Our science is delivered through the following six programmes feeding into each theme:

HIV Epidemiology and Intervention Programme

Programme leader : Dr. Eugene Ruzagira 

Summary

Work under the HIV Epidemiology and Intervention Programme has two broad aims. Firstly, to prevent acquisition of new HIV infections; and secondly to improve survival and quality of life among people living with HIV. To address these aims several scientific projects are being undertaken partly by the Unit, and partly through scientific collaboration with our long-term partners and institutions in Europe, USA and Africa. The programme underwent a prolonged transition period without a dedicated programme lead. Caretaking of the programme was assured by other Senior Scientists from PGPI and SOC programmes, whilst the HIV epidemiology was under the umbrella of the Cancer Epidemiology programme.

Cancer Epidemiology Programme

Programme leader : Prof. Robert Newton

Summary

Activities of this Programme have focused primarily on understanding the epidemiology, transmission and pathogenesis of cancer-causing infections. We have previously shown that cancer is the most common non-communicable disease (NCD) in Uganda and that oncogenic infections account for up to a quarter of all deaths – more if you include HIV. With one doctor per 8,300 people in Uganda and limited cancer-specific expertise, resources for diagnosis and treatment are sparse and most cancers present late, if at all. Our population-based research is unique in SSA and is driven, therefore by the need for cancer prevention. Given the ubiquity across sub-Saharan Africa (SSA) of viral carcinogens, opportunities for impact via policy-based public health interventions are far-reaching.

Over the last year, we have been successful in obtaining funds for work within our rural population cohort - the General Population Cohort (GPC) - on the major causes of cancer in Uganda and in the wider region: Kaposi’s sarcoma-associated herpesvirus (KSHV; the cause of Kaposi’s sarcoma), Helicobacter pylori (H. pylori; the cause of stomach cancer, lymphomas and gastric/duodenal ulcers), Human Papillomaviruses (HPVs; the cause of cervical and other ano-genital cancers and some oral cancers) and Hepatitis B Virus (HBV; a cause of malignant and non-malignant liver disease). The various activities are aimed at reducing transmission and pathogenesis of these key oncogenic infections and are described in more detail below.

Social Aspects of Health Across the Life-Course Programme

Programme leader : Prof. Janet Seeley

Summary 

The aim of the programme is to further our understanding of the social aspects of health and wellbeing for specified individuals and populations to inform the design, implementation and evaluation of interventions, as well as contribute to policy development. We work primarily across HIV and Non-Communicable Disease themes, and are beginning to develop work related to Vaccines, all in close collaboration with the relevant programme teams.

Specific objectives

This programme focuses on different stages of the life course and specific populations: 1) Children and adolescents; 2) Key (at-risk) populations; 3) People 50 years and older. Each focus area is led by two to three Ugandan senior members of the programme team. We partner with colleagues working in other programmes in several different projects as well as in the projects which we lead. Developing effective multidisciplinary approaches to research is a key part of our work. We focus in this report on the projects we lead or those where we have substantial input. Other projects, in which we play a role, will be reported under the lead programme’s report.

Pathogen Genomics Phenotype and Immunity Programme

Programme leader : Prof. Pontiano Kaleebu

Summary

This programme aims to conduct research that will lead to better understanding of pathogen genomics in order to characterise diseases and epidemics for better control and to investigate virological, immunological and genetic factors required for the development of effective interventions against HIV-1 and other infections. The HIV epidemic is monitored through genetic characterisation. We are using molecular in combination with social-epidemiological and modelling approaches to provide novel avenues to monitor epidemic trends and transmission dynamics, and to contribute to targeted interventions through the identification of transmission clusters and hotspots. We are monitoring the emergence of HIV drug resistance (HIVDR) and contributing to intervention against HIVDR development. We are investigating whether transmitted/early HIV-1 viruses have recurrent patterns (signatures) that distinguish them from chronic viruses. We are investigating whether Zika virus exists among humans, primates and mosquitos in Uganda and conducting studies to molecularly characterize the Zika genome.

We are investigating the host and viral factors associated with HIV Superinfection. This information will contribute to knowledge on protective immune responses. We are conducting studies of the potential protective immune responses against HIV through PrEP in highly exposed populations. This is in order to explore whether exposure to HIV under PrEP cover could induce immunity equivalent to that afforded by a live attenuated vaccine. We are participating in other studies to contribute to HIV vaccine research and development such as sensitivity of HIV transmitted viruses to broadly neutralizing monoclonal antibodies. We are participating in other vaccine work such as Ebola and RVF. Finally, we are part of studies aimed at understanding the role of pre-existing status of the immune system and presence of endemic infections on hepatitis B vaccine responses.

Immunomodulation and Vaccines Programme

Programme leader : Prof. Alison Elliot

Summary

The I-Vac programme undertakes vaccine trials, studies addressing the immunomodulating effects of infection exposure on vaccine responses and other health outcomes, and related studies on the immunology and management of tuberculosis and schistosomiasis.

Our principal goal is to understand the impact of infection exposure on human immunological programming and health. Our overarching hypothesis is that chronic and cumulative infection exposure influences immunological mechanisms through active processes (during current infection), lasting epigenetic modifications, and genetic selection; that (therefore) some effects do not immediately respond to treatment; and that effects critically impact upon major health outcomes including vaccine responses and susceptibility to pathogens, allergy-related disease and metabolic conditions. The main focus of our new work is on vaccines, addressing the role of infectious exposures in population differences in vaccine immunogenicity. We are also continuing allergy-related and metabolic studies.

NCD Phenotyping Programme

Programme leader : Prof. Moffat Nyirenda

Summary

The long-term vision is to build the infrastructure and scientific leadership to develop excellence in NCD research and training that is accessible and future-proof for conducting aetiological, evaluation and implementation research, which will stimulate improvements in prevention and control of these disorders in Uganda and the region.

Specific objectives

With an initial focus on cardiometabolic disorders, notably diabetes, the goal of the NCD Phenotyping programme is to understand the determinants and mechanisms that underlie differential manifestations of these disorders in Africa, in order to inform local intervention strategies. Specifically, the programme aims at:

1. Understanding the pathophysiology and risk factors for diabetes in Africa, and their influence on differential manifestation of this condition in the region.


2. Improving the outcomes of diabetes in sub-Saharan African through better diagnosis and management.


3. Understanding the interactions between infection (notably HIV) and common NCDs (diabetes/hypertension), and designing and testing models of integrated care.