Title: NIHR Global Health Research Group on estimating the prevalence, quality of life, economic and societal impact of arthritis in Tanzania: a mixed methods study at University of Glasgow
Funder: Department of Health and Social Care

Abstract: A) Building on strategic objectives of UoG This work aligns with the University of Glasgow’s (UoG) strategic plan to be a world-class, world changing university and specifically, a place where research that positively impacts on the health, wealth and cultural wellbeing of the world is conducted, as laid out in ‘University of Glasgow, Inspiring People, Changing the World; University Strategy 2015-2020’. http://www.gla.ac.uk/media/media_410447_en.pdf Internationalisation is a central tenet underpinning this strategy and one evidenced in this proposal. B) Existing facilities The University of Glasgow (UoG), incorporates the Institutes of Biodiversity, Animal Health and Comparative Medicine (IBAHCM), Health and Wellbeing (IHW), and Infection, Immunity and Inflammation (III). These Institutes build on existing strengths within UoG and its partner organisations, bringing together experts from a range of disciplines. The University provides an excellent scientific environment with dedicated Master's degrees, including the MSc in Global Health, MSc in Health Technology Assessment, alongside Continuing Professional Development (CPD) Courses and tailored seminars, to build academic and non-academic skills. The Health Economics and Health Technology Assessment (HEHTA) Group has a dedicated project manager, managing a portfolio of international projects and supporting communications, public engagement, and knowledge transfer/exchange. UoG will contribute financially to this programme through investigator time and supporting study visits, as detailed in the justification of costs. C) Link to existing Institutional partnerships and strategies This application represents a unique combination of experts from these Institutes within UoG, working together for the first time to directly address global health challenges. This application will allow these researchers to uniquely consolidate their research strengths by combining expertise in health economics with One Health, social science and infection, immunity and inflammation. This team reflects strength in three of UoG’s research beacons: Precision Medicine and Chronic Disease, One Health, and Addressing Inequalities. This team is uniquely positioned to commence research in to how to improve arthritis diagnosis and management as build social science capacity in TZ. The proposal is led by Professor Emma McIntosh (IHW), deputy director of the Health Economics and Health Technology Assessment (HEHTA) group, who brings almost 25 years expertise in health economics' methodology and health intervention assessment, along with project management, line management and interdisciplinary research experience. Health economist methodologists are ideally positioned to lead such a proposal given the capacity for economic methods to be embedded within every stage of research from conception and design to data collection and analysis. Professor McIntosh is supported in this proposal by senior researchers and clinicians with a wealth of experience in research collaboration. This proposal builds on recent platforms established for our successful One Health programme in Tanzania through IBAHCM, to allow for further engagement with University colleagues in IHW and III and the College of Social Science. IBAHCM has recently secured permanent UoG funding for a new Chair in Environmental and One Health Economics and an associated lecturer post in One Health Economics based in HEHTA. These new posts represent a strategic and sustainable investment by the UoG to develop its capacity in addressing Global Health Research challenges. In addition, McInnes (III) recently led a pan-European task force that created the RheumaMap that in turn sets out a 10 year vision and research agenda for Rheumatic and Musculoskeletal diseases (RMD)s. This vision in part sets out to seek equality of access and detection of RMDs early and accurately and the provision of care as required initially in Europe but with a global agenda. Early recognition of disease has been captured in the recently launched “Don’t Delay, Connect Today” campaign whereby the European League Against Rheumatism (EULAR) seeks to promote early recognition and appropriate management of RMDs. McInnes will serve as President-elect of EULAR until 2019 and then become President of EULAR in 2019-2021. Via his EULAR role, McInnes interacts directly with the International League Against Rheumatism (ILAR) committee bi-annually and will thereby serve as a conduit for the group’s engagement with this critical advocacy group in favour of RMD patients throughout sub-Saharan Africa. D i) Partner involvement in prioritising research topics and themes Tanzanian partners have been involved from the inception of this project, particularly in the framing of the research questions. Face-to-face meetings with key Tanzanian partners were held in Glasgow in September 2017, to scope existing areas of unmet need in Tanzania. Professor Blandina Mmbaga, Director of the Kilimanjaro Clinical Research Institute (KCRI) has been instrumental in developing the research proposal and has identified key partners in Tanzania including the relevant District and Regional Medical officers and existing research infrastructures (including District Surveillance Survey teams). D ii) Plans for involving the users of research and other stakeholders. Based on recent evidence that LMICs are now encouraging increased public participation in health sector priority setting (Bolsewicz Alderman et al., 2013) we aim to establish, for the first time at KCRI, a Patient Public Involvement (PPI) group for joint pain/arthritis initially using DSS enumerators and workshops to facilitate initial focus groups (see WP 4/5). The aim of this group will be to use qualitative methods to document and describe the lived experience of those with joint pain/arthritis and for attendees to share common and divergent experiences. We shall exploit four channels of communication to ensure that knowledge generated makes impact. 1) Face-to-face engagement with policy makers and public through workshops, focus groups and training seminars. 2) Policy guideline reports from the study findings which will be written and shared with the national and international bodies responsible for Non Communicable Diseases. 3) Publication in international peer reviewed journals and conference presentations within and outside Tanzania will be done as part of the dissemination. 4) Use of media and information technology through websites and social media to inform the community of signs and symptoms of arthritis and preventive measures including raising awareness of possible links between joint pain and zoonotic infections. A communication plan with comprehensive overview of communication and dissemination activities with all stakeholders will be developed. The knowledge translation officer will work with the study team to identify the policy brief for the community and policy makers, which will include research findings and recommendations and strengthen communication for future planning. Lay language will be used to deliver policy communications e.g. in newspapers or media, to allow people to understand and utilise the system, and to sensitise health care workers, policy makers and other stakeholders.

