Clinical Research Office. A partnership between Sheffield Teaching Hospitals NHS Foundation Trust and the University of Sheffield

Academic Directorate of Communicable Diseases

Interested in getting actively involved in what we do? Click here to find out more about our Lay Advisory Panel for patients and carers with experience of Meningitis, Hepatitis B  and C Tuberculosis Influenza and Clostridium difficile

 

Click here for the Academic Directorate of Communicable Diseases Research Strategy

 

 

Key Contacts

Name

 Role                       

Email
Telephone number
Dr Karen Rogstad  
Research Lead - Infectious Diseases     

0114 2713548    

Dr Josh Wright Clinical Director josh.wright@sth.nhs.uk 0114 2711738
Ian Scott
Operations Director
0114 2265052
Kath Knight
Deputy Operations Director
0114 2268266
Fiona Wolfe
Service Manager
0114 2711876
Julie Senior
Deputy Group Finance Manager
0114 3052076
Sarah Moll
Directorate Research Coordinator 
0114 2713910
Aimee Card
Clinical Research Office Coordinator
0114 226 5945
Gaurika Kapoor Clinical Research Office Coordinator (Industry-Sponsored Studies) gaurika.kapoor@sth.nhs.uk

0114 226 5939

Tracey Sutton
Research Administrator 
0114 2711889
Andrea Long
Research Administrator  
S. Yorkshire & the Humber Local Speciality Group for Microbiology & Infection
0114 2712285

 

Introduction

The Directorate of Communicable Diseases now includes the Departments of Infection & Tropical Medicine (ID), Genitourinary Medicine (GUM), Sheffield Contraception and Sexual Health and the Centre for HIV and Sexual Health. It is widely regarded as being progressive, innovative, and well-managed, with excellent evidence-based clinical services, and robust finances. The Directorate has been active in developing their research infrastructure, appointing a number of Research Nurses, a Research Coordinator and a Research Administrator. There is an established Research Executive Committee, which meets monthly and actively promotes and monitors research activity across the Directorate ensuring it is aligned with the Trust’s and Directorate’s research strategy. The Directorate includes one University Professor (while the directorate is actively recruiting to a recently vacated University chair. and 2 Honorary Chairs. The Directorate includes an undergraduate dean. It is a major contributor to undergraduate and postgraduate teaching of Clinical Microbiology, Infectious Diseases and Genitourinary Medicine in South Yorkshire nationally and internationally. 

The Directorate became an Academic Directorate in Autumn 2011.

Research Themes/Key investigators

No. Theme Basic concept Key investigators
1. Hepatitis Investigation of epidemiology, clinical manifestations, basic science and management including care pathways.
Dr B Stone,
Consultant Physician, ID
Dr K E Rogstad, Consultant Physician, GUM
Dr Alicia Vedio
Consultant Physician, ID
Dr Ray Poll,
Nurse Consultant, ID
2. Severe Community Infections Investigation of the mechanisms, complications and management of respiratory tract and other serious community acquired infections.
Dr Paul Collini
Dr Julia Greig
3. Vaccination Investigation of responses of patients and volunteers to putative and novel vaccines.
Dr Thushan de Silva
Prof Steve Green
Dr Tom Darton
4. HIV Investigation of the mechanisms, management of HIV infection and its complications.
Dr Thushan de Silva
Dr Paul Collini
Dr Karen Rogstad
5. Sexual Health and Public Health Investigation of epidemiology, prevention and management of STIs in adults, adolescents and children including novel service delivery methods, Public Health research on STI’s including HIV, viral Hepatitis, sexual health, domestic and sexual violence, TB.
Dr Claire Dewsnap
Clinical lead, GUM
Dr Karen Rogstad
Consultant Physician, GUM
Gill Bell,
Nurse Consultant, GUM
6. Outpatient Parenteral Antiobiotic Therapy (OPAT) and Operational Research Clinical research into the development and use of OPAT; other operational research across a wide range of sub-specialty areas.
Dr Julia Greig
Dr Ann Tunbridge
Dr Kat Cartwright

 

Theme 1:  Hepatitis – Research Leads Dr B Stone/Dr K E Rogstad (other key investigators Dr Alicia Vedio and Dr Ray Poll )

Hepatitis C virus (HCV)

