In-SPHERE May 2023

In-SPHERE

In-SPHERE

Issue 3: May 2023

URBAN PLANNING FOR PANDEMICS

PROFILE: PROFESSOR VALSAMMA EAPEN

SPHERE GRANTS

SPHERE GRANTS

SPUR NATIONWIDE

SPUR NATIONWIDE

HEALTH INITIATIVES

HEALTH INITIATIVES

MINI HEARTS PLAY A ROLE IN REDUCING HEART DISEASE RISK

Our Partners

Each of our 16 Partners has a proven record of pioneering advancements across healthcare research, innovation and education.

It is this fusion of these different entities into one potent force that makes The Partnership unique - the whole is greater than the sum of the parts.

IN THIS ISSUE:

In-SPHERE, published three times a year, is the official research magazine of Maridulu Budyari Gumal, the Sydney Partnership for Health Education Research and Enterprise (SPHERE).

In-SPHERE showcases the work of our Clinical Academic Groups (CAGs) and Strategic Platforms as well as our Partner Organisations.

Acting Executive Director: Professor Christopher White

Editorial Committee

Linda Music (Editor/Chief Writer)

Renecia Lowe (Sub-Editor)

Kaitlin Bonner (Writer)

Ritesh Chimoriya

Elizabeth Henness

Smita Khandelwal

Stephanie Macmillan

Leila Niemela

SPHERE has always been centred around creating better health outcomes for our communities. Yes, the research that our partners do together is cutting-edge, but the goal is developing workable solutions to the biggest health challenges that our communities face.

UNSW Sydney is one of the founding partners of SPHERE, and seven years in, the focus on patient outcomes clearly remains. Across our Clinical Academic Groups (CAGs) and key strategic programs, we are already seeing innovative programs and tools become available to our clinicians and to the broader community.

This highlights a key goal of SPHERE, and its strongest opportunity. There is already much research undertaken by scientists, clinicians, administrators, and many other players in health, so why do we need SPHERE? And these existing research activities often address issues that lead to better health outcomes, but are they the MOST important issues? And is the investment our community has made through our national and state schemes being optimally used?

SPHERE brings together several health services, Universities and Medical Research Institutes. It offers a clear pathway to understand the needs of our health services, and the broader

Foreword

Professor Vlado Perkovic Dean, Faculty

of Medicine & Health, UNSW Sydney

community, to prioritise the most important research that we can do, and then to ensure that the knowledge identified through this research is optimally implemented.

To achieve these outcomes, it is critical to bring together patients, clinicians, researchers, administrators, and many others in research groups. This is the fundamental purpose of the Clinical Academic Groups and there are many examples where this has proven successful.

But we must do more. A specific focus on including patient voices, linking with clinicians and managers, and including the groups who will need to implement findings of research, will lead to faster and more effective translation. This is ultimately what SPHERE is all about.

There are some great initiatives underway. For example, being patientcentred means listening to the community and the Consumer and Community Involvement Group has been established to help achieve this. I can also see other initiatives across the Partnership to involve the community in our research and its translation.

SPHERE’s translational focus has also been empowering for our researchers and our clinicians. Working in multi-disciplinary teams and moving agilely between bench and bedside,

they are ensuring that their discoveries and innovations reach patients.

Another benefit of being part of SPHERE is the possibility of previously unconnected groups working together in new ways. Some of these collaborations have been quite unexpected – like the Topsy Turvy project during the COVID-19 pandemic. Healthcare leaders partnered with artists to translate their diverse experiences of the pandemic through drawings, text, and sound.

I was pleased to see SPHERE’s strengths recognised when we were recently re-accredited by the National Health and Medical Research Council (NHMRC) as a Research Translation Centre. The NHMRC recognises Research Translation Centres as providing collaboration between health care, research and education organisations and driving translation of health and medical research. This is an acknowledgement of the strength of the joint efforts of SPHERE partners to serve our community.

Please enjoy this issue of InSPHERE where we showcase some of the individuals and groups contributing to the strength of the partnership, and better solutions for the people of NSW, and do keep contributing. We have much to do together.

In brief

Age and Ageing CAG endorse new report on Falls prevention

The Australian and New Zealand Falls Prevention Society (ANZFPS), together with the Centre of Research Excellence (CRE) in the Prevention of Falls Injuries, have launched their latest report ‘The rising cost of falls: Why investing in prevention can’t wait’, which details their vision for Australia to have a world class National Falls Prevention Strategy by 2025.

Professor Kim Delbaere, President of the ANZFPS, is a Senior Principal Research Scientist and the Director of Innovation & Translation at the Falls, Balance & Injury Research Centre at Neuroscience Research Australia (NeuRA). Professor Delbaere says the report was created not due to the lack of research being done in the area of falls prevention, but the lack of awareness about the scale and severity of the problem.

