disempowerment, lack of agency, sadness, depression, and even symptoms associated with PTSD.   Respondents also described the impact of the lockdowns on productivity and mental health, with many more work hours required to attain a similar level of pre-Covid quality.  For communities, the main impacts of the pandemic were also the lockdowns and their subsequent impact on mental health.  ConclusionAmidst the chaos of the pandemic, there were valuable lessons learned about the need and the method of preserving vulnerable communities as well as maintaining the health of researchers, partners, and communities by balancing the home and work life.

Cost-Benefit Analysis (CBA) or the Highway? An Alternative Road to Investigating the Value for Money of International Development Research.

Research for development (R4D) funding is increasingly expected to demonstrate value for money (VfM). However, the dominance of positivist approaches to evaluating VfM, such as cost-benefit analysis, do not fully account for the complexity of R4D funds and risk undermining efforts to contribute to transformational development. This paper posits an alternative approach to evaluating VfM, using the UK’s Global Challenges Research Fund and the Newton Fund as case studies. Based on a constructivist approach to valuing outcomes, this approach applies a collaboratively developed rubric-based peer review to a sample of projects. This is more appropriate for the complexity of R4D interventions, particularly when considering uncertain and emergent outcomes over a long timeframe. This approach could be adapted to other complex interventions, demonstrating that our options are not merely “CBA or the highway” and there are indeed alternative routes to evaluating VfM.Supplementary InformationThe online version contains supplementary material available at 10.1057/s41287-022-00565-7.

Transforming North-South research partnerships: Lessons learned from energy, technology & enterprise global challenge research fund projects

The Global Challenges Research Fund (GCRF) provided a mechanism for academia to undertake projects relevant to the Sustainable Development Goals but there have been limited opportunities to critically interrogate such projects. In this paper we will use the Technology Implementation Model for Energy to deconstruct the purpose, assumptions and expectations, engagement strategies, and reflective processes of four GCRF projects in order to better understand relationships between researchers and those being researched. Thus, the aim of this paper is to explore and understand the lived experiences of four inter-disciplinary GCRF Primary Investigators implementing poverty alleviating technologies in a range of sectors to generate recommendations that can be applied to wider academic communities engaging with vulnerable populations.Our key findings show that despite the integration of Theory of Change models and the Responsible Research and Innovation (RRI) framework in GCRF-funded projects, project aims continue to be driven by researchers rather than reflecting end-user needs. Whilst some projects looked to generate feelings of ownership, adequate engagement strategies and reflective learning practices, these processes are often not formally embedded in project activities resulting in a decoupling of researcher expectations and end-user assumptions – ultimately derailing project outcomes. Our recommendations for academics operating within the International Development space are to 1) Talk early, often and transparently, 2) Keep Thinking – who benefits?, 3) Be reflective, responsive, and open to change and, 4) Use a systematic approach to facilitate this process.

Comparing dedicated and designated approaches to integrating task-shared psychological interventions into chronic disease care in South Africa: a three-arm, cluster randomised, multicentre, open-label trial