The directorate has utilised research nurse support from the CRF and identified recruitment into the MRC Hepatitis C virus (HCV) UK consortium as a priority area over the last two years. We will continue to recruit to national HCV studies as these become available. There is active discussion to establish the department as a centre for investigation of new Directly Acting Antiviral agents and potential funding will be sought from Industry. Discussions with a number of industry partners have been conducted with planned participation in new trials of antivirals in the management of HCV. We will aim to attract at least one clinical directly acting antiviral (DAA) HCV study in the next 12 months to be lead by Dr Stone and/or Dr Rogstad. Work will also be undertaken to evaluate the psychological aspects related to hepatitis C infection and management; funding will be sought from one of the NIHR funding streams following guidance from the Research Design Service. We plan to conduct pilot work in this area with the aim of an NIHR application in 24-36 months. There is also potential to expand some of the basic research on complications of chronic infection, such as those Dr Stone conducts in HIV, and applying this to the HCV population. Dr Stone will look at opportunities to develop this as pilot work utilizing B Med Sci students or other staff to start to explore some of the consequences of HCV to bone health along the lines discussed below for HIV, although this is a longer term aspiration (≥ 36 months time span).


Hepatitis B

During 2014/15 the directorate will continue to develop and evaluate outreach educational programmes for public and health care workers about hepatitis B virus infection (HBV) in English and other languages. A recent DoH/NIHR award focuses on issues relating to hepatitis and access to treatment in the Chinese and South-east Asian community living in South Yorkshire (CATH-B) and South Tees. This study lead by Dr Vedio will aim to reach its recruitment target over the next 12 months. Senior Public Health researchers and social scientists from the School of Health and Related Research (ScHaRR) are collaborators in this study. 

Ray Poll, Nurse Consultant for Viral Hepatitis is actively involved in service development, service evaluation and research.  In partnership with colleagues he has set up nurse led clinics for patients affected by hepatitis within the hospital and in drug misuse services.  

He  was awarded Doctor in Professional Studies in September 2014.  His research investigates ‘Non-attendance at drug service hepatitis C outreach clinics: clients and staff experiences’.  Over the next few months he will be liaising with the NIHR Collaborative Leadership in Applied Health Research and Care for South Yorkshire to discuss opportunities to undertake post-doctoral research in evaluating interventions designed to improve attendance and engagement with clinical services. Our goal is that this will generate at least one publication in the next 12 months and pilot work will be commenced in the next 12 months leading to a further application from the NIHR or alternative sources for funding in the 24-36 months. There is a high level of patient involvement in this theme with a number of hepatitis members on our Community infection and hepatitis PPI group. This theme will impact hepatitis care through observational studies, contribution to clinical trials involving DAA and qualitative research addressing access to care and testing of at risk patient groups.​​​​​​​

Theme 2: Severe Community or Hospital based Infections – Dr Paul Collini and Dr Julia Greig

This theme builds on extensive collaboration across the University through the Florey Institute  for Host-Pathogen Interactions and utilises research from both within the medical school with strong links to the Department of Infection and Immunity in the Medical School. This theme involves both molecular and animal based programmes, which are being translated into different patient groups. There is a strong record of MRC/Wellcome trust funding and this has formed the basis of successful clinical fellowship applications (Three current, two former and two in submission). It has also lead to successful involvement in the MRC consortium COPD-MAP (£6M award funds £0.5M Sheffield) investigating the basis of respiratory infections in COPD and active participation in the research councils lead initiative into antimicrobial resistance (AMR) with recent awards from the MRC Innovation call and bids submitted to form a Florey based consortium (£3M bid) and as contributors to the ESPRC AMR bridging the gaps initiative (£0.6M bid). In the next year we will advance the Florey consortium bid for application in 18 months’ time in 2016, as per the MRC timeline.

Host susceptibility to severe infection.