“Australia was well ahead with

their vision 20 years ago (when they launched the National Injury Prevention and Safety Strategy 2004 – 2014) but falls prevention has not been seen as a priority issue by policymakers and government since. While some local and state-based initiatives exist, there is little national coordinated action and resource sharing, and these efforts have been unsustainable without ongoing funding. This lack of coordination has led to inefficiencies, duplication of efforts, and a lack of coherence in overall strategy.”

“Falls and fall injuries are a large and growing problem for all Australians. Fall injuries in older adults cost Australian healthcare systems $2.5 billion each year and can be devastating for individuals and their loved ones. Concerns about falling

are more common than falls itself, and have (also) been associated with various negative outcomes, including depression, decreased quality-of-life and social isolation.”

While engagement with the report has had a promising start, Professor Delbaere highlights the importance of the work still to come.

“Addressing falls prevention in Australia will require a concerted effort from policymakers, healthcare providers, researchers, and the public to raise awareness, increase coordination and resources, and develop evidence-based strategies to reduce falls and their impact. We look forward to working with government and our partnering organisations to make a difference in years to come.”

This report has been endorsed by the Age and Ageing Clinical Academic Group of SPHERE. The AAA CAG will continue to support this initiative through the sharing of knowledge and resources over the years to come.

For more information and to access the report, go to the ANZFPS website If you would like to get involved in this Call To Action, please email Prof Kim Delbaere at k.delbaere@neura.edu.au.

By Kaitlin Bonner

Concerns about falling are more common than falls itself, and have (also) been associated with various negative outcomes, including depression, decreased quality-of-life and social isolation.

Profile

Andres Ramirez

A new perspective to consumer engagement

When Andres Ramirez joined SPHERE’s Inaugural Age and Ageing Consumer Council, he came in with a new perspective. Although too young to be a consumer of services for the aged, Andres’ experience with multicultural groups provides the Council with significant insight into how research can better serve ageing migrant communities.

Why are you interested in ageing research?

Through my involvement with a Colombian community group and the Australian and Latin American Young Professionals Association in Queensland, I participated in business initiatives that sought to support migrant communities, particularly Latin Americans, arriving in Australia.

This work exposed me to an ageing segment of the Latin American community in Australia, people who migrated to Australia in the 60s and 70s and who are now in old age. While they have strong social networks in their respective communities, many do not have the same support or confidence when finding information and accessing services for the aged.

This is why I’m interested in exploring how research can be better tailored to these communities to cater for linguistic and cultural diversity in ageing groups, so research outcomes can be improved and communities can benefit from more customised services and resources.

You have a Masters in Education and a Masters in Governance and Risk Management with extensive experience in these areas. How does your knowledge, skills and experience add to the Council and to research in general?

I think ageing research can benefit from the perspectives of education and risk management. Risk Management goes beyond the management of physical hazards. I think it is essential that research also considers any psychosocial risks (impacts on mental health, for instance) to which the participants of research may be exposed.

Equally, my experience in Education and Governance may assist the Council in defining its involvement in research activities. There may also be an opportunity for research around ageing to be further promoted across migrant communities, so I am keen to explore options to make those communities more aware.

Why is a Consumer Council important for the AAA CAG?

The consumer perspective that the Council provides is invaluable so research activities can be better defined and tailored to the needs of ageing people. By collaborating with people who’ve experienced some of the issues the research aims to understand or explore, then studies can be better designed, developed and completed.

Do you have any particular interest in the type of ageing research you’re hoping to be involved in?

I am particularly interested in research around Alzheimer’s and dementia. I am aware of studies conducted in these areas that highlight the benefits of learning another language, so I am keen to see how this could translate to migrant communities who have acquired a second language and the physical benefits of doing so.

Tell us something about yourself outside your professional life and your role on the AAA CAG Consumer Council.

I am originally from Colombia and during my undergraduate studies, I had the opportunity to represent the country at an international folkloric dance competition in Peru. When I moved to Australia, I ensured that I kept dancing by getting involved with Colombian Folkloric dance groups. This involves not only the actual performance of the dances, but also research into the significance of the costumes and cultural elements behind the meaning of a dance. For me, this is an effective way to provide people in Australia with a different perspective of Colombia, beyond the negative stereotypes that exist about my country.

Profile Professor Glenn Marshall AM

You wear many different hats. Can you tell us about your different roles and what they entail?

I have always worked as a clinicianscientist. My primary appointment is as a Paediatric Oncologist at the Sydney Children’s Hospital in the Kids Cancer Centre where I see patients most days. Seeing children with cancer and their families each day has informed every aspect of my research career and still inspires me.

