Title: NIHR Global Health Research Unit on Respiratory Health (RESPIRE) at The University of Edinburgh
Funder: Department of Health and Social Care

Abstract: Strategic alignment: We are aligned with UoE priorities in “Digital transformation & data” and “Influencing globally”, which highlight the untapped potential to develop mutually enriching, data-enabled partnerships to support transformational change. We will leverage the resources of Edinburgh Data Science and the Global Health Academy (GHA). More specifically, RESPIRE will synergise efforts from the Usher Institute of Population Health Sciences & Informatics (Usher), MRC Centre for Inflammation Research (CIR) with its clinical research expertise in respiratory disorders and the Edinburgh Clinical Trials Unit (ECTU) with its expertise in statistics & evaluation of complex interventions. Furthermore, it builds on multi-million pound grants in applied research in asthma (Asthma UK), COPD (MRC), influenza (Horizon 2020), pneumonia (Gates), RSV (IMI), lung imaging (EPSRC), TB (EDCTP), antimicrobial resistant lung infection (MRC), mHealth (FP7), data science (MRC/EPSRC), & health system governance (EU/WT). Existing infrastructure: RESPIRE will be based in the Usher, which houses the Centres of Global Health Research & Medical Informatics and is home to a large (>250) multi-disciplinary research group & a cohort of MPH (~50) & PhD students (~75). It hosts the Farr Institute, Asthma UK Centre for Applied Research (AUKCAR), RSV consortium in Europe (RESCEU) (~60 partners), RSV Global Epidemiology Network (>70 LMIC research groups) and WHO’s Collaborating Centre for Population Health Research and Training, and runs online Masters in Public Health, Family Medicine and Global eHealth. See accompanying letter detailing UoE’s institutional support. Partnerships & capacity/capability strengthening: RESPIRE will work through building respectful, reciprocal, sustainable relationships. These, for example, include the WHO PREPARE study which has assembled data on 200k pneumonia cases from >40 (mainly) LMIC groups to inform WHO global policy on pneumonia. We have partnered with countries in South Asia, namely Bangladesh, India, Malaysia and Pakistan: i) that have a high respiratory disease burden and unmet need; ii) with whom we have a proven track-record; iii) where there is opportunity to complement existing efforts; and iv) where there is institutional support to engage in transformative applied respiratory research in the poorest populations. This geographically focused approach will allow us to develop a regional network of excellence. Our key partnerships in these partner LMICs are detailed below. We also have the following UK/international partners: • University College London (UCL): We will draw on the expertise of Zumla’s team in infectious diseases in LMICs & also learn from their track-record of building equitable partnerships/capacity development, aligned closely to research/training needs. • Education for Health (EfH): We will capitalise on EfH’s track-record of training professionals (online & train-the-trainer approaches) in provision of respiratory care, including in partner LMICs. • International Primary Care Respiratory Group (IPCRG): We will leverage the IPCRG’s membership of the Global Alliance against Chronic Respiratory Diseases (GARD) and the global needs assessment/research prioritisation exercises and regional research workshops that we have undertaken with the IPCRG and partner LMICs, with a view to developing long-term alliances. Capacity and capability will be increased through collaborative working on programmes, running face-to-face/online research masterclasses, supporting secondments, increasing intake of Masters and PhD students from target LMICs, and collaboratively developing follow-on grants. We will follow the 11 principles of research partnerships promoted by GCRF/NIHR–for example, by: setting research agendas through joint decision-making and promoting mutual learning through close interaction among all partners; and establishing fair data access, authorship and other benefit-sharing arrangements. Our managerial procedures will ensure clear responsibilities of each partner and promote equal and respectful relationships. Research plans Context: Respiratory (communicable and non-communicable) disorders are responsible for very substantial morbidity and mortality in LMICs, but are currently relatively neglected by global research funders. Much of this ill-health is preventable through bridging the ‘second translational gap’. In the target LMICs, this necessitates a detailed appreciation of local challenges–for example, social stigma associated with diagnoses, limited appreciation of risk factors (e.g. smoking/biomass fuel exposure) and the role of self-management/ alternative therapies, high clinician workloads and limited continuity of care–using these to develop innovative tools/solutions that involve mobilisation of indigenous assets aligned with global opportunities. Based on our NIHR work with UK South Asians, we recognise the value of achieving impact by adapting/culturally tailoring interventions that have already been found to be effective in other populations. We will undertake implementation studies of adapted interventions in the context of acute lower respiratory tract infections (LRTIs) and chronic respiratory disorders. This will in the longer-term be complemented by the development of novel interventions for areas where there is no available evidence from other contexts through initiating relevant underpinning work leading to definitive trials. Vision: To achieve substantial reductions in morbidity/mortality from under-resourced respiratory disorders and achieve a step-change in national/regional infrastructures and capacity/capability in applied respiratory research. Aims: To establish a world-leading Unit that will: i. Map and collate continuing and emerging respiratory challenges; ii. Prioritise existing evidence-based interventions that have the potential to be adapted to reduce mortality/morbidity in LMICs; iii. Support local adaption/tailoring of interventions for deployment in low-resource environments and catalyse developmental work in areas of unmet need; iv. Support local implementation efforts and evaluation of programmes of work; v. Identify the best delivery mechanisms for long-term delivery/scaling-up. Objectives: We seek to: Short-term (1-2y) • Promote shared understanding and develop effective, reciprocal and ethical working relationships • Agree local research priorities, and commence adaptation projects in both research programmes • Identify research gaps that require more underpinning work and establish working groups to develop new grant applications. Medium-term (2-3y) • Ensure that the programmes of research progress according to plan • Increase capacity and capability in undertaking applied implementation research • Submit collaborative related follow-on grants • Develop sustainability plans. Long-term (3-4y) • Maximise the local, regional and global impact from the new knowledge and experience generated by RESPIRE • Jointly publish in top-tier journals • Communicate findings to professionals, policymakers and the general population • Apply learning to embrace new clinical contexts and expand partnerships • Secure follow-on grants to sustain RESPIRE activities into the future. Research programmes: We will develop research programmes in: 1) Acute LRTIs – i.e. bronchiolitis, bronchitis and pneumonia; and 2) Chronic respiratory disorders–i.e. asthma, COPD, bronchiectasis, lung cancer, and post-TB and -HIV chronic lung complications. Specific local projects will be prioritised in association with LMICs. Illustrative candidate topics are outlined under ‘Additional information’. Cross-cutting research platforms: We will develop cross-cutting platforms in: I) Stakeholder engagement; II) Capacity development; and III) Methodology and data science. These will be co-led by senior academics from UoE and partner organisations and will support individual research programmes, develop the infrastructure needed to increase capacity/capability and support sustainability/scaling-up efforts. Deliverables: • Short-term: Establish a vibrant RESPIRE network; agree a statement of health/research priorities in partner LMICs • Medium term: Complete formative evaluations; tranche of Masters graduates • Longer term: Publish summative evaluations with plans for sustainability; tranche of PhD graduates; generalisable learning to inform future work with LMICs. Partnership with LMICs/end-users: Our plans have been jointly formulated with partner LMICs. We will support LMIC partners (including academic, health policy and service provider and people living with respiratory illnesses) to identify priority gaps, adapt and evaluate interventions and develop strategies for scaling-up successful interventions. Plans for commissioning research: Resources will be made available to partner LMICs to undertake internal workshops, prioritisation exercises and early-stage descriptive/qualitative work. Responsive mode: We can play this role in the context of pandemics (e.g. influenza, as we currently do for the HTA), antimicrobial stewardship, and data science/security through, for example, shifting resources/staff, to convene expert working groups. Sustainability plans: We have a strong track-record in leveraging additional funding (e.g. 5x increase for AUKCAR within 3 years; successful long-term highly productive research programmes run by RESPIRE partners). By focusing on high prevalence, high burden conditions that have been neglected and affect the poorest populations, we have identified areas of likely growth. We see opportunities to expand to other respiratory priorities–for example, air quality, occupational lung disorders & respiratory co-morbidities. We will use our government/NGO and public/private sector networks to advocate for funding.