Our basic science programme investigates the host response to S. pneumoniae and S. aureus in particular (aligned with the focus of the Florey Institute). Our programme investigates the basis of the host response to bacterial or viral infection leading to bacterial super-infection and has the over-arching goal of understanding the basis of disease susceptibility (so that we can target preventive strategies to those who need them) and so we can develop host based approaches to treatment (that will remove our reliance on antimicrobial therapy and hence limit the emergence of antimicrobial resistance). Current MRC/WT clinical research fellows are engaged in projects examining the evolution of virulence factors in S. aureus, determining the role of epigenetic modifications induced by prior infection as a marker of susceptibility to pneumonia and in understanding how pneumococcal pneumonia may modify macrophage phenotype in atherosclerotic plaques to modulate cardiovascular risk. Two fellowship applications are in review  (MR/WT for one applicant) and a further two for our next ACF will be submitted in the next 12 months. There are also two small industry based projects (with GSK) and it is hoped that these and the work with ABPI partners as part of the COPD-MAP consortium can lead to MRC-MICA applications in the next 12-24 months. The industry input is a particularly strong model of how investigator led original findings can be translated by industrial partnership in an effort to move our discoveries to new therapeutics available in the clinic. These studies are a major contributor to the directorate’s accruals typically resulting in 30% or more of our overall accrual and also contribute significantly to the Trusts experimental medicine programme currently forming one of the pillars of the NIHR CRF experimental medicine programme.

Therapeutic strategy and diagnostics.

Dr Julia Greig is local PI for several studies investigating optimal treatment of S. aureus infection (ARREST, OVIVA) that actively add to the directorate’s accrual. A current bid is in place to the Binney charity to ensure additional research time for Dr. Greig. If successful this will allow Dr Greig to start to establish a unique collection of clinical strains of S. aureus and S. pneumoniae the first of which will be a collection of S. aureus discitis strains. These will be shared with Florey Investigators and will further foster close ties between clinical and basic science in Sheffield with the goal of facilitating Sheffield lead research and enabling a translational component to future clinical research training fellowship applications. We also aim that Dr Greig will be making her own grant applications within 36 months if she obtains some research support. We will aim to attract funding for Dr Greig and ethics for this initiative in the next 12 months. Dr Johnson a trainee in microbiology, has a Wellcome Trust Research Clinical Fellowship to examine the interrelationship of key strains of S. aureus causing clinical infection and using this to probe understanding of key virulence factors (working in the laboratories of Prof Simon Foster and Prof Steve Renshaw, University of Sheffield). We will apply these approaches to Sheffield based clinical collections collected by Dr Greig. We also play an active part in investigations into community viral infections.  Particular emphasis will be to ensure effective recruitment to clinical trials and continue to recruit industry trials to Sheffield. There also studies of viral infections in patients with lung disease (PI Prof Sabroe respiratory medicine and co-investigator Prof Dockrell with MRC funding). There is also ongoing research into C. difficile infection (Industry) and the directorate will continue to bid for further industry trials.

PPI input for this theme also comes from the community infection and hepatitis group (RAPID). This theme provides a strong basic science perspective on susceptibility to infection and targeting antimicrobial resistance through alternative host-based therapies. It is well funded and is closely aligned with the University research strategy through the Florey Institute. It also provides a true bench to bedside research platform. It also has a global reach. This theme is also a cornerstone of the CRF’s experimental medicine programme along with our HIV work in theme 5.

Theme 3: Vaccines – Research Lead, Dr Rogstad (also Prof Green, Dr de Silva and Dr Darton).

The directorate has a longstanding reputation in vaccination studies supported by some major studies, such as CARRIAGE and involvement in work which has lead to some high impact publications e.g. Lancet. And work which was recognised nationally as a beacon for NIHR – commercial partnership research. Dr de Silva has secured BHIVA funding to investigate two vaccine approaches (double dose Engerix vs. Fendrix) to enhance immune response to Hepatitis B immunization responses in HIV. This study will commence in early 2015. Dr de Silva is also leading a project with start up funding from the Academy of Medical Sciences as part of their NIHR lecturer grant scheme to apply a systems biology approach to the investigation of immune responses to live influenza A virus infection. This study completed enrolment in October and the participants are in follow-up. This data set will be interrogated and developed to form the basis of an Intermediate Fellowship application by Dr De Silva to the MRC, Wellcome Trust and possibly also NIHR-applications due in next 6-12 months.

