Infections Group
Our work is focussed on understanding infections in pregnancy and childhood, with an emphasis on prevention of vertical (mother-to-child) transmission, delineating risks for adverse outcomes and addressing key questions central to clinical practice and public health.
We conduct active research, surveillance programmes and projects on established and re-emerging infections including HIV, viral hepatitis, syphilis, Zika virus and other arboviruses, conducted in diverse settings, including the UK, elsewhere in Western Europe, Ukraine, Russia, Jamaica, Haiti, Ecuador, Brazil, Malawi and South Africa.
We also manage and coordinate the Integrated Screening Outcomes Surveillance Service (ISOSS) which monitors the screened for infections in pregnancy (HIV, syphilis, hepatitis B), and the Children's HIV and AIDS Reporting System (CHARS) on behalf of the NHS Infectious Diseases in Pregnancy Screening Programme and NHS England.
The Children's HIV and AIDS Reporting System (CHARS) conducts long-term clinical surveillance of children living with HIV in England for the NHS Infectious Diseases in Pregnancy Screening Programme, NHS England and NHS Improvement and the UK Health Security Agency's National Infection Service, with Regulation 3 approval.
The purpose of CHARS is to monitor outcomes and quality of services and to contribute to the national epidemiological monitoring. The main objectives of the paediatric HIV surveillance are:
- to provide data for public health surveillance of HIV infections among children living with HIV
- to monitor the quality of care of children living with HIV until transition to adult services, including producing quality of care indicators
- to support NHS commissioning of services
The Integrated Screening Outcomes Surveillance Service (ISOSS) monitors screening outcomes for the NHS Infectious Diseases in Pregnancy Screening Programme (IDPS) with Regulation 3 approval.
The goal of the ISOSS is to collect, analyse and report obstetric and paediatric data on HIV, syphilis and hepatitis B in pregnant women and children in order to:
- assess key outcomes of the IDPS Programme
- assess the IDPS Programme's impact on prevention of vertically-acquired HIV, hepatitis B and syphilis
- protect the health of women with and infants exposed to these infections
The ISOSS team investigate all new vertical transmissions of HIV and syphilis occurring in England. ISOSS interview all clinicians involved in the care of the mother and baby during and after pregnancy. Interviews are conducted across specialities including paediatrics, maternity and specialist care.
Detailed anonymised case reports are taken to the IDPS Clinical Expert Review Panels (CERP). The panels consist of relevant clinical specialists including maternity, laboratory, paediatrics, sexual health services as well as representatives from BASHH and BHIVA.
The purpose of the panels is to:
- establish the circumstances surrounding the transmission
- identify and contributing factors and learning points
- feed recommendations into the IDPS/ISOSS team
PhD Research Projects
Georgina Fernandes (student), Prof. Claire Thorne (primary supervisor), Dr Elizabeth Chappell (subsidiary supervisor), Dr Alasdair Bamford (subsidiary supervisor)
Summary: While there have been major successes in early HIV diagnosis and treatment initiation which have resulted in high rates of viral suppression in pregnancy and low vertical transmisssion rates in Europe, pregnant women remain a priority population for treatment optimisation.
The treatment of HIV in Europe has evolved over recent years to include newer and more potent antiretrovirals with important implications for pregnant women and their infants who have traditionally been viewed as a vulnerable population and therefore excluded from pre- and post-licensure drug trials. This has meant information to enable women and their health care providers to make informed treatment choices has been limited. As more pregnant woment are conceiving on antiretroviral therapy, which means the foetus is exposed to antiretrovirals for the entire gestation period, the priorities have shifted to concerns regarding the safety of these antiretrovirals in pregnancy, in particular for newer drugs with limited safety data.
Using individual patient data on pregnant women living with HIV in Europe and their infants, the objectives of this project are to:
- investigate recent patterns (temporal and geographic) of antenatal ART use (i.e., at conception and in women newly initiating ART)
- delineate policies and practices around the use of neonatal prophylaxis, particularly risk stratification approaches based on maternal characteristics and treatment
- assess use (including off-label) of specific antiretroviral regimens, including long-acting injectables, in pregnancy and investigate the associated pregnancy, birth and neonatal outcomes
- examine the frequency, timing, and type of antiretroviral drug switches in pregnancy, and the consequent maternal and infant outcomes (i.e., virologic suppression at delivery, vertical transmission)
Justin Willenborg (student), Prof. Claire Thorne (primary supervisor), Manolis Bagkeris (co-supervisor), Sema Mandal, UKHSA (co-supervisor)
Summary: In England, around 0.4% of pregnant women are living with chronic hepatitis B, with much of this disease burden concentrated among women born in high hepatitis B prevalence settings. The aim of this PhD is to investigate the frequency and risk factors for adverse pregnancy and newborn outcomes in women living with chronic hepatitis B and their infants in England. Outcomes to be assessed will include pregnancy complications such as pre-eclampsia and gestational diabetes, and neonatal outcomes including preterm delivery, low birthweight, small-for-gestational age, stillbirth and neonatal mortality. The potential role of the inequalities will be assessed.
Contacts:
| Name | Position | Contact |
|---|---|---|
| Claire Thorne | Professor of Infectious Disease Epidemiology | claire.thorne@ucl.ac.uk |
| Helen Peters | ISOSS & CHARS Manager | helen.peters@ucl.ac.uk |