Community health workers (CHWs) are increasingly providing task-shared psychological interventions for depression and alcohol use in primary health care in low-income and middle-income countries. We aimed to compare the effectiveness of CHWs dedicated to deliver care with CHWs designated to deliver care over and above their existing responsibilities and with treatment as usual for patients with a chronic physical disease. We did a three-arm, cluster randomised, multicentre, open-label trial done in 24 primary health-care clinics (clusters) within the Western Cape province of South Africa. Clinics were randomly assigned (1:1:1) to implement dedicated care, designated care, or treatment as usual, stratified by urban-rural status. Patients with HIV or type 1 or type 2 diabetes were eligible if they were 18 years old or older, taking antiretroviral therapy for HIV or medication to manage their diabetes, had an Alcohol Use Disorders Identification Test (AUDIT) score of eight or more or a Center for Epidemiologic Studies Depression Scale score of 16 or more, and were not receiving mental health treatment. In the intervention arms, all participants were offered three sessions of an evidence-based psychological intervention, based on motivational interviewing and problem-solving therapy, delivered by CHWs. Our primary outcomes were depression symptom severity and alcohol use severity, which we assessed separately for the intention-to-treat populations of people with HIV and people with diabetes cohorts and in a pooled cohort, at 12 months after enrolment. The Benjamini-Hochberg procedure was used to adjust for multiple testing. The trial was prospectively registered with the Pan African Clinical Trials Registry, PACTR201610001825403. Between May 1, 2017, and March 31, 2019, 1340 participants were recruited: 457 (34·1%) assigned to the dedicated group, 438 (32·7%) assigned to the designated group, and 445 (33·2%) assigned to the treatment as usual group. 1174 (87·6%) participants completed the 12 month assessment. Compared with treatment as usual, the dedicated group (people with HIV adjusted mean difference -5·02 [95% CI -7·51 to -2·54], p<0·0001; people with diabetes -4·20 [-6·68 to -1·72], p<0·0001) and designated group (people with HIV -6·38 [-8·89 to -3·88], p<0·0001; people with diabetes -4·80 [-7·21 to -2·39], p<0·0001) showed greater improvement on depression scores at 12 months. By contrast, reductions in AUDIT scores were similar across study groups, with no intervention effects noted. The dedicated and designated approaches to delivering CHW-led psychological interventions were equally effective for reducing depression, but enhancements are required to support alcohol reduction. This trial extends evidence for CHW-delivered psychological interventions, offering insights into how different delivery approaches affect patient outcomes. British Medical Research Council, Wellcome Trust, UK Department for International Development, the Economic and Social Research Council, and the Global Challenges Research Fund.

Widespread exposure to Crimean-Congo haemorrhagic fever in Uganda might be driven by transmission from Rhipicephalus ticks: Evidence from cross-sectional and modelling studies

Crimean-Congo haemorrhagic fever (CCHF) is a widespread tick-borne viral infection, present across Africa and Eurasia, which might pose a cryptic public health problem in Uganda. We aimed to understand the magnitude and distribution of CCHF risk in humans, livestock and ticks across Uganda by synthesising epidemiological (cross-sectional) and ecological (modelling) studies. We conducted a cross-sectional study at three urban abattoirs receiving cattle from across Uganda. We sampled humans (n=478), livestock (n=419) and ticks (n=1065) and used commercially-available kits to detect human and livestock CCHF virus (CCHFV) antibodies and antigen in tick pools. We developed boosted regression tree models to evaluate the correlates and geographical distribution of expected tick and wildlife hosts, and of human CCHF exposures, drawing on continent-wide data. The cross-sectional study found CCHFV IgG/IgM seroprevalence in humans of 10·3% (7·8-13·3), with antibody detection positively associated with reported history of tick bite (age-adjusted odds ratio=2·09 (1·09-3·98)). Cattle had a seroprevalence of 69·7% (65·1-73·4). Only one Hyalomma tick (CCHFV-negative) was found. However, CCHFV antigen was detected in Rhipicephalus (5·9% of 304 pools) and Amblyomma (2·9% of 34 pools) species. Modelling predicted high human CCHF risk across much of Uganda, low environmental suitability for Hyalomma, and high suitability for Rhipicephalus and Amblyomma. Our epidemiological and ecological studies provide complementary evidence that CCHF exposure risk is widespread across Uganda. We challenge the idea that Hyalomma ticks are consistently the principal reservoir and vector for CCHFV, and postulate that Rhipicephalus might be important for CCHFV transmission in Uganda, due to high frequency of infected ticks and predicted environmental suitability. UCL Global Challenges Research Fund (GCRF) and Pan-African Network on Emerging and Re-Emerging Infections (PANDORA-ID-NET) funded by the European and Developing Countries Clinical Trials Partnership (EDCTP) under the EU Horizon 2020 Framework Programme for Research and Innovation.