Horton KC, MacPherson P, Houben RJGM, WhiteRG, Corbett EL. Sex differences in tuberculosis burden and notifications in low- and middle-income countries: a systematic review and meta-analysis. PLOS Medicine. 2016. 13(9): e1002119. PMCID: PMC4918937. A major systematic review and meta-analysis that evaluated data from >3.1 million individuals who participated in TB prevalence surveys in low- and middle-income countries between 1994 and 2016. With Katherine Horton and Liz Corbett, I designed, conducted and analysed the study, which has already had an important effect on influencing WHO STOP-TB recommendations for identifying groups vulnerable to TB. We found strong evidence that men have over two-times greater prevalence of microbiologically-confirmed tuberculosis compared to women, and spend substantially longer infectious in the community before accessing diagnosis. This implies that improved strategies to identify, screen and link men to TB care are urgently required to control TB and reduce mortality.
CRT Samp Size: An interactive sample size calculator for cluster - randomised trials. MacPherson P, 2016. (https://pmacp.shinyapps.io/CRTSampSize/). An online interactive application that allows researchers to estimate sample sizes required for a wide variety of designs of clusters randomised trials. I designed, programmed all code and implemented this application. Link to application is going to be included in the forthcoming 2nd edition of Hayes' and Moulton's seminal "Cluster Randomised Trials" textbook (CRC Press). I have used this application in designing the present pragmatic trial.
Kelly C, Gaskill K, Richardson M, Klein N, Garner PG, Mac Pherson P. Discordant immune response with antiretroviral therapy in HIV-1: a systematic review of clinical outcomes. PLOS ONE. 2016. 11(6):e0156099. PMCID: PMC4902248. A systematic review conducted by Christine Kelly (Wellcome PhD Student) and P Mac Pherson that systematically demonstrated an important group of adults who fail to achieve satisfactory CD4 cell count reconstitution following antiretroviral therapy and virological suppression, and remain at high risk of clinical complications. These data will have important policy implications as we are entering the HIV test- and-treat era.
Nliwasa M, Mac Pherson P, Chisala P, Kamdolozi M, Khundi M, Kaswaswa K, Mwapasa M, Msefula, Sohn H, Flach C, Corbett EL. The sensitivity and specificity of loop- mediated isothermal amplification (LAMP) assay for tuberculosis diagnosis in adults with chronic cough in Malawi. PLOS ONE. 2016. 11(5): e0155101. PMCID: PMC4865214. A diagnostic accuracy study conducted in Ndirande Health Centre by PhD student Marriott Nliwasa. Marriott demonstrated excellent capacity for TB clinical research at the clinic (same clinic as proposed for the present fellowship), and showed that LAMP was insufficiently accurate as a near-patient TB diagnostic in primary care, meaning that improved diagnostic algorithms are required. Additionally, data from this study allows accurate estimates of numbers of clinic attenders, prevalence of TB symptoms, and prevalence of microbiologically-confirmed TB among clinic attenders to inform the sample size estimates for the present study.
Maheswaran H, Petrou S, Mac Pherson P, Choko AT, Kumwenda F, Lalloo DG, Clarke A, Corbett EL. Cost and quality of life analysis of HIV self-testing and facility-based HIV testing and counselling in Blantyre, Malawi. BMC Medicine. 2016. 14(1):34.
Nliwasa M, Mac Pherson P, Mukaka M, Choko AT, Mdolo A, Mwapasa M, Kaswaswa K, Kumwenda M, Msefula C, Chipungu GA, Mwandumba HC, Corbett EL. High Mortality and Prevalence of Undiagnosed HIV and Tuberculosis in Adults with Chronic Cough in Malawi: A Prospective Cohort Study. International Journal of Tuberculosis and Lung Disease 2016. 20(2): 202-210. PMCID: PMC4711670. A prospective cohort study conducted in Blantyre communities by PhD student Marriott Nliwasa, which demonstrated that adults with chronic cough have high prevalence of HIV, and very high risk of mortality over one year of follow-up. Important data to inform the design of the present fellowship.
Choko A T, Mac Pherson P, Webb EL, Ball,H, Sambakunsi R, Mdolo A, Makombe SD, Desmond N, Hayes RJ, Maheswaran H, Corbett EL. Uptake, accuracy, safety and linkage into care over two years of promoting annual self-testing for HIV in a community-based prospective study in Blantyre, Malawi. PLOS Medicine. 2015. 12(9):e1001873. PMCID: 4562710.