Lay abstract: The NIHR Global Health Research Unit on Respiratory Health (RESPIRE) at The University of Edinburgh aims to reduce the number of deaths and the burden of respiratory diseases globally, with an initial focus on South Asia where respiratory conditions account for around 1 in 5 of all deaths. Furthermore, awareness of the relative importance of respiratory disease is low and these conditions have not attracted the attention and priority they deserve from health systems, policymakers and funding agencies nationally, regionally in South Asia or globally. Strengthening collaborations with leading research groups in four large South Asian countries, namely Bangladesh, India, Malaysia and Pakistan, the RESPIRE collaboration builds on a track-record of epidemiological research and capacity development in low- and middle-income countries (LMICs) and leverages critical mass in respiratory, informatics and health services research hosted at the Usher Institute of Population Health Sciences and Informatics at The University of Edinburgh (UoE), UK. RESPIRE focuses on two programmes of research with three underpinning platforms. Research Programme 1 addresses the continuing challenge posed by acute infections such as pneumonia (which still causes very high levels of severe morbidity and mortality in South Asian children and adults and contributes a substantial proportion towards global child mortality from pneumonia). Research Programme 2 addresses long-term non-communicable diseases (NCDs)which often develop and worsen over time, including asthma, chronic obstructive pulmonary disease (COPD) and lung cancer. These two research programmes are supported by an underpinning infrastructure of three cross-cutting platforms: Platform I: Stakeholder Engagement & Governance; Platform II: Training & Capacity Development; and Platform III: Methodology & Data Science. RESPIRE is working to develop collaborative, reciprocal and ethical relationships with its Partners in South Asia and to build capacity and develop capability for Partners to undertake research that is robust and which progresses the global respiratory health agenda whilst also being responsive to and relevant for each particular country’s context and priorities. It is seeking to address issues that have been identified as a priority for applied research and action by RESPIRE Partners and to focus on problems of the poorest population groups in these countries, where possible. Our overall approach is to work to enrich already existing local cohorts and/or develop new cohorts and then embed studies within these to enable provision of resources, and capacity building, which continue to benefit our Partner LMICs. We began by identifying and prioritising foundational, low cost, within country projects and supporting PhD studentships, and progressed to developing more ambitious, cross-country projects which are all commencing during 2018.

Research activity codes: 1.5 RESOURCES AND INFRASTRUCTURE (UNDERPINNING)
Health categories: CANCER AND NEOPLASMS;INFECTION;RESPIRATORY