Lay abstract: To date, most health research in Africa has been focussed on infectious diseases. However Africa is currently facing a preventable crisis caused by the rapid rise in people developing non-communicable diseases (NCDs) i.e. non-infectious diseases. In Tanzania (TZ), NCDs now account for 27% of all deaths. This burden is recognised by the TZ Ministry of Health, with development of a plan to prevent and manage NCDs. However, the focus on NCDs has been dominated by other diseases such as cardiovascular, cancer and diabetes, with little attention paid to arthritis. This is out of proportion to the impact that arthritis has on disability. Worldwide, musculoskeletal disorders are ranked the second most common cause of disability. A large global study reported that musculoskeletal diseases accounted for 20% of all years lived with disability in low and middle income countries, yet plans to reduce NCDs do not include musculoskeletal diseases. An ageing population has made this arthritis burden much worse. Lack of data exists on the frequency, economic, social and quality of life impacts of arthritis in developing countries. Another major gap that has been recognised in TZ is a lack of capacity for social science research and intervention science. Such capacity is needed for better management of NCDs and for improving the design of treatments for existing infectious disease problems. In addressing capacity gaps for NCD and intervention science research, this proposal addresses two priority areas for development of health research capacity in TZ. Our vision is for an enhanced TZ social science research capacity with an initial goal to measure the health and economic burden of arthritis, paving the early stages to better management. The research proposal was designed in collaboration with Tanzanian partners at the Kilimanjaro Christian Medical Centre (KCMC) a major teaching hospital and medical research complex. Widespread anecdotal evidence suggests arthritis is a specific area of local unmet need. In hospitals, arthritis is often underrecognised, symptoms incorrectly attributed to infectious diseases and its presence not captured in hospital admissions coding. Prevalence estimates from health systems or robust community surveys do not exist and the associated economic and social impact of arthritis poorly understood. This research, based on work packages and led jointly by co-applicants at the University of Glasgow (UoG), University of Newcastle, and partners in TZ is designed to: 1) Establish a Tanzanian Centre for Excellence in Social Sciences; 2) Design studies to identify the frequency of arthritis in TZ people by looking at hospital records and doing a household survey; 3) Understand and describe the quality of life, financial and social effects of living with arthritis; 4) Understand and test best research methods to measure quality of life of people with arthritis and measure impact on ability to work and usual activities; 5) Set up arthritis patient groups; 6) Support TZ researchers/clinicians in conducting sustainable research; 7) Train TZ staff in supporting postgraduate training programs in TZ/UK; 8) Provide international clinical and research experience and partnerships to TZ researchers; 9) Work with TZ policy makers to raise the profile of arthritis. Our proposal also aims to build capacity for developing the skills of TZ researchers in NCDs and social science by bringing together expertise at the UoG and research partnerships at KCMC.

Research activity codes: 8.5 RESOURCES AND INFRASTRUCTURE (HEALTH SERVICES)
Health categories: MUSCULOSKELETAL