This theme also builds on studies in collaboration with University researchers in particular with Prof Heath,  Dr de Silva and Prof Heath have an MRC application already submitted. There are plans to conduct an industry based study of C. difficile vaccination and one with European collaborators to study immune responses to Yellow Fever. There are also ongoing discussions between Dr De Silva, Prof Green and Prof Dockrell with Prof Snowden and Dr Chantry in haematology with the view of developing studies in haematology patients particularly those postransplantation and this is an area we believe we could develop for future NIHR bids over 24-36 months. Discussions are ongoing and the first steps would be to obtain some ethical approvals and conduct some pilot work. This theme is also strengthened by the recent appointment of Dr Tom Darton as NIHR lecturer from Oxford. Dr Darton has a track record in vaccine research involving typhoid and can provide a global dimension to our vaccine work while Dr de Silva has established links to work with cohorts in the Gambia as part of his on-going programme. Dr Darton will develop his programme over the next 12 months in Sheffield and we would anticipate he will make an application to the Academy of Medical Science in the next 18 months to support initial research. This is one area where we believe we can demonstrate our research has global impact and wish to use this as a template  to help us demonstrate similar impact in the future in other areas such as severe infections and HIV. This research theme builds on existing strengths and also brings together university and NHS research staff. It provides a practical translational approach investigating the immunological basis of licensed and developmental vaccine strategies and has impact that extends beyond the UK.

Theme 4: HIV – Research Lead Dr Karen Rogstad and Dr Paul Collini (also Dr de Silva)

HIV research bridges each of the translational gaps and also involves the Directorate with a South Yorkshire – wide HIV Clinical Research Network (SYHN). There are strong links to the University and Basic Science in the Department of Infection and Immunity and investigator’s work in the category 3 laboratories in the University. There are established links in the Medical School  with human metabolism (metabolic bone research with Prof McCloskey), oncology (KS clinical trial work with Prof Woll) and respiratory medicine (Research bronchoscopy with Prof Sabroe and lung imaging with Prof Wild). The research in this theme is central to our overall strategy and overlaps that in all other themes particularly our work on sexually transmitted infection (STI) transmission and prevention, HIV bacterial co-infection work and our strong HIV-related vaccine programme. There is also a very well developed pipeline of industry supported trails and this forms a template we wish to use to develop industry based studies in other themes notably hepatitis, severe infections and vaccines.

HIV pathogenesis studies

 Dr B. Stone has secured industry funding (ViiV healthcare) to work with Prof E. McCloskey (Metabolic Medicine) and Prof D.H. Dockrell and this work has been prioritised for accruals in 2013/14. He is funded by an award of research PA support from the Sheffield Hospitals Charity and a grant from ViiV healthcare. He is registered to undertake an MD at the University of Sheffield based on his research. On completion of his project the aim is to apply for further NIHR funding (24-36 months).

Dr Collini an NIHR lecturer is studying pulmonary infection in HIV and in 2015 he will be applying to the AMS for funding to enable collection of data towards his advanced fellowship application to the MRC/NIHR and WT in 2016. His work builds on the findings of his MRC Clinician Training Fellowship (2010-13) and the award of his PhD in 2014. Dr Collini is performing a study involving research bronchoscopies on HIV-positive individuals that investigates the viral and immunological determinants of chronic lung inflammation in people living with HIV. Dr Bowman is local PI for a multi-centre study to recruit samples for a genetic analysis of elite controllers (EXOME study).The initial recruitment phase completed in July 2014 and discussions continue around the next steps of this project.

Optimizing ART and other therapies.

There is also a strong track record of investigational therapy in HIV, including SCART, a Sheffield led multi-centre phase 1 study of a novel kinase inhibitor, targeting MEK in the treatment of Kaposi’s sarcoma (KS) in collaboration with oncology (Prof P J Woll and Dr R Young), which started recruiting in 2012. By October 2014, SCART had successfully completed phase 1 of this study and is continuing to recruit in phase 2. Other phase I/ 2 studies include a recent multi-centre HIV vaccine trial in which we participated, and others are in discussion. There are plans to conduct pilot work on neurological disease and the psychological input of HIV and also to support novel diagnostic approaches in select patient groups, in association with the neurosciences directorate and academic clinical psychology. It is anticipated this work will help adherence to lifelong antiretroviral therapy (ART) and will help develop research skills in our non-medical healthcare workers including nursing staff. We are also heavily involved in Industry and MRC/INSIGHT and industry based studies of ART. These provide access to newer therapies that might not otherwise be available to our patients and enhance industry participation. In 2014 /15 active studies include the MRC START trial, the extension phase of MRC PIVOT, the ViiV ARIA study and Gilead GS-US-236-0140. We are in discussions with other companies about four other industry trials including BMS and JACG about other studies

