Major new research programme could fast-track health service improvement in low and middle-income countries

A community health volunteer practises applying fluorescein to detect corneal abrasions, Nepal. Credit: Jessica Kim.

The London School of Hygiene & Tropical Medicine’s (LSHTM) International Centre for Eye Health (ICEH) and Peek Vision have been awarded a Wellcome Trust Collaborative Award in Science.

This £3.8m funding will support the expansion of Peek Vision‘s smartphone-based eye health systems, which allow eye health programmes in low- and middle-income countries to improve access to their services.

Partnering with the Ministry of Health, Kenya, and the University of Botswana, the award will allow independent research groups to work together on projects where they can collectively amplify their skills for a common goal.

Professor Andrew Bastawrous, lead investigator at LSHTM’s ICEH, and CEO of Peek Vision, said: “The problems with gathering evidence to help eye service delivery is that the research cycle is so long, resulting in the evidence not always translating into practice. For randomised controlled trials it can be many years. This grant will help us to find ways to radically improve that for eye health and other areas.”

Eye health services using Peek can screen for eye health conditions by using a smartphone app to conduct vision checks and then track patients through the health system. The data can be accessed in real-time, allowing them to monitor the performance of services and appropriately respond to changes in their programmes.

The award will build on this existing methodology and software to enable users to test multiple improvements to their current screening and referral programmes at the same time. It will be possible to test several factors affecting the effectiveness of a service, for example the frequency or content of text alerts, or which solutions to local challenges (e.g. type of transport to treatment) work best.

By running several of these tests in rapid sequence or in parallel, the results could mean that successful, evidence-based changes to the health service can be implemented immediately. Programme implementers will be able to test their hypotheses in a real-world, uncontrolled setting, without the need for comprehensive research or statistical know-how.

Professor Josip Car, Director, Centre for Population Health Sciences and Director, WHO Collaborating Centre for Digital Health and Health Education at the Nanyang Technological University, Singapore, said: “This project is a stellar example of how mobile health can be utilised in very simple ways to great effect. The learnings from this study could have far-reaching consequences, not only in eyecare, but for the improvement of any complex health system. By using a process where hypotheses can be tested in quick succession or in parallel, and the results implemented immediately, the team are showing us how mHealth can truly be the future of healthcare, deeply integrated into its delivery, and providing huge benefit for patients worldwide.”

The award, for implementation within Kenya and Botswana over 5 years, will aim to improve eye health within the target countries, while assessing this new trial framework.

Prof Bastawrous added: “One third of the planet lacks access to basic eye care, with eighty percent of blindness and vision impairment being due to conditions we can effectively treat today with interventions such as glasses and cataract surgery. The vast majority of these people are in lower and middle-income countries. In eye health we have already delivered some fantastic innovations, now we need to focus on innovating delivery. This award is a fantastic opportunity to work further with our partners and provide a radical new way to assess eye health interventions, for the benefit of people and countries who need it most.”

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