Project Summary
People who inject drugs (PWID) experience high rates of blood borne viruses (BBV). Emerging evidence suggests that incarceration and homelessness increase their transmission risk of BBV. Infectious disease modelling will be used to project the role of these social factors to BBV epidemics among PWID and evaluate interventions to mitigate this risk.

Detailed description
HIV and Hepatitis C virus (HCV) are blood borne viruses with a high burden among people who inject drugs. Due to the criminalisation of drug use and its social exclusion, this group experience frequent incarceration and homelessness. Although interventions among people who inject drugs are effective in reducing the burden of HIV and HCV, evidence suggests incarceration and homelessness could limit their impact and increase the transmission of HIV and HCV. These factors may also act synergistically, with recently released prisoners being more likely to be homeless, and homeless individuals having high rates of incarceration.
The World Health Organisation (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have set targets for eliminating HCV and HIV. To meet these targets among people who inject drugs, it is important to understand how much incarceration and homelessness drive the transmission of HIV and HCV, and so the importance of targeting interventions to reduce these risks. Recent studies by our team have shown that incarceration is an important driver of HIV and HCV epidemics, but there is little evidence for homelessness.
This PhD project will use infectious disease modelling, paired with epidemiological analyses and a systematic review to evaluate the degree to which counteracting the detrimental effects of homelessness could be important for reducing the transmission of HIV and HCV among people who inject drugs. We propose the following:

1. Undertake a systematic review and meta-analysis to synthesise available evidence on the effect of homelessness on the risk of HIV and HCV acquisition (i.e. incident infection) among people who inject drugs.
2. For 3 cities, utilise available epidemiological datasets to develop and parameterise models of HIV and/or HCV transmission, incorporating the effect of homelessness and incarceration on transmission risk and uptake of interventions.
3. Through modelling, assess whether homelessness increases HIV and/or HCV transmission in each city. Evaluate the impact of interventions that reduce homelessness or improve the uptake of prevention and treatment interventions among this group.
   Through existing collaborators, we will model London, a Ukrainian city and a third city in USA/Africa/SE Asia, with travel occurring to these sites. Collaborators with expertise in homelessness (Peter McKie from University of Cardiff and Al Story from UCL) will guide the modelling and interventions considered. Prospective students will be highly numerate, with the project including training in modelling, epidemiological analysis, and systematic review and meta-analysis. As for a recent project considering incarceration, the PhD will result in high impact journal articles and will have policy influence through presentations at international conferences, and meetings with WHO, UNAIDS, the Institute of Global Homelessness and other agencies.

Requirements and training

The PhD candidate will need to 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 statistics and epidemiology, Stata, systematic reviews and meta-analysis, and infectious disease modelling. 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 Cardiff
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 lead supervisor for this PhD project (PV) leads the infectious disease modelling group at the University of Bristol, comprising 23 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 10 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. We will also enable them to 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 draw upon the additional expertise of one of the UK’s leading homelessness scholars. Dr Peter Mackie (PM) is a Senior Lecturer at Cardiff University in the School of Geography and Planning, where his research focusses on housing and homelessness, particularly the prevention of homelessness. His work in this field has had a significant impact on government homelessness policies and laws.

Focus and collaborations
In considering the effect of homelessness on disease transmission we are dealing with how social inequalities (lifestyles affect health) affect the resilience and ease with which people can access interventions and keep them safe from diseases. This is a novel area of modelling research that considers the social determinants of health. We have had success in this area of modelling as illustrated by our recent modelling on the health harms of incarceration.
To enable access to important data and to ensure the relevance and realism of our modelling, the PhD will involve a strong collaboration with a number of academics (including Peter Mackie from GW4 Cardiff) that specialise in undertaking research to improve the health and wellbeing of the homeless nationally and internationally (Dr Peter Mackie, Cardiff University, Dr Al Story and Professor Andrew Hayward, UCL). The PhD will also utilise and strengthen international partnerships and collaborations in Eastern Europe, USA, Africa or Asia. Through working in a number of international settings the project will have global relevance, enabling us to develop responses that can deal with differences across settings. We will use existing links with international agencies (WHO, UNAIDS, Global Fund, Global Institute of Homelessness, UN-Habitat) to ensure our findings can influence international health policy and homelessness policy. This will include engagement with homeless charities and agencies to maximise the relevance of what we do, and to ensure its dissemination and influence.

How to Apply:
You will need to complete an application to the GW4 BioMed MRC DTP for an ‘offer of funding’
Please complete the online application form https://cardiff.onlinesurveys.ac.uk/gw4-biomed-mrc-dtp-student-2019 by 5pm, 23 November 2018.
The Research Theme Panels will complete the shortlisting and inform applicants by 18 December 2018.
If you are shortlisted you will need to;
• contact your chosen supervisor(s) to discuss your application between 3 and 14 January 2019
• submit two references and a copy of your academic transcript(s) by 18 January 2019
• attend an interview in Cardiff on 22 or 23 January 2018
Further details will be included in the shortlisting letter.

Contact Person
Contact Professor Peter Vickerman at peter.vickerman@bristol.ac.uk for additional questions and to submit your application.