Dr Bowman is local PI for the Health Protection Agency ( now Public health England, PHE) and Gilead funded PROUD study; a preventative study of HIV. The study underwent substantial protocol change in October 2014 as a result of interim data analysis that demonstrated successful endpoints for efficacy of Pre- exposure prophylaxis to prevent acquisition of HIV in high risk MSM (men who have sex with men). A larger study examining sustainability of response and HIV viral resistance development is undergoing the necessary regulatory approval and plans to commence in 2015.

The directorate will use a new computer system to ensure increased collection of HIV data; this initiative will enable an application to join UKCHIC, a national database of approximately 50,000 HIV positive individuals. Ethics approval has already been submitted and once the new computer system is operational we aim to collect data on over 800 patients whose data will also count towards portfolio accrual. It is not clear when all the relevant IT issues will be finalised but we anticipate we may be able to commence collection of UK CHIC data in 24-36 months.

HIV service delivery

Dr C.A. Bowman as Chief investigator, together with Gill Bell as joint PI with Hilary Piercy from Sheffield Hallam University, designed and developed the portfolio adopted national multi-centre qualitative study of the role of the advanced nurse in the delivery of HIV care ANCHIVS. Funding is from an unrestricted educational grant of £127,000 from ViiV healthcare. The study started in April  2014, phase 1 is complete ( results were presented at the National HIV Nurses Association (NHIVNA) conference in 2014), phase 2a started in September  2014. and will continue in 2015. Gill Bell as PI, successfully completed a project in collaboration with the directorate’s HIV Lay Expert Advisory Panel (LEAP) members,, developing and evaluating a Nurse Led Adherence Service Study (NLASS) to explore factors influencing adherence to antiretroviral treatment. This was funded from STH Charitable Funds. The work was presented at the 2014 National HIV Nurses association(NHIVNA) conference, winning a prize for best presentation. Dr.Rogstad was local PI for the study Development and Implementation of Positive Voices: the National Survey of People Living with HIV, a joint study led by Public Health England and UCL. Both in the Formative study,  2013/14, which involved user input through LEAP, and input from this group as well as from elsewhere was used to inform the trial design for pilot study. The pilot study was completed  in 2014. Data analysis is awaited and there are plans for PHE to expand the study next year.

Dr Bowman has accepted an invitation to be the local PI for a PHE national portfolio study examining the stigma associated with living with HIV ( Stigma Index) that will recruit in spring 2015.   

HIV studies provide experimental protocols, clinical trials and qualitative studies involving a range of health care workers. They are strongly supported by LEAP input and reflect the directorate’s strong leadership nationally in HIV service delivery and improvement delivered through a highly effective regional HIV network  (SYHN)

Theme 5: Sexual Health and Public Health, Research Lead Dr K Rogstad and Dr C Dewsnap (other key investigator Ms G Bell) 

Treatment of STI

Sheffield GUM has a national reputation for contributing to epidemiological studies around STIs and HIV. Dr C.A.Bowman is local PI for the national GUMNet group and its steering group that agree the strategy and programme of work. During 2014/15 there enhanced STI and HIV surveillance has continued as part of a longstanding collaboration between Sheffield GUM and PHE. We currently participate in a variety of collaborative studies with Public Health England (PHE), to assess incidence and prevalence of STIs, antimicrobial resistance profiles in gonorrhoea (GRASP), securing accruals and income for research nursing staff. This theme is particularly strong in work associated with clinical translation and other optimisation of strategies to deliver therapy for STIs. Dr Bowman is PI for the G-TOG Study which will make a significant contribution to accrual with a target of  90 patients and will provide £658.00 per patient with a total of £59,220.00  income for research staff by 2016. This HTA funded portfolio double blind randomised study seeks to determine whether gentamicin may become an effective antibiotic in the management of gonorrhoea is the face of increasing bacterial resistance to currently used antibiotics and is likely to inform future treatment guidelines. Dr Bowman is currently involved in the development of another proposal ( Chief Investigator Prof Jonathan Ross in Birmingham ) for a HTA funded trial into the management of recurrent Bacterial Vaginosis (BV) and the plan is to develop this study to start in late 2015/early 2016. The grant total for this study is 1.5 million.  Recent NIHR HPV research investigated the treatment costs and psychological effects of genital warts through the NIHR portfolio adopted QOLIGEN study. The results of this study will contribute to the future choice of vaccine for the national HPV immunisation programme. There is also a multi-centre study to investigate the uptake and completion of HPV vaccine in adolescents.  In addition Dr Dilke-Wing has worked actively on clinical trials involving Pelvic Inflammatory Disease (PID) and other areas of STI research.  She will continue to participate in future trials as opportunities arise. Collectively these studies will inform treatment guidelines and cost effective therapy implementation for STI

