Title: NIHR Global Health Research Unit on Global Surgery: Establishing a Sustainable Network of Surgical Research
Funder: Department of Health and Social Care

Abstract: Background: The NIHR Global Health Research Unit on Global Surgery (GSU) initially funded in 2017, established 7 surgical research Hubs (Benin, Rwanda, Ghana, India, Nigeria, Mexico, South Africa), coordinating research through more than 70 ‘Spoke’ hospitals across 3 continents, prioritised through LMIC led Delphi processes (2016-20). _x000D_ Research completed: A global randomised trial (RCTs) in wound infection prevention (5800 patients), second recruiting (11,000 patients), 4 prospective cohort studies (150,000 patients), 3 modelling studies, 7 pump-priming studies, 4 qualitative studies, 3 CEI projects and 2 guidelines, publishing 28 peer reviewed papers from this work. _x000D_ Proposal: In this funding envelope we will seek excellence through a new body of prioritised primary research, equitable partnerships through transfer of research leadership to the Hubs, sustainability through new Hub-based training centres._x000D_ We will achieve this across 4 domains:_x000D_ Domain 1: Research_x000D_ • Interventional: Practice-changing evidence to rapidly evaluate healthcare technologies to improve patient outcomes; with focus on postoperative mortality and surgical infection. We will complete 2 new global RCTs, selected from 4 pilot RCTs (completed by 2022)._x000D_ • Observational: Themed around transforming systems of care, 4 projects will aim to strengthen whole health-system resilience for the surgical patient by:_x000D_ (i) Improving access to emergency surgery by applying health economic models_x000D_ (ii) Using data to support decision making in the post-pandemic recovery period_x000D_ (iii) Developing research questions for a new integrated rural surgery network_x000D_ (iv) Hub-led cohort studies targeted towards local priorities_x000D_ Domain 2: Education and Training_x000D_ Establish sustainable research capacity through new Hub-led and delivered training and education programmes. These will be delivered by bespoke Training Centres, responding to LMIC training needs, facilitating South-South collaboration and be accessible to other global health researchers. _x000D_ 3 bespoke Training Centres are proposed:_x000D_ • Surgical Research Skills: Providing postgraduate training programmes (23 MSc & PhDs). _x000D_ • Data Training: Embedded digital technology, data management, and analysis capability._x000D_ • Management Training: To provide holistic research management support through the entire research programme lifecycle_x000D_ Domain 3: Community Engagement and Involvement (CEI) _x000D_ To date, we have established pathways into local communities by co-producing specific research projects with patient partners. Over the next 5 years, we will establish flexible, context-specific, and sustainable local CEI Steering Committees, coordinated through each Hub. CEI will be integrated into research prioritisation, research design and delivery, and act as a pathway to disseminate research to stakeholders._x000D_ Domain 4: Impact_x000D_ We are seeking to deliver practice change to benefit patients across continents, through high-quality research. This will be achieved through three key mechanisms, reaching from the individual patient through to international policy teams: _x000D_ • Health service delivery through patient groups and clinical workers _x000D_ • Informing national guidelines reaching national surgical societies, health service providers _x000D_ • Multi-stakeholder dissemination of our outputs globally, with integrated impact assessment._x000D_ Our impact will be evaluated and adapted during the programme, to begin sustainable transfer of ownership to the Hubs.

Lay abstract: Background: Surgery remains a major and under-addressed challenge in global health. Large proportions of patients in low and middle income countries (LMICs) lack access to safe, affordable surgery. We have demonstrated that this is leads to more deaths and infections after surgery than would be expected, exposing inequities that requires urgent solutions. _x000D_ _x000D_ Work to date: Over the last four years, we have set up seven surgical research Hubs in Benin, Rwanda, Ghana, India, Nigeria, Mexico and South Africa, that link out to 70 urban and rural hospitals. This network prioritised the surgical topics that needed research. Subsequently, they recruited 8000 patients into trials to test new surgical interventions and collected outcomes from 160,000 patients undergoing surgery from across the world._x000D_ _x000D_ Aims: In this application, we seek to establish sustainable surgical research in LMICs by transferring leadership, training and delivery to the Hubs. This will embed local ownership of the global research projects, ensuring relevance and responsiveness to local priorities, whilst preserving worldwide impact on alleviating surgical diseases. _x000D_ _x000D_ Methods: By pairing efficient processes with devolved responsibility to the Hubs, we have already completed a major trial (5800 patients recruited in 21 months) and have a further global trial and several smaller studies underway. This established network will now expand the research and accelerate delivery, to bring faster change to patients. The new research topics comprise: _x000D_ _x000D_ • Randomised Trials: These are the highest quality study type, providing evidence for the use of new techniques and devices. We will complete at least 2 global trials, selected from 4 smaller pilot studies, based around reducing infections and death after surgery._x000D_ _x000D_ • Non-randomised research: This body of work is aimed at transforming the whole pathway of surgical care. These projects will use a range of different methods (e.g. data and interviews) to influence four key areas: (i) how communities can increase access to emergency surgery, (ii) how hospitals can re-start surgery after COVID-19, (iii) incorporating rural patients/hospitals into all aspect of our research, (iv) setting up local studies, run locally, that can develop into international trials._x000D_ _x000D_ Training and Education: We have developed a major training package for future managers, researchers, and research leaders, to build sustainable surgical research and management capacity. Based around bespoke ‘Training Centres’ in the Hubs, these will promote Hub-Hub training, independence, and external funding opportunities. We will also support the current Hub Directors in increasing their leadership roles and influence._x000D_ _x000D_ Community Engagement and Involvement: We will expand our existing work with local communities within our Hubs to establish new community based CEI Steering Committees. Each committee will have responsibility for one global study and will support research from design to delivery, also piloting dissemination pathways to stakeholders._x000D_ _x000D_ Dissemination and Impact: Our aims are to empower frontline surgeons to bring about change for their patients, whilst advocating to policy makers for high level change. We will evolve our dissemination pathways, currently reaching 25,000 surgeons, and global and local stakeholders (including patients, surgical societies, WHO), to widely disseminate research findings.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.2 HEALTH AND WELFARE ECONOMICS;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE;8.5 RESOURCES AND INFRASTRUCTURE (HEALTH SERVICES)
Health categories: GENERIC HEALTH RELEVANCE