The University of Bristol-University of Cape Town Cotutelle PhD Programme
Background to the Bristol-Cape Town Cotutelle PhD Programme:
The University of Bristol (UoB) and the University of Cape Town (UCT) have worked together to develop a framework agreement for operating Cotutelle PhDs. Cotutelle PhDs are distinguished by a number of features that comprise a very attractive opportunity for ambitious and talented early career researchers:
- Genuine shared co-supervision with academics in both Universities
- Registration at both Universities simultaneously to ensure you have full access to the full range of facilities and resources at both institutions
- Your PhD is carried out at both institutions (approximately a 50/50 split) with the sequence decided by the nature of the specific PhD project – there are funds to support this travel
- A Cotutelle PhD award and certificate which recognises the role of both institutions to benefit your CV and career prospects
- Be part of a cohort of 7 Cotutelle PhD students across Health Sciences and Social Sciences
- Full membership of the Graduate Schools at both Universities to provide you with two postgraduate research families
- Support and training at both Universities to help prepare you for your future career
These Cotutelle PhDs are of 4-years duration, and are fully-funded PhD scholarships, with the tuition fees and living expenses at both institutions covered by the studentship package (see Financial Details of the Cotutelle PhD Scholarship below).
Cotutelle PhD Project:
Using modelling to improve the prevention response for HIV and hepatitis C virus among people who inject drugs in South Africa
Supervisors: Peter Vickerman (Bristol), Andrew Scheibe (Cape Town) and Leigh Johnson (Cape Town)
Contact for details on this PhD project:
PhD Project Summary
Evidence suggests emerging epidemics of HIV and hepatitis C among people who inject drugs (PWID) in South Africa. There is a low coverage of prevention and treatment services among this group, with injecting drug use also being linked with homelessness and high levels of incarceration, which can further heighten their vulnerability. This PhD will use epidemiological methods and Infectious disease modelling to help develop and evaluate the prevention response for tackling HIV and HCV among PWID across South Africa.
PhD Detailed description
Historically, injecting drug use was not seen as an important risk behaviour for transmitting HIV in sub-Saharan Africa. However, recently a number of epidemics have been documented in various countries including Tanzania1, Senegal2, Kenya 3, and South Africa4, with new epidemics being identified in other countries. These epidemics differ from HIV epidemics among people who inject drugs (PWID) elsewhere by occurring in the presence of high prevalence generalised HIV epidemics. There are also common features to most these epidemics, with most PWID being males, but HIV prevalence generally being 2-4-fold higher in female PWID 1-3, likely linked to high risk sexual behaviours, sex work, stigma and injecting practices (they frequently inject after the males). Hepatitis C virus (HCV) infection is also prevalent in PWID, but the HCV prevalence in these epidemics is generally much lower than in other PWID populations.1,5 This is thought to be due to the early nature of the HCV epidemics in sub-Saharan Africa.
Unlike other HIV prevention responses in Africa, intervention programming for PWID are sparse and in their early stages. There are needle and syringe programs and opioid substitution therapy (methadone) in some countries, but the coverage is generally low6 and only in some cities. Injecting drug use is also linked to poverty, homelessness and high levels of incarceration (% ever incarcerated 62-70%) 2-5, thus increasing their vulnerability and heightening their risk of infection in some situations (South Africa)4,5.
Although success is being achieved in controlling the HIV epidemics in sub-Saharan Africa, the emerging epidemics of HIV and HCV among PWID need urgent attention. There is little understanding of the dynamics and likely drivers of these epidemics and what interventions are needed to control them.
A number of surveys have been undertaken amongst PWID in Durban, Cape Town, Pretoria, Johannesburg and other cities, with data suggesting increasing HIV prevalence, from 14% in 20134 to 21% in 2017 5, and a higher HCV prevalence of 45%, being highest in Pretoria (73% for HCV and 38% for HIV5). Data also suggests high levels of incarceration (% ever incarcerated is 70%4) and homelessness (68% 5). Although interventions in South Africa include opioid substitution therapy (OST) and needle and syringe programmes (NSP), which evidence suggests reduces HIV and HCV transmission risk 9-11, coverage is limited to a number of cities in South Africa (4 cities have OST and 5 cities have NSP). Awareness raising and routine screening for HCV are not currently implemented in PWID programmes (due to limited funding and funder priorities) and access to curative treatment for HCV is limited to one tertiary hospital in Cape Town. This emphasises more needs to be done to control these epidemics, with encouraging recent data suggesting the use of new syringes is linked to lower HCV prevalence in South Africa5; giving support to further expansion of NSP.
To guide future prevention planning for PWID in South Africa, we propose the following PhD project that uses epidemiological, modelling and economic methods to give insights into how to improve the prevention response for tackling the HIV and HCV epidemics among PWID across South Africa. To do this, we propose the following:
- To undertake epidemiological analyses on existing datasets to develop an understanding of the main factors (intervention, behavioural, type of drug injected, and structural) associated with differing levels of HIV and HCV transmission among PWID in South Africa. Also collate and analyse forthcoming data on access to HIV and HCV care among PWID in South Africa, and outcome data from existing OST and NSP interventions.