Lewis JM, MacPherson P, Adams ER, Ochodo E, Sands A,Taegtmeyer M: Field accuracy of fourth-generation rapid diagnostic tests for acute HIV-1: a systematic review. AIDS. 2015. 29(18):2465-71. PMCID: PMC4645957. In previous clinical studies, the team identified the suboptimal diagnostic accuracy of 4th generation HIV rapid tests for identification of acute HIV-1 infection. Peter MacPherson conceptualized and designed this systematic review to synthesise available evidence, and supported Joe Lewis (Liverpool Wellcome Trust PhD Fellow) to write up the study. We showed that these tests have extremely poor performance for screening for acute HIV infection, and should not currently be recommended for use at point of care.
MacPherson P, Munthali C, Ferguson J, Armstrong A, Kranzer K, Ferrand R A, Ross D A. Service delivery interventions to improve adolescents’ linkage, retention and adherence to antiretroviral therapy and HIV care: a systematic review. Tropical Medicine and International Health. 2015; 21(3): 1015-32. Undertaken as part of a World Health Organization- commissioned evidence synthesis process to inform the 2015 Consolidated Guidelines on Antiretroviral Therapy. With David Ross, Peter MacPherson led the design, data collection, analysis, interpretation and writing up of this study that demonstrated, for the first time, the paucity of interventions available to support adolescents to access HIV care.
MacPherson P, Lalloo DG, Webb EL, Choko AT, Makombe SD, Butterworth AE, van Oosterhout JJ, Desmond N, Thindwa D, Squire SB, Hayes RJ, Corbett EL. Optional home initiation of HIV care following HIV self-testing: a cluster randomised trial to improve uptake of ART in Blantyre, Malawi. JAMA. 2014 312(4): 372-379. PMCID: PMC4119051. The major trial manuscript arising from the Wellcome Trust Clinical PhD Fellowship of Peter MacPherson, which has directly informed WHO HIV testing and treatment guidelines, and is already highly cited. With the trial team and support from Liz Corbett, he designed, undertook, analysed and wrote up this cluster randomised trial among 16,660 adults living in urban slums in Blantyre. The team showed that an offer of home initiation of HIV care following home HIV self-testing resulted in a 3-times increase in antiretroviral therapy initiations at acceptable programme costs.
Munthali C, Taegtmeyer M, Garner PG, Lalloo DG, Squire SB, Ford N, Corbett EL, MacPherson P. Comparison of the accuracy of the WHO clinical staging system compared with CD4 count for identifying ART eligibility in sub-Saharan Africa: a systematic review and meta-analysis. Journal of the International AIDS Society 2014. 17:18932. PMCID: PMC4057784. I designed this systematic review, and supported Chigo Munthali, a Malawian MPH student at LSTM, to collect data, analyse and write up results. We showed that the WHO clinical staging system has poor sensitivity for detection of CD4 count-defined antiretroviral therapy eligibility, and contrary to previous WHO guidelines, should not be recommended for making individual treatment decisions.
MacPherson P, Houben RJGM, Glynn JR, Corbett EL, Kranzer K. Pre-treatment loss- to-follow-up among TB patients in high burden and low-to-middle income countries: a systematic review and meta- analysis. Bulletin of World Health Organization. 2014 92: 126-138. PMCID: PMC3949536.With collaborators from LSHTM, I designed this study, collected the data (with Rein Houben), did the statistical analysis and wrote up study results. We showed high rates of pre-treatment loss to follow-up among sputum smear positive TB patients from Africa and Asia, meaning that TB case detection rates reported by WHO are likely to be substantially over- estimated. Important review to inform the design of the present fellowship.
Sloan DJ, van Oosterhout JJ, Malisita K, Phiri EM, Lalloo DG, O’Hare B, MacPherson P. Evidence of improving antiretroviral therapy treatment delays: an analysis of eight years of programmatic outcomes in Blantyre, Malawi. BMC Public Health. 2013 13:490. PMCID: PMC3664085. Derek Sloan (Wellcome Trust Clinical PhD Fellow), Joep van Oosterhout (HIV Physician in Blantyre) and I designed this study to investigate how rates of treatment delay have changed since HIV care programme inception in Blantyre. I did all statistical analysis and wrote up the manuscript.