I have an appointment at the Children’s Cancer Institute (CCI) as Head of the Embryonal Cancer Group. At CCI I lead a group of more than 20 scientists, clinician-scientists, bioinformaticians and a pathologist, all working on the cause, prevention and treatment of embryonal child cancer. Our research work is heavily translational in nature, meaning we are always seeking real world application of our findings. I am part of the leadership group of ZERO, a precision medicine program for children with cancer, which I helped initiate some

nine years ago. Over the past 10 years I have gradually passed on my leadership roles at the CCI, SCH and, of several state and national research networks to others, including recently the Directorship of Kids to Adults Alliance (K2A) and Child UnLimited to Prof Raghu Lingam (UNSW) and Prof Harriet Hiscock (Murdoch Institute and RCH Melbourne). I am still involved in the consumer component and on the operations group.

How long have you been working in Children’s cancer space and what led you to this specialty?

I have worked on the problems faced by children with cancer for more than 35 years. I was inspired to work in this area of medicine because of some inspirational mentors who were clinicians who thought like scientists, by the chance to apply scientific enquiry to the problems I see in the clinic every day, and most importantly, by the children and their parents affected by this disease.

What does your typical day/week look like?

I see children with cancer and their families most days as inpatients or outpatients in a clinic at SCH or at outreach clinics in Canberra and Coffs Harbour. Every day I also meet with scientists working with me. I still chair the ZERO MTB each few weeks, which is an amazing learning experience as we struggle to find treatments for children with high risk cancer. I set aside a few hours each working week for grant writing or drafting manuscripts. This activity continues on Saturday and Sunday afternoons.

What is the best part of your job/s?

There are many which include: telling families their child is cured, seeing adults who I have treated in our long-term follow-up clinic; getting invited to 21sts, weddings and other significant events in the child’s life; working with great clinical and

scientific colleagues; suddenly realising we have a really important new experimental result after long years of toil and then publishing in a good journal; and ultimately seeing clinical practice change due to our work.

What is your role in SPHERE?

I have been a Co-Director of K2A and now the national Child UnLimited with Claire Wakefield and Raghu Lingam for five years.

How does SPHERE help contribute to your research in children’s cancer?

We could not have begun K2A without the support of SPHERE. In K2A and Child UnLimited we focus on children with chronic illness: improving the whole of child life and that of their families through research on

consumers, mental health problems, models of care, missed education and transition for these kids to an adult health system.

What is your greatest professional achievement?

Improving the way we treat child cancer so more kids are surviving and thriving, hopefully achieved by inspiring others. Giving hope to families who come to us in need, winning their trust, and then doing the best we can to help them.

In your spare time, you paint portraits. How long have you been painting?

I actually do a lot of things in my spare time. One of those is oil portraiture and landscape painting. I have had one show and am planning

another with artist friends. Recently, I have undertaken a few portrait commissions. Yes, I have sadly not yet been hung in the Archibald or Moran prize. I really enjoy the art which I picked up in my 40s having never painted before, as it is so different to all the other things I do.

What is your greatest personal achievement?

Marrying my wife (although I am not sure you can “achieve” a marriage?) and receiving her unwavering support even in the difficult times. Raising my son and welcoming our new grandson into the world recently.

More about Professor Marshall

Published more than 230 research articles on biological, clinical and survivorship aspects of child cancer

Received awards from NHMRC and CINSW for excellence in translational research

Order of Australia (AM) in 2014 for significant service to medicine

Director of the Kids Cancer Centre for 18 years (until 2016)

Fellow of Australian Academy for Health and Medical Science in 2017

2019 – Premier’s Award as the Outstanding Cancer Researcher of the Year

Health Services Research Award from Research Australia (2019)

Painting by Professor Marshall: ‘Luc at Louvre’

Middle Rock

Profile Professor Valsamma Eapen

Professor Valsamma Eapen always knew she wanted to work with children. She also knew she wanted to study medicine in keeping with other family members. Becoming a paediatrician seemed the obvious career choice.

But in her internship year, working in a children’s oncology unit and then in the Emergency Department, Prof Eapen realised that the path she was on did not align with her dreams.

“I found working in both these environments, extremely stressful and emotionally difficult. I witnessed children coming into ED as highacuity patients and saw some take their last breaths. I realised that although I still wanted to work with children, I needed to go down a different pathway,” she explained.

The pathway she took led her down a new trajectory which would see her become one of Australia’s leading researchers and educators in child and adolescent psychiatry with a focus on

Neurodevelopment, Autism, Attention Deficit Hyperactivity Disorder and Tourette Syndrome.

“I was fascinated with the brain and the mind/body connection so neuropsychiatry and neurodevelopment seemed like a good idea because it meant I could work with young children to make a difference rather than wait until conditions had set in which makes them difficult to change.