- Develop, parameterise and calibrate a model of HIV and HCV transmission among PWID in 2-3 settings in South Africa (Pretoria, Durban and Cape Town).
- Use these models to determine the role of different factors and interventions in impacting on the existing epidemic dynamics of HIV and HCV in these settings, including a consideration of the role of poverty, homelessness, type of drug injected, and incarceration in enhancing these epidemics. Use these projections to determine possible target points for either scaling up existing interventions or initiating new interventions.
- Through collating, collecting or estimating the cost of existing and potential new interventions, use economic modelling to determine the likely optimum intervention strategies for controlling the different HIV and HCV epidemics among PWID in South Africa.
The PhD will be an active collaboration between researchers from Universities of Cape Town and Bristol. Peter Vickerman’s Bristol team has many years of experience of undertaking this type of work in varied global settings, whereas the team in Cape Town (Andrew Scheibe) are at the fore front of undertaking policy relevant research among PWID in South Africa. Leigh Johnson’s in-depth experience of modelling the HIV epidemic in South Africa will also be invaluable for co-supervising the HIV modelling. This team of supervisors will ensure the student is ideally placed to successfully undertake this PhD, with the supervisors’ collaborative network maximising the policy influence of the findings in South Africa and elsewhere in Africa.
Bristol and Cape Town
The project will involve equal time in Bristol and South Africa. Most of the first 2 years will be spent in Bristol obtaining training in infectious disease modelling and other skills (see next section). These initial years will also involve working with Andrew Scheibe (Cape Town) on datasets from South Africa, and in developing initial models. More of the subsequent years will be spent in South Africa to continue their training and modelling, and possibly to undertake cost data collection. Costs for tuition fees in both settings are covered by the scholarship, and the student will also receive a stipend to cover their living costs. Costs are also included to enable basic field costs and travel between South Africa and the UK.
Requirements and training
The PhD candidate will be highly numerate but may have varied skills depending on their previous qualifications and training. Depending on the skills, the student will receive training in epidemiological methods, infectious disease modelling and economic analysis at both institutions. A wide variety of courses in these subject areas are free to PhD students at the University of Bristol and are run each year (http://www.bristol.ac.uk/medical-school/study/short-courses/).
Environment – Bristol and Cape Town
The 2014 Research Excellence Framework confirmed the University of Bristol as a leading centre for health research. In Population Health Sciences our research environment was classed world-leading and has contributed to improving health and health-care in the UK and globally (http://www.epi.bris.ac.uk/). Research in PHS is collaborative and multi-disciplinary, while being both methodological and applied, with clinical and non-clinical scientists collaborating on projects that span activity from life-course and public health epidemiology to evaluation of health technologies. There are extensive national and international research collaborations, and many academic staff provide health policy advice to government organisations and international bodies.
The University of Cape Town (UCT) has consistently been the most highly rated university in Africa over the last decade, and attracts leading scientists from across the African continent. The Centre for Infectious Disease Epidemiology and Research (CIDER) at UCT is a multi-disciplinary research group that addresses public health challenges relating to HIV, tuberculosis and other infectious diseases. The group plays a leading role in informing health policy and health programme monitoring, nationally and provincially, and also collaborates with several international research groups on various projects.
The lead supervisor for this PhD project (Peter Vickerman) leads the infectious disease modelling group at the University of Bristol, comprising 20 staff and students. The group has a strong policy emphasis, with a major focus of their work being the use of modelling to help understand the transmission of blood borne viruses (HIV and HCV) and sexually transmitted diseases among people who inject drugs and other vulnerable groups (female sex workers and men who have sex with men), and the impact and cost-effectiveness of prevention measures. This sub-group has an international reputation and includes 7 researchers that work collaboratively on varied projects in different global settings. Importantly, these modellers are multi-skilled, not just undertaking modelling but also epidemiological analyses and systematic reviews to improve the evidence for the impact of interventions and factors that affect their impact. Importantly, we also see it as important that our modellers gain experience and skills in sharing their modelling with non-specialists. These are crucial skills for maximising the policy influence of modelling research, which can frequently be inaccessible to non-modellers. The group has a supportive structure including weekly meetings where team members share their work to get each other’s input. PhD students are active members of the group and are mentored by junior staff.
Importantly, the proposed PhD project will also draw upon the additional expertise of one of the South Africa’s leading modellers. Dr Leigh Johnson (PM) is an epidemiologist and actuary with 20 years of experience in HIV research and infectious disease modelling. He is lead developer of the Thembisa model, which is used to produce UNAIDS estimates for South Africa, and to advise the South African Department of Health on optimal HIV prevention and treatment strategies. He also leads the MicroCOSM modelling project, which aims to assess social drivers of HIV and other sexually transmitted infections in South Africa. He is co-chair of the UNAIDS Reference Group on Estimates, Models and Projections, and is an editor of two international journals (AIDS and Infectious Disease Modelling).