Sexual health service delivery

Another area of major focus in this theme is effective delivery of STI services including in hard-to-reach groups. Collaborative research involving GUM, SCASH, Centre for HIV and Sexual Health (CHIVSH), Public Health and School of Health and related Research (SCHARR) is being undertaken to assess the impact on patient access, service delivery and cost effectiveness of the integration of sexual health and HIV services, with the aim of defining the optimal configuration of services. Dr Rogstad was co-investigator on the British Paediatric Surveillance NIHR study on STIs in children. The study is now completed and the data published along with an accompanying editorial and establishes a springboard for other studies. The Department of Health/Home Office awarded Dr Rogstad a grant of £60K for the British Association for Sexual Health and HIV to develop a national proforma to detect risk factors for  Child Sexual Exploitation in any young person accessing sexual health care. This study involved young person focus groups including victims of sexual exploitation by groups or gangs, service users, service non-users and vulnerable young people. Piloting was UK wide involving 20 centres including General Practice and Outreach Services. The final outcome was the launch of the National proforma in April 2014 with Ministerial support. A post-implementation study is planned in 2015. Dr Rogstad is also one of 3 investigators on a Health Protection England Fellowship investigation on bacterial sexually transmitted infections as a marker of child sexual exploitation. This is a multi-centre study and results will be the basis of a NIHR grant application for a prospective study after completion of the fellowship in approximately 36 months time. Dr Rogstad is a co-investigator in a proposed study with Department of Sports Medicine to assess an intervention to increase physical activity in sexual health clinic attendees by motivational interviewing and free gym membership. The pilot work has been conducted and although an initial NIHR application was unsuccessful the useful feedback will be used along with further supportive data to enable a re-application in 2015/16.

Other areas which are being developed in this theme to support service delivery include a project by Gill Bell and Dr. Jilly Martin Department of Psychology, University of Sheffeild to assess the effectiveness of health promotion and prevention work involving one to one interventions to reduce STIs. An initial bid for funding from the HTA was unsuccessful but  a further application is planned in 2015. In addition work by Dr Rogstad is using systems thinking to inform implementation of electronic patient records in collaboration with Sheffield Hallam University. This projects will be further developed in 2015 with a view towards attracting grant funding in the next 36 months. In addition the directorate is actively involved in developing and evaluating its educational programmes for health care workers on STIs, partner-notification, and one to one interventions to prevent teenage conceptions and STIs and will continue to develop this work during 2014/15. The recent integration of sexual health services, including genitourinary medicine, contraception and health promotion, has facilitated closer collaboration and development of training programmes. 

Overall this sub-theme should contribute to national policy around the delivery of integrated STI services.

STI transmission

Work in this part of the theme includes work that is focused on HIV transmission so interdigitates with theme 4 but is embedded in the STI theme as the core expertise lies in this group and is transferrable to other STI. The goal of the HIV specific work is to increase identification of HIV to block transmission and the subtheme involves strategies to identify the utility of testing specific patient groups, employing novel diagnostics or using prophylactic therapy for targeted patient groups. Researchers  participated in a national GUMNet collaborative study to identify strategies for the reduction of HIV transmission including pre-exposure prophylactic use of antiretroviral drugs (PreP) and behavioural change interventions (funding -HPA plus Gilead sponsorship).

Dr Rogstad is also part of a multi-site NIHR application on the use of near patient diagnostics in men who have sex with men. If successful this will commence in 2015. Dr. Bowman is co-applicant on a major national NIHR study which is under review to address interventions that will reduce STI in young people.

