Interviews from the Frontline: Research

Harriet Gliddon is a postdoctoral research associate at the London Centre for Nanotechnology, and is affiliated with the i-sense EPSRC Interdisciplinary Research Centre. Her research focuses on developing rapid molecular tests for infectious diseases.

She provides insightful perspectives on how those outside of clinical medicine make crucial contributions to the global health agenda.

You are presently working on developing a novel diagnostic for tuberculosis as the subject of your PhD, the basis of which won you Imperial College’s Student Challenges Competition for Innovation in Global Health in 2016. What motivated you to pursue this line of research?

My journey has been a mixture of lucky coincidences, accidents and random choices.

During my undergraduate degree in Biochemistry, I worked on a few different projects on topics like synthetic biology, parasitic infections and biosensing. During this time I also got really interested in global health, mainly through my involvement with Medsin and Universities Allied for Essential Medicines (UAEM), and this passion has definitely affected my career choices.

I initially wanted to go down the microbiology route, so ended up doing a Master’s in Biomedical Research, specialising in microbial pathogenesis. But I quickly realised that I wanted to do something more interdisciplinary and translational than the work I was doing for my Master’s.

A chance meeting with Professor Michael Levin and a quick chat about his research made me realise that gene expression signatures could be used as very accurate diagnostic biomarkers for tuberculosis (TB), and if we could build a diagnostic test around them that could totally transform the way TB is diagnosed. Mike mentioned that I could do my PhD split between his lab and the lab of Professor Molly Stevens, who is very well known for developing ultra-sensitive nanomaterial-based biosensors. I was very excited about doing an interdisciplinary PhD and working on such an interesting area.

What advice do you have for students with an interest in global health, particularly for those who come from a background outside of health? Why should students of a scientific background engage with global health problems, and what can they bring to the field?

I think it was Professor Dame Anne Johnson who said there is space for anyone, from any background, to contribute to global health. However, it’s definitely more challenging for those coming from a background outside of health.

First you need to have a genuine passion for the subject, something that motivates you. Don’t let the fact that you’re not a medical student/professional get in your way of keeping up to date with all the latest developments in the field, because they affect us all. Read as much as you can, get involved in every way possible, and don’t be intimidated. Find a good mentor and chat to as many people working in global health as possible.

How has your understanding of health and medicine evolved since your research began to focus on tuberculosis?

As PhD students and postdocs, we complain about presenting all the time. But constantly having to present your work is really important for challenging and developing your ideas. One of the most important aspects of this is presenting to very diverse audiences.

During my PhD, I would have to present to two very different lab groups. One was a mix of physicists, materials scientists and chemists, and the other was comprised of clinicians, bioinformaticians, research nurses and molecular biologists. Every question and comment  from them went some way to shaping my work.

Since I started my first Master’s project on TB pathogenesis, I think the most important thing I’ve learnt about is the importance of social issues related to TB.

We could have the best medical interventions possible, but without solving the social issues that predispose certain individuals to contract TB, we’ll never conquer the disease. I’ve really enjoyed learning about all the advances that have been made on the policy side of things and how new studies in, for example, novel treatments for TB, are funded.

You spent 2 months as an intern at the WHO in 2016. What did you do whilst you were there, and was it a valuable experience? How did it influence and complement your research?

During my two months at the WHO Department for Reproductive Health and Research (RHR), I was a member of a team working towards the elimination of mother-to-child transmission (EMTCT) of HIV and syphilis. Mother-to-child transmission (MTCT) of HIV and syphilis is a significant public health challenge, but can easily be prevented by screening pregnant women and treating them accordingly.

My role involved collating data on the performance of rapid diagnostic tests (RDTs) that simultaneously detected antibodies to HIV and Treponema pallidum, the causative agent of syphilis. I designed a systematic review to evaluate data on the operational performance of these dual HIV/syphilis RDTs.

MTCT of HIV and syphilis remain significant causes of perinatal morbidity and mortality. Approximately 1.5 million pregnant women are infected with HIV, and 900,000 are infected with syphilis. Untreated maternal syphilis results in significant adverse pregnancy outcomes, such as spontaneous abortion, stillbirth, fetal death, preterm birth, low birth weight, neonatal death and congenital syphilis.

Antenatal screening followed by treatment early in pregnancy effectively treats the pregnant woman and prevents congenital syphilis in infants. WHO has prioritised the EMTCT of HIV and syphilis, and several countries have now achieved validation of EMTCT for HIV and/or syphilis, including Cuba, Belarus and Thailand.

While the testing of pregnant women for HIV is relatively well-resourced, syphilis-infected pregnant women often go undiagnosed and untreated. Many countries have antenatal syphilis screening policies, but more than 350,000 adverse pregnancy outcomes occur annually due to untreated maternal syphilis, despite the low cost of treatment.  Early diagnosis and treatment of both HIV and syphilis in pregnant women has been proven an effective strategy in the prevention of both adverse outcomes of pregnancy and MTCT.

The benefits of dual HIV/syphilis RDTs include:

  1. Procurement can be streamlined;
  2. Storage space can be minimised;
  3. Training of healthcare personnel can be simplified;
  4. Only a single finger-prick is required;
  5. Patients can receive their test results in a shorter time period;
  6. Fewer adverse pregnancy outcomes were observed when a dual HIV/syphilis test was used compared to separate tests for HIV and syphilis;
  7. It’s less costly than two single RDTs for HIV and syphilis.

After completing my internship at the WHO, I was contracted to perform a systematic review and multi-criteria decision analysis on rapid HIV/syphilis RDTs, which will contribute to the establishment of WHO guidelines for the use of the tests in field settings.

The systematic review appraises the available evidence on the operational performance, cost-effectiveness and acceptability of dual RDTs. The multi-criteria decision analysis will assess the clinical utility of the dual RDTs.

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