“If you intervene in the first 2000 days of a child’s life (from pregnancy to start of school) when the brain’s plasticity is the most malleable, then you have the most potential to change their life trajectory and that became the focus of my life’s work.”

Prof Eapen initially worked with Tourette patients because it combined all the facets of mind/brain/body connection that fascinated her.

“Tourette’s was the crystallisation of everything I was interested in: the brain and its involvement in involuntary

movements such as tics and the mind overlay through behaviours such as obsessions, compulsions, and socially inappropriate actions associated with this lack of control, and of course the secondary psychological challenges due to stigma, bullying etc.”

Wanting to learn more about neurodevelopmental disorders, and Tourette’s in particular, Valsa moved to London where she completed her PhD at University of London via research at the UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, whilst undertaking her registrar training at the University College Hospital scheme and child psychiatry training at the Great Ormond Street Hospital scheme, London.

A trip across the seas

In 2008, Prof Eapen moved to Australia where her interest in neurodevelopmental disorders broadened to include an equity angle

in the context of her clinical work in South West Sydney where Prof Eapen heads the Academic Unit of Child Psychiatry, South West Sydney Local Health District. It is in this space that she began to make significant impact, not only to the lives of children and their families, but also to the health system.

Changing the health landscape

Working in child mental health, Prof Eapen has seen first-hand the difficulties families face when confronted by what she describes as a fragmented health system.

“In South West Sydney, I came to a new realisation that it doesn’t matter what condition you have, it’s the social determinants of health that make or break your trajectory. That is, you can have the same diagnosis, but the social determinants will dictate what treatment you can access, who you can see and how your condition progresses,” explains Prof Eapen.

Of particular concern to Prof Eapen was that parents were not engaging in the critical child developmental checks because of these social determinants as well as the complex and disjointed system that many families struggle to navigate (e.g. GP, state, NGO, private).

“In our first NHMRC Grant we aimed to understand how well baby health checks are done, who accesses, where, and the outcomes. We had a cohort of 2000 babies born in Liverpool and Bankstown hospitals who we followed up at six, 12, and 18 months. What we knew clinically was confirmed about the very low uptake of the blue book* developmental checks with only around 30% engaging at 12 months and a further steep decline after that.

Prof Eapen’s qualitative work found

that the divide between the state and federal system was a significant issue. She discovered that families weren’t taking their children to child and family health nurses for their child developmental checks due to a range of issues including lack of transport, language barriers, poor health literacy, and unique help seeking patterns of multicultural families, and often they were only visiting their local doctors when their child was sick. Critical developmental checks were not being undertaken by GPs as these checks formed part of the State’s child and family services and not the federal GP system.

Prof Eapen explains that while one-

in-five Australian children have one or more developmental difficulties (e.g. speech delay, autism) when they start school, many are not identified early, thereby missing opportunities for early intervention.

Watch Me Grow

To bridge the gap between the different service systems and to overcome the poor awareness as well as the structural, financial, geographic barriers to service access, the Watch Me Grow program was developed with a view of ‘going to where the children go’ in order to empower parents to engage in the

developmental monitoring of their children. Initially piloted in South Western Sydney, Watch Me Grow is now being scaled up across three sites covering multicultural (Fairfield, NSW), regional/rural/Aboriginal (Taree, NSW) and low socioeconomic (Wanneroo in WA) communities for early identification as well as a tiered care response based on needs.

(see article SPHERE Grants Spur Nationwide Health Initiatives on p 19 for more information about Watch Me Grow).

And that’s not all…

If she isn’t busy enough with Watch Me Grow, Prof Eapen is working on a range of other projects including continuing her work in Tourette’s and Autism.

“I’m doing a cannabis trial for people with Tourette’s who haven’t responded to conventional treatment and my team is also trialling a behavioural intervention group program for Tourette Syndrome as well as developing a novel intervention for functional tics.”

As Director of Early Years program of the Autism CRC (completed in 2022), the world’s first national, cooperative research effort focused on Autism across the lifespan, Prof Eapen had oversight of several national programs such as the Autism Subtyping program with sites across all the six states in Australia, the Australian Autism Biobank project, in addition to the development of the National Autism guideline.

“I’ve also developed a Quality of Life in Autism (QOLA) scale which is now being used by 98 teams across 32 countries and recently published a cross-cultural comparison paper across seven countries.”

As Professor and Chair of Infant, Child and Adolescent Psychiatry at UNSW Sydney, Prof Eapen teaches medical students and registrars and supervises honours/Masters/ PhD students and medical students, registrars and fellows for scholarly research projects. In this regard, she is the Australian faculty lead for the Child Psychiatry International Fulbright Medical students Mentorship program.

