Assessing the burden of HTLV in the England: co-infection with another blood borne or sexually transmitted infection

Applications are invited for a fully funded PhD studentship, either full time over 3 years, or part-time. The start date is October 2024.

Project overview

Human T-lymphotropic virus type 1 (HTLV-1) affects at least 5-10 million people worldwide and is the cause of adult T cell leukaemia/lymphoma, HTLV-1 associated myelopathy and multiple other serious inflammatory conditions. In the UK, the population living with HTLV-1 is estimated to have increased over the last 30 years from 15,000 to 36,000. The communities most affected are of black Caribbean or African heritage. The virus is predominantly transmitted sexually and vertically but, despite this, almost no testing is performed in sexual health or antenatal services. Testing is crucial as those found positive should be linked to NHS specialist services for life-long care, and to access counselling on how to prevent transmission to their babies and partners.

It is likely that HTLV in the UK is more common in people who have another sexually transmitted or blood borne infection, although this is currently unknown. We plan to offer HTLV testing to people with another blood borne virus (BBV) or sexually transmitted infection (STI), including HIV and syphilis, to identify HTLV seroprevalence. We will evaluate which measures are most effective at increasing HTLV testing in those at risk, and ascertain cost effectiveness of testing in this setting. Findings will inform clinical guidance and public health policy to reduce HTLV transmissions.

Project details

The student will undertake a systematic review to ascertain the known prevalence and incidence of BBVs/STIs in people with HTLV-1, and of HTLV-1 prevalence and incidence in people with another BBV/STI.

They will coordinate an HTLV enhanced testing study in five NHS HIV clinics. Potential interventions for increasing HTLV testing will be drawn from the HIV testing literature and following feedback from stakeholders including Patient and Public Involvement Groups. The student will assess patterns of HTLV testing including numbers tested, diagnosed positive and linked to care. They will compare overall findings to the numbers tested in the six months prior to the study period from local laboratory records, and compare patterns of testing in different clinics. People newly-diagnosed with HTLV will be invited to take part in qualitative semi-structured interviews to explore psycho-social impacts of receiving a HTLV diagnosis.

The student will design and coordinate a similar HTLV enhanced testing study in sexual health clinics within the five NHS Trusts. Clinic attendees with a diagnosed STI will be offered an HTLV test. The prevalence of HTLV, and of coinfection with other BBV/STI, will be determined overall and in different demographic groups. In a separate unlinked anonymous study, residual serum samples from patients with confirmed treponemal infection will be tested in the national reference laboratory at UKHSA for HTLV antibodies to determine HTLV seroprevalence. The student’s role will be to analyse results of testing.

The student will also undertake a cost effectiveness analysis for the costs of introducing enhanced HTLV testing in HIV and sexual health settings including the estimated cost to diagnose one HTLV positive case, using a static model.

Principal supervisor

Professor Graham Taylor, Department of Infectious Disease, Imperial College London

Co-supervisors

Dr Daniel Bradshaw, Virus Reference Department, UKHSA

Dr Carolina Rosadas, Department of Infectious Disease, Imperial College London

Associate Professor Sema Mandal, Blood Safety, Hepatitis, STI & HIV Division, UKHSA

Dr Ruth Simmons, Blood Safety, Hepatitis, STI & HIV Division, UKHSA

Requirements

A strong academic track record with a 2:1 or higher in a relevant undergraduate degree, such as biomedical sciences or statistics, or its equivalent if outside the UK.

Following interview, the selected candidate will be registered on the Imperial College London PhD programme. 

The closing date for applications is: 28th June. Interviews will be held during August.

Application enquiries

Please contact Dr Daniel Bradshaw for any enquiries relating to this PhD Studentship: daniel.bradshaw@ukhsa.gov.uk

Application procedure

Please provide a CV, a one-page personal statement detailing your research interests and reasons for applying, and contact information of two professional/academic references. All documents should be in electronic format and sent via e-mail to: mary.bryan@ukhsa.gov.uk