Tristan Lee

This project develops and enhances G-methods to improve causal inference in clinical research by combining longitudinal data with advanced statistical techniques, addressing time-varying treatments, confounders, and spatial correlations.

LoDoCA is a prospective cohort study among children and adolescents with HIV in Lesotho, southern Africa who changed from an antiretroviral therapy regimen containing lopinavir to a regimen containing dolutegravir. The study compares treatment satisfaction and previously reported adverse effects of either drug, including neuropsychiatric (sleep, depression) and gastrointestinal outcomes. Sleep is a key focus, as sleep disturbance has previously been reported as an adverse effect of dolutegravir among adults. Thus, sleep is measured by actigraphy (movement-sensing devices worn by participants around their wrist from around bedtime to morning) in addition to questionnaires.

Community Based Chronic Care Lesotho (ComBaCaL) is a collaborative program between Lesotho and Switzerland dedicated to developing, testing, and sharing innovative solutions to enhance chronic disease care in remote settings in low- and middle-income countries.

At the core of ComBaCaL is the concept of Community Health Workers (CHWs) supported by a digital clinical decision support system, enabling them to provide treatment for selected conditions in remote areas with limited access to clinics.

In phase 1, we empowered CHWs to independently prescribe and manage treatment of uncomplicated hypertension and type 2 diabetes. This approach was effective in large cluster-randomised trials.

In the current phase 2, the focus has expanded to integrated care packages addressing a wider range of conditions, including HIV, sexual and reproductive health, and health services for children under five. The aim of this phase is to prepare ComBaCaL for scale.

For detailed information and a comprehensive list of our publications, visit: www.combacal.org.