Prof Eapen is the Chair of the Bi-national Faculty of Child and Adolescent Psychiatry, The Royal Australian and New Zealand College of Psychiatrists (RANZCP), and in this role she led a pre-budget submission to NSW Government in 2021 that resulted in the biggest ever investment in child mental health of $109 million for establishing rapid response Safeguards teams across NSW.

She is also the Treasurer and President Elect, International Neuropsychiatry Association.

Where to next?

From a young age, Prof Eapen had a vision to work with children but her work has grown beyond that.

“My work continues around finding evidence to support a tiered model of care that is responsive, integrated, sustainable and equitable in which all children irrespective of their socioeconomic, cultural and linguistic or geographic backgrounds have access to early identification of child developmental and mental health needs in conjunction with early intervention that is not just early in illness but early in life.”

* The ‘blue book,’ as it is known, is provided to all babies born in NSW and serves as the child’s first health record journal.

• Prof Eapen has published over 350 peer reviewed journal articles including in prestigious journals (e.g. Nature Reviews, Nature Medicine, BMJ, Neuron, Cell, Lancet (Child and Adolescent Health), JAMA Pediatrics), 6 books, >50 book chapters, international resources, podcasts, print, radio, and TV engagements.

• Her book “Where There Is No Child Psychiatrist” is used internationally to upskill professionals in early identification and management of child mental health problems, particularly in developing countries.

• Prof Eapen is part of grants totalling >$40million and leads the field, 4th worldwide for scholarly output for the topic “Child Development/Early Intervention” and 1st in Australia for topic “Tourette/Tic Disorders.”

“If you intervene in the first 2000 days of a child’s life, when the brain’s plasticity is the most malleable, then you have the most potential at changing their life trajectory and that became the focus of my life’s work.”

”

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... we can potentially reduce the risk for these women by implementing correct therapy.

Mini hearts reducing heart disease risk

They may be tiny, but these mini hearts (pictured p14) are showing promise in helping reduce the risk of cardiovascular disease and death in women who have had gestational hypertension and pre-eclampsia in pregnancy

Ateam of researchers led by Associate Professor Lana McClements from University of Technology (UTS), in collaboration with St George Hospital and funded by SPHERE’s Cardiac and Vascular Health Clinical Academic Group, are seeking answers to explain why women who have had hypertensive disorders of pregnancy (HDP) are at an increased risk of developing and dying from cardiovascular disease (CVD).

And they’re doing it by creating mini hearts, composed of patients’ own blood cells, on which they can test biomarkers and treatments.

“Women who’ve had a hypertensive disorder of pregnancy have a 200300 per cent increased risk of developing CVD later in life than women who did not,” explains A/Prof McClements.

“Despite a well-established link between HDP and cardiovascular disease later in life, the mechanisms of this association are poorly understood. For this reason, we aim to re-create

Women who’ve had a hypertensive disorder of pregnancy have a 200-300 per cent increased risk of developing CVD later in life than women who did not.

the complex CVD conditions associated with HDP by analysing our in-vitro bioengineered cardiac spheroid models of the human heart.

“If we can identify early signs of CVD at the molecular and cellular level, which can’t be picked up in the doctor’s office through regular tests like blood pressure monitoring, then we can potentially reduce the risk for these women by implementing correct therapy.”

Creating mini hearts

The first stage of the research involved developing 3D heart models specific to each patient. A/Prof McClements explains there are three main cell types in the heart: cardiac fibroblasts, cardiac endothelial cells and cardiomyocytes. Researchers extract stem cells from a patient’s blood with which they then create cardiomyocytes and cardiac endothelial cells. When these cells are combined with generic cardiac fibroblasts in a gel, researchers successfully create personalised cardiac spheroid models of the human heart.

“We then interrogate these models, at a molecular level, to see if there are any differences in the mini-hearts developed from women who had HDP five years prior compared with women who had normal healthy pregnancies.” The blood samples were collected at St George Hospital as part of the P4 study in collaboration with A/Prof Amanda Henry, A/Prof Greg Davis and Dr Lynne Roberts.

“Another way we did this is by incubating the generic mini hearts with blood plasma from women who had HDP or healthy pregnancies to see if it changed the way cells in the mini hearts contract which is a measure of heart function.

“What we found is that the hearts which had been incubated with plasma from women who had HDP contracted a lot faster which could be a sign of early heart dysfunction. We also observed that some of the inflammatory markers known to be linked to cardiac disease were also increased for women who had HDP,” explains A/Prof McClements.

“We plan to test some of the new and known preventative treatments on these models and see if we can inhibit these inflammatory markers.”

Having discovered these differences, researchers are now turning their attention to understanding what happens at the single cell level.