Corbett EL, MacPherson P. TB screening in high HIV prevalence settings: turning promise into reality. International Journal of Tuberculosis and Lung Disease. 2013 17(9): 1125-1138. PMCID: PMC3966511.A highly-cited “State of the Art” review of literature, identifying key clinical and public health interventions to improve TB screening and entry to TB care in high HIV prevalence settings. Much of the conceptual framework for the present fellowship application drawn from this work.
MacPherson P, Lalloo DG, Thindwa D, Webb EL, Squire SB, Chipungu GA, Desmond N, Makombe SD, Taegtmeyer M, Choko AT, Corbett EL. A novel community health worker tool outperforms WHO clinical staging for assessment of antiretroviral therapy eligibility in a resource-limited setting. Journal of Acquired Immune Deficiency Syndromes. 2014 65(2): 74-8. PMCID: PMC3966510. As part of my Wellcome Trust Clinical PhD Fellowship, I designed and evaluated in communities in Blantyre a novel community health worker antiretroviral therapy eligibility tool to overcome difficulties individuals face in accessing treatment. In blinded evaluation, the novel tool outperformed the current WHO clinical staging system.
MacPherson P, MacPherson EE, Mwale D, Squire SB, Makombe SD, Corbett EL, Lalloo, DG, Desmond N. Barriers and Facilitators to linkage to ART in primary care: a qualitative study of patients and providers in Blantyre, Malawi. Journal of the International AIDS Society. 2012. 15(2): 18020. PMCID: PMC3535694. As part of my Wellcome Trust Clinical PhD Fellowship, P MacPherson designed, analysed and wrote-up this qualitative study to describe barriers faced by adults seeking HIV care in Blantyre, and to inform the design of the cluster randomised trial.
MacPherson P, Corbett EL, Makombe SD, van Oosterhout JJ, Manda E, Choko AT, Thindwa D, Squire SB, Mann, GH, Lalloo DG. Determinants and consequences of failure of linkage to antiretroviral therapy at primary care level in Blantyre, Malawi: a prospective cohort study. PLoS One. 2012. 7(9): e44794. PMCID: PMC3439373. As part of my Wellcome Trust Clinical PhD Fellowship, I designed, analysed and wrote up this prospective cohort study to identify barriers faced by adults seeking HIV care in Blantyre, and to inform the design of the cluster randomised trial.
MacPherson P, Choko AT, Webb EL, Thindwa D, Squire SB, Sambakunsi R, van Oosterhout JJ, Chunda T, Chavula K, Makombe SD, Lalloo DG, Corbett, EL. Development and validation of a GPS- based map book system for categorizing cluster residency status of community members living in high- density urban slums in Blantyre, Malawi. American Journal of Epidemiology. 2013 177(10): 1143-7. PMCID:PMC3649638. A methodological paper. P MacPherson designed and evaluated a novel map-book system to allow the identification of trial cluster residency status of community members recruited at sites distant from their household. This work has been taken forward by Rebecca Harris (LSHTM) and P MacPherson, and we are currently evaluating an electronic version of the mapbook tool that will be used in the present fellowship.
MacPherson P, Lalloo DG, Choko AT, Mann GH, Squire SB, Mwale D, Manda E, Makombe SD, Desmond N, Heyderman RS, Corbett EL. Suboptimal patterns of provider initiated HIV testing and counselling, ART eligibility assessments and referral in primary clinic attendees in Blantyre, Malawi. Tropical Medicine & International Health 2012. 17(4): 507-517. PMCID: PMC3378506. As part of my Wellcome Trust Clinical PhD Fellowship, P MacPherson designed, analysed and wrote up this highly- cited cross- sectional study, which was conducted among adults attending primary health care centres in Blantyre to describe the uptake of provider-initiated HIV testing and inform the HIV testing component of the design of the cluster randomised trial.
MacPherson P, Dimairo M, Bandason T, Zezai A, Munyati SS, Butterworth AE, Mungofa S, Rusikaniko S, Fielding K, Mason PR, Corbett EL. Risk factors for mortality in smear-negative TB suspects: a cohort study in Harare, Zimbabwe. International Journal of Tuberculosis and Lung Diseases 2011. 15(10): 1390-1396. PMCID: PMC3272461. A cohort analysis of participants from Liz Corbett’s DETECT-TB Trial in Harare. P MacPherson designed, analysed and wrote- up this analysis. Risk of mortality had not previously been described in individuals with smear-negative tuberculosis, and we showed that HIV-infected smear-negative TB suspects had a high and sustained risk of death.