There is unique expertise in the directorate in the analysis of HIV phylogenetics. Dr de Silva has described how these techniques can be applied to HIV-2 transmission. Researchers led by Dr Rogstad will work with Dr. de Silva to explore whether these can be applied to explore local epidemiology of heterosexual HIV infection in South Yorkshire. We plan to develop this with ethics approval and conduct pilot work, which we would hope could lead to an NIHR fellowship application for a GUM trainee in 24 months. This is an area, which can lead to Sheffield led individual research.

This subtheme will aim to identify populations for targeted testing, combined with innovative testing algorithms and application of prophylactic therapies. The subtheme will apply these approaches with the goal of limiting HIV transmission. 

Overall this theme will conduct research that improves management of STI through optimising therapeutic approaches, ensuring sexual health service delivery is appropriate to the changing needs of the NHS and applies strategies to block transmission building on our specific expertise in HIV care.

Theme 6: Outpatient Parenteral Antibiotic Therapy (OPAT) and Operational Research – Research Lead, Dr J Greig  (also Dr KE Cartwright and Dr A. Tunbridge)

This theme is focused on service delivery. OPAT has made a significant contribution to how antimicrobial therapy is delivered and is a popular service development. The OPAT service in Sheffield is regarded as one of the national beacons and there is a large opportunity to help shape the direction of OPAT services nationally through networked and Sheffield led investigation. The previous OPAT lead Dr Ann Chapman played a prominent role nationally and a new consultant Dr Cartwright has recently appointed who is keen to build on this potential and develop her own research around OPAT. This theme also explores how point of care diagnostics can alter management of patients with influenza and examines the utilization of hospital beds during influenza season.

OPAT

Dr Cartwright is PI for the CIVAS study, a multicentre portfolio study investigating cost effectiveness and patient preferences in OPAT in order to inform a cohesive national strategy for OPAT service planning. Other research priorities include research to examine the incidence of Clostridium difficile diarrhoea after OPAT: this is a very poorly studied area and researchers plan to initiate a prospective study with dedicated funding to examine this. In addition there are plans to continue to develop ongoing work, for example on retention of training in self-administration for OPAT, a qualitative study of the patient experience, and investigation of venous thromboembolism risk in OPAT patients. Funding for the latter will be sought from the RfPB programme.   OPAT has the potential to support RfPB type bids. As a new consultant Dr Cartwright will develop this area over the next 36 months with a view towards moving towards NIHR type applications.  It is hoped through experience and networking opportunities in this area she will develop her own research portfolio.    

Influenza studies

Influenza 003 (MRC-INSIGHT, Prof Dockrell PI) examines the clinical features of patients admitted with influenza to hospital. It is also investigating the viral evolution of influenza A.  Influenza A point of care testing is being explored as a method to expedite the diagnosis and flow through hospital units of patients with flu (Alere Diagnostics; PI Dr Evans and Dr Mohammad Raza with Dr Tunbridge, Communicable Diseases). In the 2014/2015 2015/16 flu seasons we are exploring the utility of this approach in the Medical Assessment Unit and Infectious Disease Unit at STHFT. Data is forming a research project for a microbiology trainee’s research project but the data generated from this will form pilot data for a funding application in 24 months. We are also studying the local epidemiology of viral respiratory infections (including influenza) in immunocompromised hosts (Prof Dockrell with Dr Evans, Dr Mohammad Raza and Prof Snowden (Haematology)) in one of our largest recruiting studies in 2014/15 and this will help inform future infection control policy and needs particularly in the haematology department. The research in this sub-theme generates significant patient accrual but also has the potential to develop into a new source of research activity supporting NIHR RfPB type applications. This is an area which we are currently nurturing and believe can develop over 36 months into one which can support patient centred research and make a significant impact to patient care.

This theme is the most recently developed strand of our research strategy. It involves several newer investigators such as Dr Cartwright and Dr Evans but we believe it has significant future potential. It is already a significant source of accrual but also has the potential to directly impact patient care with rapid effect and has the potential to attract funding designed for research that will directly benefit patients such as RfPB. It also can be a vehicle for research by clinical trainees who wish to undertake NIHR fellowships.