“What we’re doing now is RNA sequencing of individual cells to see if there are any differences in cells on a gene level.

“This is important as every organ including the heart is heterogenous with some sub-populations of cells showing certain patterns whilst others don’t. We want to understand in what specific types of cells are changes happening in women who had HDP compared to healthy controls, and how we can target these changes with treatments on a personalised basis.

What’s next?

This study is helping researchers not only understand the mechanism behind why women who had HDP have a higher incidence of future cardiovascular disease but also which biomarkers can be used to identify women at risk of developing CVD at an early stage.

“A blood sample can help us identify women who need closer monitoring, as well as identify therapeutic targets towards personalised treatment of women’s CVD,” says A/Prof McClements.

“Our unique approach combining expertise in cardiovascular and obstetric medicine, genomics and bioengineering will also allow us to fully understand, for the first time, HDP-induced cardiovascular disease and develop personalised monitoring platforms and treatment strategies to address the unmet needs of patients.”

Removing the need for animal research

The development of bioengineered hearts also removes the need for animal research.

“If we have patient-derived 3D models of hearts, we won’t have to use

3D cardiac spheroids “mini hearts”. Staining of: cardiac fibroblasts (vimentin+), cardiomyocytes (troponin T-C+), and cardiac endothelial cells (CD31+) DAPI labels all cells

animals for research which is in line with the three R’s of animal research: Reduction, Replacement, Refinement. This is even more important considering the U.S. Food and Drug Administration no longer requires drugs to be tested on animals before human trials.”

The project is a collaboration between SPHERE’S Cardiac and Vascular Health Clinical Academic Group Maternal, Newborn and Women’s CAG, Diabetes, Obesity and Metabolic Disease CAG, Frontiers Technology CAG, SESLHD and UTS.

Read more:

https://bsd.biomedcentral.com/ articles/10.1186/s13293-021-00376-1

https://www.mdpi.com/20734409/10/4/899

SPHERE IS seed grant helps secure MRFF funding

In 2020, Dr Luckett and his research team were the successful recipients of a SPHERE Implementation Science Platform seed grant for their project titled “Using behaviour change theory to drive scalability of the hand-held fan for chronic breathlessness.”

The aim of their research was to explore approaches to manage breathlessness crises for people living with COPD. This grant provided the team with the necessary resources to commence their research program, enabling them to develop resources, collect preliminary data and develop collaborations with key stakeholders.

As a result of the early research findings, Dr Luckett and the team have recently been awarded a MRFF Consumer-Led Research grant ($397,111.74) for a three-

year research project (20232025) to partner with consumers, carers, and clinicians to co-design a comprehensive and targeted selfmanagement plan for breathlessness crises for people living with COPD.

The SPHERE Implementation Science Strategic Platform awards translational research seed grants each year to support academic and clinical multidisciplinary teams to translate evidence into clinical practice using an implementation science framework. Dr Luckett’s story is an excellent example of how this seed funding can lead to successful, high-impact funded research.

We encourage all researchers, clinicians and consumers to keep an eye out for the announcement of the 2023 Implementation Science seed grants later this year. Who knows, your

Dr Tim Luckett

research program may be the next to secure vital funding and make a significant impact.

Back Row (L to R): Dr Carmine Gentile, A/Prof Lana McClements, Dillan Pienaar Front Row (L to R) A/Prof David Gallego Ortega, Ms Sahar Ghorbanpour, Ms Clara Ming, Dr Kristine McGrath

SPHERE grants spur nationwide health initiatives

Big things come in small packages, so the saying goes.

Nowhere is this more evident than the success of two SPHERE-funded projects which have gone on to become nationwide health initiatives changing health outcomes for patients across the country.

Point-of-care hepatitis C testing: From pilot to national scale-up

What started as a small seed grant by SPHERE’s Infectious Disease, Immunity and Inflammation (Triple I) Clinical Academic Group for a Pilot project has grown to become a national initiative receiving over $17 million in grant funding and bringing together partnerships across all Local Health Districts (LHDs), UNSW, consumer organisations and industry.

The need for a new approach for hepatitis C testing

Hepatitis C infection poses a significant public threat in Australia and globally. The good news is that new hepatitis C therapies can cure infection in >95% of people, leading to declines in liver-related deaths. Progress towards hepatitis C elimination in Australia is impeded by low testing and treatment.

“Among the estimated 124,000 people with hepatitis C in Australia,

47% don’t know they have the virus, or have not received treatment due to testing and treatment barriers,” explains Lead investigator, Professor Jason Grebely from the Kirby Institute, UNSW.

These barriers have led to declines in annual treatment from 32,000 in 2016 to 6,500 in 2021, with the most marginalised populations of people who inject drugs and those in prisons yet to receive treatment.