Also, the proposed PhD project will work collaboratively with Dr Andrew Scheibe, who is actively involved in harm reduction programming and related research in South Africa. He is a senior technical advisor to TB HIV Care, a civil society organisation that implements HIV, TB and viral hepatitis services to people who inject drugs across three South African cities, and affiliated to the University of Pretoria and the Durban University of Technology – institutions that run harm reduction services in those respective cities. Dr Scheibe provides expert input to the South African National AIDS Council around their people who inject drugs programme, and is part of the National Hepatitis Technical Working Group and a technical expert for the National Department of Health’s Technical Working Group that is developing the Health Sector Drug Master Plan. His publications have contributed to the evidence base highlighting the need for harm reduction services in the country, and around feasibility of implementation in the local context.
Start date: As soon as possible.
Financial Details of the Cotutelle PhD Scholarship:
This is a fully-funded PhD Scholarship which includes all tuition fees. When the student is physically present in Bristol, they will receive the standard UK stipend for PhD students, scaled to the amount of time spent in Bristol (currently £14,800 per annum). Similarly, when the student is resident in Cape Town they will receive a stipend at the standard UCT rate. A sum of £3,000 per year is available to cover project expenses, directly incurred as a part of the research. Three return air flights are also included in the Scholarship package, and funds to attend one international conference during the PhD period.
This programme is open only to citizens of South Africa or other African countries. Academically, interested candidates should either hold or expect to obtain shortly an upper second-class honours degree (or international equivalent) or a master’s degree in a subject relevant for the proposed research. Consult the admissions statement for the Bristol Population Science PhD programme at: http://www.bristol.ac.uk/study/postgraduate/2019/health-sciences/phd-population-health-sciences/
This webpage also contains information about the English Language requirements. Please contact Peter Vickerman if you are unsure about your eligibility.
How to Apply:
For this Cotutelle PhD Programme, interested students should apply via the Bristol application website. Please follow the instructions at https://www.bristol.ac.uk/study/postgraduate/apply/
This online system allows you to save your application as you go along. Please be sure to specify “The University of Bristol-University of Cape Town Cotutelle Programme” when answering the question about your source of funding.
Also please be aware that you can add transcripts or other requested documentation after you have submitted your application.
Please let the Project Supervisors know that you are applying to the programme.
Please complete the online application by Monday 15th April, at 5 pm (GMT)
Shortlisted candidates will be interviewed by the supervisory team.
Contact for the Cotutelle Programme:
For academic enquiries about this project, please contact Professor Peter Vickerman at firstname.lastname@example.org
For all other enquiries and questions about the Cotutelle PhD Programme, please contact Dr. Terry McMaster, Director of the Bristol Doctoral College, University of Bristol, or Prof. Peter Meissner, director of Postgraduate Studies, University of Cape Town.
- Bowring AL, Luhmannn N, Pont S, et al. An urgent need to scale-up injecting drug harm reduction services in Tanzania: Prevalence of blood-borne viruses among drug users in Temeke District, Dar-es-Salaam, 2011. Int J Drug policy 2012; 24: 78-81.
- Lepretre A, Ba I, Lacombe K, et al. Prevalence and behavioural risks for HIV and HCV infections in a population of drug users of Dakar, Senegal: the ANRS 12243 UDSEN study. Journal of the International AIDS Society 2015; 18: 19888.
- Kurth AE, Cleland CM, Des Jarlais DC, et al. HIV Prevalence, Estimated Incidence, and Risk Behaviors Among People Who Inject Drugs in Kenya. J Acquir Immune Defic Syndr 2015; 70(4): 420-7.
- Scheibe A, Makapela D, Brown B, et al. HIV prevalence and risk among people who inject drugs in five South African cities. Int J Drug Policy 2016; 30: 107-15.
- TB HIV Care. The viral hepatitis C initiative for key populations in South Africa, 2018.
- Larney S, Peacock A, Leung J, et al. Global, regional, and country-level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: a systematic review. Lancet Glob Health 2017; 5(12): e1208-e20.
- Degenhardt L, Peacock A, Colledge S, et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Health 2017; 5(12): e1192-e207.
- Lane T. Report of the South African Key Populations Cascades Stakeholder Group Workshop – Summary and Recommendations from February 2018 Workshop. UCSF, San Francisco, 2018.
- Platt L, Minozzi S, Reed J, et al. Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs. Cochrane Database Syst Rev 2017; 9: CD012021.
- MacArthur GJ, Minozzi S, Martin N, et al. Evidence for the effectiveness of opiate substitution treatment in relation to HIV transmission in people who inject drugs: a systematic review and meta-analysis. BMJ 2012; 345(e5945): 1-16.
- Aspinall EJ, Nambiar D, Goldberg DJ, et al. Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis. International journal of epidemiology 2014; 43(1): 235-48.