The activities primarily aim at reducing problems of poverty by improving the health of Brazilian communities. The development of an advanced and dependable data analytics infrastructure will enable the effective and efficient monitoring of Dengue fever outbreaks in Brazil. Dengue is an endemic problem in many Brazilian areas where public health assistance is inefficient. The Brazilian public health system cannot meet the demands of these areas due to the resources scarcity, which calls for developing trustworthy mechanisms to support efficiently decisions about the areas that have priority on resource allocation. This software infrastructure can be reused in the future in other developing countries suffering from Dengue outbreaks. The monitoring infrastructure will provide its data analytics capabilities through a unique software architecture that can be used through several mobile platforms and social networks. This infrastructure can only be developed through collaborative research with the leading UK researchers.

This research partnership will build and strengthen scientific collaboration between UK and Brazilian researchers. Our team will work together to develop new, innovative research in order to reduce the vulnerability of Amazonian cities to extreme climatic events, such as floods and droughts. We hope that this research enables decision-makers in Brazil to identify those cities that need humanitarian assistance most during climate emergencies, and also build long-term resilience (capacity to absorb these shocks) to floods and droughts. Our team members come from various academic disciplines, including statistics, health science, economics, environmental social science, and spatial modelling. We will use secondary data sources to examine how adaptive capacity, local institutions and natural hazard exposure (the occurrence of droughts and floods) influence the negative impacts of these climate events on the well-being of people living in Amazonian cities. We are also interested in how extreme climatic events may influence food prices in these cities, which has implications for the affordability of food for the poorest city-dwellers. Our network also involves local citizens, and we will work with a range of community members in our focal cities in order to make sure that are research is locally-relevant and useful. Finally, we are investing significant effort in improving career opportunities for Amazonian scientists, and will achieve this through UK-Brazil researcher exchange, and workshops to train Masters and PhD students in the UK and Brazil.

The recent Astana Declaration emphasizes the importance of health systems based on a strong Primary Health Care (PHC), which should be part and coordinate multisectoral actions addressing economic and social determinants of health. PHC should be one of the main hubs of the network of interventions composing the welfare state, synergistically connecting the healthcare system with social and poverty-relief interventions. Several Latin American countries (LAC) have implemented and expanded over the last two decades PHC, healthcare system components, and social assistance interventions with different degrees of intensity and connection. However, recent economic crisis and austerity measures are threatening the consolidation of public healthcare systems and of the welfare state in the majority of LAC. Some evaluations of PHC in a limited number of countries have found positive effects on specific health outcomes, but no study has performed multi-country comparisons or adopted a comprehensive approach for the estimation of the effects -including long-term effects- of PHC programs on a broad range of health outcomes (notifiable diseases, hospitalizations and mortality - overall and for specific causes and age-groups), measuring its synergistic impact with the other healthcare system components and with social assistance, in particular conditional (CCT) and social pensions (SP). Similarly, no research has measured the influence of PHC coverage duration and of contextual factors such as local governance indexes or human development index. While the synergistic impact of PHC with CCT is expected because the health conditionalities should be attended in the PHC units, the interaction effects of SP with PHC are plausible because of the physiological effects of the relief from poverty, in particular in the pathways of prevention and cure. The aim of this project is to systematically address all these issues for a comprehensive evaluation of the effectiveness of PHC on the broadest possible range of morbidity and mortality outcomes in Brazil, Colombia, Ecuador and Mexico (BCEM). The comparative evaluation will be possible because BCEM have undertaken different PHC, healthcare and social assistance implementations during the last two decades. Aggregate and individual-level, longitudinal and cross-sectional, socioeconomic and health data from a wide range of sources in each BCEM will be merged and the most robust quasi-experimental designs will be used to evaluate these comprehensive PHC impacts on such a wide number of outcomes. With the large amount of data and parameters from all the retrospective impact evaluations, and using a microsimulation modelling approach -arguably one of the most accurate forecasting techniques up-to-date - we will forecast the effects of different PHC coverage reductions - due to budget constraints or austerity measures - in conjunction with the above mentioned welfare state components, versus scenarios of coverage stabilization or coverage expansion, evaluating differences in a broad range of health outcomes in BCEM up to 2030. Using all the granularity of data and effect estimates, we will evaluate the most effective PHC, CCT and SP expansion coverage dynamics -on specific subpopulations- in the next years. We will also calibrate and select the best policy scenarios for the reduction of health inequalities and the achievement of each health-related SDG in each BCME. This project will also consolidate a network of researchers in LAC and will develop algorithms and methods to integrate ex-post and ex-ante impact evaluations of public policies using ecologic and individual-level data. All the datasets created in the study will be made available in an open dynamic platform of comprehensive LAC data from healthcare systems, social interventions and health outcome, and the research network will use the platform and the developed algorithms to stimulate continuous cycles of monitoring, evaluation and forecasting.

This project is primarily about improving the number of people with good research skills through a scientific partnership between the University of Exeter and the Oswaldo Cruz Foundation (Fiocruz). Together we will do this by passing on established methods of health technology assessment, particularly health economic modelling. Health technology assessment involves identifying the benefits and harms of any new approach to health care, particularly whether the costs of introducing the new technology seem justified. We will also attempt to improve health technology assessment in an area of common interest, new diagnostic tests for the identification of infectious disease and complications arising from them. In contrast to disease treatments, approaches to evaluating the effectiveness and cost-effectiveness of tests designed to improve our ability to identify whether someone has a particular disease such as hepatitis are at an earlier stage of development. From the perspective of the UK, this project will help the University of Exeter appreciate the challenges of doing health technology assessment outside the UK. As well teaching the techniques of health technology assessment, we will improve research skills by jointly working on a specific assessment comparing the impact of two different non-invasive diagnostic methods - AST to Platelet Ratio Index (APRI) and transient elastography (FibroScan) - to monitor whether liver scarring is beginning, getting worse or better in people living with Hepatitis C. There will be reciprocal visits and regular communication between both centres to these ends during 2015.

According to World Health Organization, the number of leprosy new cases in 2012 stood at 189,018 around the world. Although not fatal, leprosy is responsible for more than 12 thousands cases of irreversible motor disability and deformity per year in the world. The disease is caused by the Mycobacterium leprae, an obligatory intracellular pathogen that preferentially infects skin macrophages and Schwann cells causing nerve damage and scarring, which results in the disfigurement and the classic hand and foot deformities of leprosy. Brazil has 33,303 cases/year of leprosy, being the most affected country in Latin America, representing 14 percent of the global number of cases and is surpassed only by India, which has approximately 134,752 new cases per year. Intracellular bacteria must obtain nutrients from their host cell and grow by either adapting their own metabolic pathways or manipulating the metabolism of the host. Understanding how they obtain nutrients from their host and how they utilize them will lead to better understanding the infection and may inspire novel ways to grow the bacteria for vaccine or drug studies; which is particularly relevant to the leprosy bacillus which cannot be grown in pure culture in the laboratory. In this project we will use a newly-developed developed technique called 13C flux spectral analysis to investigate the metabolism of M. leprae in its host cell. The M. leprae cells will be grown in mouse footpads, and then incubated in media containing a mixture of 12C and 13C-labelled glucose and metabolites extracted for analysis. We will use another technique called mass spectrometry to determine the distribution of 12C and 13C carbon in these metabolites and computer analysis of the data will reveal clues to both the nutrients used by M. leprae and how it utilises them. The work will be published in a peer-reviewed journal and may lead to novel approaches to growing the leprosy bacillus and developing new drugs.