A major barrier to improving testing and treatment is that the current diagnostic pathway requires multiple visits (HCV antibody to confirm exposure, HCV RNA to confirm active infection, and one or more assessments to start treatment) leading to frequent loss to follow-up. This is amplified in populations with high hepatitis C burden, such as people who inject drugs and those in prison.

“New point-of-care hepatitis C testing

Professor Jason Grebely

SPHERE grants spur nationwide health initiatives

technologies capable of detecting current hepatitis C infection in one hour are a game-changer. These new tests enable diagnoses and treatment in a single visit, overcoming the barrier of multiple visits that frequently leads to loss to follow-up,” says Professor Grebely.

The TEMPO Pilot study

Initially funded as a seed grant by SPHERE’s Infectious Disease, Immunity and Inflammation (Triple I) Clinical Academic Group, the TEMPO Pilot study partnered with the Kirketon Road Centre, South Eastern Sydney Local Health District (SESLHD) and the New South Wales Users and AIDS Association (NUAA) to evaluate an intervention integrating point-of-care hepatitis C testing, nursing care, and consumer-based support to facilitate same-day testing and treatment.

Overall, 101 participants were tested, 27% were found to have current hepatitis C infection, and 81% initiated treatment. Key to the success of the project was strong partnerships with the SESLHD and NUAA.

From pilot project to national program

The TEMPO Pilot study provided critical evidence and catalysed the implementation of the National Australian Point-of-Care Testing Program, which is scaling up pointof-care hepatitis C testing at 90 sites nationally, including community health services and prisons.

The initial TEMPO Pilot funding ($75K) has leveraged for a further $17 million in funding ($13M cash, $4M in-kind) from the Australian Government and Industry including the NHMRC (two Partnership Project Grants), MRFF (Clinical Trials Activity Grant) and Gilead Sciences, Cepheid, and AbbVie.

Since 2022, 10,035 tests have been performed with 1,248 people testing positive. Of these, 77% have initiated treatment.

Using Implementation Science for further scale-up

But Prof Grebely’s team are determined not to stop there. Their next goal is to scale-up the program even further.

“The next pressing challenge is to deliver point-of-care hepatitis C testing at scale to facilitate increased HCV testing and treatment and achieve HCV elimination. This requires an understanding of the barriers and facilitators for implementing pointof-care testing and treatment and how to address them using specific implementation strategies to embed changes into practice and bring them to scale.”

To that end, the next stage of the project will bring together experts in implementation science, epidemiology, social sciences, diagnostic testing, mathematical modelling, health economics and consumer-led research to understand what works to enhance implementation of point-ofcare testing and why. The project will develop clinical trial capacity (research training across more than 360 health services nationally), many of whom have not previously been involved in research.

“Impact will be achieved by increasing hepatitis C testing and treatment to improve the health of people with hepatitis C in Australia and address national hepatitis C elimination targets which includes an

80% incidence reduction and 65% reduction in mortality.”

A perfect example of partnerships

To date, over 150 national stakeholders, including consumers and health services, national and state/ territory viral hepatitis and drug user consumer organisations have helped co-design the program. The program also has extensive involvement of academic, industry (Cepheid, Gilead Sciences, AbbVie) and all state/ territory governments.

“Critical to the success of our program has been the involvement of consumer, government, health service, and academic partners nationally,” says Prof Grebely.

From seed to growth

From a small seed grant, the TEMPO Pilot study has grown into a national initiative that could see Australia reach the World Health Organisation’s target to eliminate hepatitis C by 2030.

“I truly believe that the initial seed funding from SPHERE’s Triple I Clinical Academic Group to pursue this project provided a catalyst and the initial data to facilitate national funding. We’ve made significant gains in improving our testing rates and are closer to achieving hepatitis C elimination and improving the quality of care for patients in Australia,” says Prof Grebely.

Watch Me Grow continues to expand

Watch Me Grow continues to expand

Watch Me Grow is another highly successful program that started with SPHERE funding.

Watch Me Grow is a novel digital application which helps to identify children with developmental difficulties. Initially funded by SPHERE and Early Life Determinants of Health (ELDoH) Clinical Academic Group, the program was developed with a view of ‘going to where the children go’ to empower parents to engage in the developmental monitoring of their children.

Understanding that more than 95% of children receive vaccination in the preschool period, the project led by Professor Valsamma Eapen (p.9) aims to engage parents in the GP waiting room during vaccination or other routine health visits. Parents complete a developmental checklist as recommended in the ‘blue book’ via the Watch Me Grow web link accessed through a QR code.

If a parent’s response to the checklist raises any red flags, the application’s algorithm automatically recommends further assessments and the GP (or another health professional as applicable) is simultaneously notified of these concerns which can then be addressed during the

consultation. The program has been shown to be feasible, accessible and effective.

