NIHR GRP: Preventing Healthcare Associated Infection and Antimicrobial Resistance in Africa The NIHR Global Research Professorship scheme is open to all professions and Higher Education Institutions in England and the Devolved Administrations, to nominate health researchers and methodologists with an outstanding clinical and applied health research record and its effective translation for improved health. Global Research Professors are required to have existing strong links with partners in institutions in countries on the OECD DAC list and the award should plan to support training and capacity development in these partners.
To address Healthcare Associated Infection (HAI) in Africa, I will use cutting edge molecular microbiology and mathematical modelling to investigate the implementation of the WHO framework for Infection Prevention and Control (IPC) in Malawi. Key to this will be the development of equitable partnerships with the Ministry of Health and College of Medicine. I will use the data to develop effective, acceptable and scalable interventions to reduce HAI in Africa.
Hospitals are perceived as places of safety, however the concentration of vulnerable people, staff and visitors makes maintaining safety a major challenge that requires the involvement of multiple professional groups and patients, staff and visitors.
Infections contracted because of admission to hospital, or exposure to other healthcare facilities are the most common adverse outcome associated with healthcare settings globally. Further, the germs, specifically bacteria, associated with HAI are increasingly resistant to antibiotics, making the treatment of HAI an increasing challenge. It is therefore best to prevent HAI.
IPC is the term used to describe strategies to prevent HAI and the WHO has published a substantial body of work to support the implementation of IPC in low- and middle-income countries (LMIC). However, HAI and IPC are often not prioritised in LMIC due to lack of resources and multiple competing priorities.
I will work in three government hospitals in Malawi. The project will be based at the Malawi Liverpool Wellcome Programme and will run in partnership with the College of Medicine, Ministry of Health and African Institute of Development Policy (AFIDEP). I will implement my project in 4 workstrands:
1)	Implementing IPC strategy: The priority will be to convene a national steering group to build an equitable partnership and reinvigorate existing ministry of health IPC teams. We will assess previous IPC strategies. I will conduct clinical and laboratory surveillance of HAI before implementing an IPC programme co-created with partners. Assessment of effectiveness of the implementation will be made and shared with policy makers.
2)	Using mathematical modelling to understand the intervention: I will recruit cohorts of patients with different types of HAI and study them in-depth by capturing comprehensive patient and bacterial data before and after implementation for key HAI syndromes. I will use cutting edge microbiological tools and mathematical methods to analyse these data and iteratively improve the IPC programme.
3)	Health economics: We will estimate the cost of HAI, and then evaluate cost effectiveness of interventions to enable policy makers to make recommendations about targeting efforts.
4)	Policy: We will actively involve MoH and CoM throughout the project, co-creating nationally scalable IPC interventions.
We will involve patents and the public in co-producing IPC strategy and interventions and in doing so raise the profile of HAI, IPC and AMR in Malawi, in partnership with MLW’s community advisory group.
Our findings will be shared with the WHO Infection Prevention team and more broadly to the academic community through presentation and peer-reviewed publication. We will engage with the public through MLW’s communications team, using radio, print and social media, and share information with hospitals through peer education meetings, and with the Ministry of Health through relevant technical advisory groups. Objectives

In equitable partnership with a national-level IPC steering group, to reinvigorate local IPC teams in three hospitals in Southern Malawi;
Establish clinical and microbiological HAI surveillance, then implement, test and improve the WHO guidelines on IPC, investigating their effectiveness within an implementation science framework;
Assess the efficacy of IPC implementation using descriptive epidemiology, high resolution molecular surveillance and causal inference;
To estimate the economic burden associated with HAI, and cost-effectiveness of IPC
Co-create acceptable, sustainable, and nationally generalisable guidelines, policy and protocols to mitigate HAI in Malawi in partnership with College of Medicine and Public Health Institute of Malawi.