Assessing hepatosplenic morbidity attributable to schistosomiasis and HIV or HBV co-infections in rural Uganda

BACKGROUND

Human immunodeficiency virus (HIV), hepatitis B (HBV), and Schistosoma mansoni (a parasitic blood fluke) all cause chronic infections that affect the liver and are highly prevalent in sub-Saharan Africa. Coinfections exacerbate liver pathologies including the severity of liver fibrosis that might ultimately lead to liver failure. In rural Uganda, the prevalence of S. mansoni is over 50% in children and adults; whereas HBV and HIV are over 9% in adults aged 16 years and older though not necessarily the same individuals. HIV, HBV, and schistosomiasis have been separately associated with low socioeconomic status. Despite their shared morbidity and social pathways, little is known about the co-distribution of these infections and their shared influence on liver pathologies including fibrosis, cirrhosis, and portal hypertension or its complications.

RESEARCH EXPERIENCE, RESEARCH METHODS AND TRAINING

This project will use data from an ongoing cohort study (SchistoTrack) in rural villages in Uganda where HIV, HBV, and S. mansoni are endemic. Ethical approvals have been obtained. The baseline and three annual follow-ups will be completed prior to the start of this DPhil project. Two more years of follow-up will occur during the timeframe of this DPhil. More information about the cohort. Rapid diagnostics for HIV (including viral load), HBV, and schistosomiasis will be available with also microscopy data for schistosome infections. Detailed information will be available on demographics, socioeconomic status, and water, sanitation, and hygiene access/behaviours, ecology, household location, health care access, and case management within primary health care centres. Data from point-of-care ultrasounds is available to evaluate liver pathologies.

Students should choose either to work on HIV and schistosomiasis, or HBV and schistosomiasis to invest in understanding fully the pathogenesis of one virus and as the populations at-risk differ within SchistoTrack.

Aims:

1. Establish the morbidities associated with singular viral infection.
2. Identify schistosome and viral interactions and their influence on hepatosplenic pathologies either cross-sectionally, through case-control, or using the prospective cohort design.

The student will gain skills in systematic literature review, primary data collection, clinical epidemiological data analysis, disease pathogenesis, community engagement, statistical programming, data cleaning, and research presentation.

FIELD WORK, SECONDMENTS, INDUSTRY PLACEMENTS AND TRAINING

This DPhil project requires one to two months of fieldwork in rural Uganda. Experienced SchistoTrack teams will lead the primary data collection.

PROSPECTIVE  STUDENT

The ideal candidate will have a Master’s degree in statistics/epidemiology/public health or a related discipline. This post is particularly suited to someone with a clinical or biomedical background.