To ensure that parents were still able to access developmental checks during the COVID period when clinics were closed, the web link was provided to families at their homes and communities through their existing service providers (e.g. primary care, state child and family health nursing, multicultural or supported playgroups, NGOs, child care centres and preschools, Aboriginal Medical Services).

With increasing mental health concerns resulting from COVID-19 lockdowns, Prof Eapen’s team knew this new iteration of Watch Me Grow needed to screen for parental mental health and family social needs in addition to providing the child developmental checklist. With funding from NSW Health COVID-19 grant, the project has been expanded to the multicultural Fairfield community and the regional/rural community of Murrumbidgee where 15% of the participants were from the Aboriginal background. The program has shown

that there was better engagement and access of services in the intervention group.

Watch Me Grow is expanding and with her latest Medical Research Future Fund (MRFF) grant, Prof Eapen and her team are scaling up the project across three sites covering multicultural (Fairfield, NSW), regional/rural/Aboriginal (Taree, NSW) and low socio-economic (Wanneroo in WA) communities for not only early identification but also a tiered care response based on needs.

An NHMRC partnership grant with NSW Health, Queensland Health and PHNs is helping to fine-tune the GPto-state service care pathway from identification to linkage with service providers. Further, an ARC Linkage grant is evaluating the role of ‘one stop shop’ First 2000 days place-based hubs and service navigation in assisting families to receive services in an integrated way.

The program was recommended by Australian Health Research Alliance as one of 10 programs of impact nationally.

Urban planning for pandemics

In the absence of immunisation, high-quality planning and design of our cities can play an important preventative and responsive role during pandemics

By Kaitlin Bonner

Pandemics have been known to shape the course of human history, and the recent outbreak of COVID-19 is no different. What is new, however, is the concept of ‘healthy urban planning’ which has gained popularity in the last 15 years and requires those involved in urban planning and design to consider the link between their work and that of healthy behaviours and spatial equality.

Urban areas are typically considered epicentres to disease transmission, and this was the case with SARS-CoV-2 and the disease it causes: COVID-19. Combine this with the fact that emerging infectious diseases are now travelling faster than they ever have before, and the need to review the role of urban planning in the design for pandemic management becomes clear.

While many recounts of responses to previous pandemics exist, there have been few systematic approaches to collating the information that could facilitate speedy decision-making in a

fast-changing environment. Further, urban planning and design-based responses are seldom considered in these responses, even though these features—at community, local, regional, federal and international scales—notably impact the transmission of diseases.

In early 2020, SPHERE’s Healthy Urban Environments (HUE) Collaboratory took on the challenge of undertaking a rapid review of the literature that considered health, policy, planning, and design responses to previous pandemics.

Professor Jason Prior from the University of Technology Sydney, the lead of the HUE Collaboratory, was one of the authors of this review.

“Until the recent pandemic, much focus has been on how urban design and planning can respond to noncommunicable diseases. The recent pandemic has drawn attention to the need for greater research focused on the role that urban design and planning can play in responding

to communicable diseases. In the absence of immunisation, high-quality planning and design of our cities can play an important preventative and responsive role during pandemics.”

This project presented one of the first ever interdisciplinary rapid reviews, uncovering and collating pandemic responses relevant to cities from public health, urban studies, microbiology, security and emergency management, land use and environmental health, among others.

“The most important finding from this rapid review is that for such high-quality planning and design to be as effective as possible, we need to act at multiple scales, ranging from globalisation which drives city-to-city transmission, to built environment interventions and actions, through to socio-environmental factors underpinning pandemics in urban contexts,” reports Professor Prior.

“Given the need to act from these multiple scales, effective responses are only possible through cross-sectoral,

interdisciplinary, and collaborative interventions. These responses need to be not only responsive in times of need but also preventive.”

There were many key findings identified in the review under their ten main themes, all of which have notable practice or policy implications (see figure 1). Some of the topics raised include the importance of local responses to ensure an effective pandemic response, the value of timing in implementing nonpharmaceutical interventions, and the acknowledgement of the significant role that socioeconomic factors play in the spread of pandemics.

“I hope that the review provides an impetus for those within HUE,

SPHERE and its partners, and the readership of the published rapid review, to give more consideration through research and practice to the role that urban design and planning can play in responding to communicable diseases, and in particular pandemics.

“It is not a matter of if we will have another pandemic, but when, and we need to be as prepared as possible, with as many preventative and responsive tools as possible, including what urban design and planning can offer. At the same time, we need to develop the cross-sectoral capacity to make this possible.”

For more information on this work or to learn more about the HUE

Figure 1: Characteristics of the literature linking urban planning and design to pandemic.