Morroni group

With our partners, we conduct multidisciplinary research focused on improving sexual, reproductive and maternal health and well-being in low- and middle-income countries (LMICs), particularly lower resource, high-HIV burden settings in southern Africa.

Research interests

Our research focuses on three core themes aimed at improving sexual and reproductive health (SRH) and maternal health in LMICs:

1. Optimising women’s sexual health and wellbeing before and during pregnancy and postpartum to support better maternal and neonatal outcomes.
2. Developing integrated approaches to sexually transmitted infection (STI) diagnosis and management, and HIV prevention and treatment with other SRH care.
3. Implementation research, to bridge the gap between evidence and practice by designing, evaluating, and scaling interventions that can be embedded in routine health services.

All of our work is underpinned by a commitment to research and clinical capacity strengthening and partnership building, within health systems and through collaboration with local, regional, and international partners.

Key projects

Director of the Botswana Sexual and Reproductive Health Initiative (BSRHI)

The Botswana Sexual and Reproductive Health Initiative (BSRHI) was established in 201t. The BSRHI aim is to address important research questions to improve sexual and reproductive health and maternal health outcomes among women and girls. BSRHI conducts research and provides clinical services, teaching and training. BSRHI also provide technical assistance and advisory support to the Botswana Ministry of Health and other regional and international organisations, such as UNFPA and the WHO. BSRHI research focuses on pregnancy planning and prevention, contraception, safe abortion care, STI diagnosis and treatment, and cervical cancer prevention.

Botswana Sexual and Reproductive Health Initiative

Current projects and awards

NIHR Global Health Research Professorship – Improving Sexual Health in Pregnancy in Africa: a people-centred approach. 

This 5-year project is generating evidence to inform improved sexual healthcare in pregnancy and post-partum in low resource, high HIV burden settings. Based on extensive public-patient involvement and engagement activities, the project is: (1) developing and evaluating novel diagnostic-driven STI control interventions; (2) co-designing and testing an intervention to improve PrEP and HIV self-testing using integrated delivery models; and (3) utilising these data to design an evidence-based ‘Better Sexual Health in Pregnancy’ intervention and an evaluation cohort. The work addresses major gaps in current STI management strategies that rely on ‘syndromic management’ which are ineffective in controlling STIs and tackles the problem of high HIV incidence during pregnancy and post-partum. Impact will be achieved through engaging key stakeholders and developing relationships to influence regional and international policy and build a well-equipped advocacy network. This project is funded by the UK National Institute for Health and Care Research.

NIHR Global Health Research Group on Improving Quality of Maternal Healthcare in Africa 

We are leading the STI and pregnancy workstream of this Global Health Research Group. We are also conducting a prospective mixed methods study, DEFEAT Syphilis Malawi, to develop acceptable, feasible interventions to address the gaps in perinatal syphilis care defined through recent research in the Malawian setting.This project is funded by the UK National Institute for Health and Care Research.

STEP-UP

The STI Testing to Enhance PrEP Use in Pregnancy (STEP-UP) Study is a 2-arm 1:1 randomized trial in Botswana aiming to test the effect of co-offering STI testing with expanded PrEP options on PrEP outcomes during pregnancy through the postpartum period among women in antenatal clinics. Pregnant and postpartum women in high HIV burden settings face elevated risk of HIV acquisition, yet research to improve PrEP use in pregnant and postpartum women lags behind other populations, creating inequitable PrEP access during periods of high HIV risk. Strategies to optimize PrEP use in pregnancy with rigorous safety evaluation are needed to advance delivery of expanded PrEP options. This study addresses urgent gaps by evaluating the co-delivery of diagnostic STI testing and expanded PrEP options within antenatal care to improve PrEP uptake, adherence, and sustained use during and after pregnancy. STEP-UP is a 5-year study funded by the US National Institutes of Health (NIH).

The AAA trial

The Antenatal micronutrients, Aspirin and Azithromycin for maximal reduction of preterm birth and related outcomes (AAA) trial is a 6-year randomized-controlled trial with associated health systems work, funded by Open Philanthropy USA. Targeting factors such as poor maternal nutrition, inflammation, and infections with simple-to-deliver combination regimens in routine antenatal care may be of benefit in reducing the risk of small vulnerable newborn births in resource-limited settings.

BASE Study

The Botswana Adolescent girls & young women STI tEsting and treatment (BASE) Study aims to implement an STI screening and treatment intervention in Botswana to provide data on the burden of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis infection among adolescent girls and young women in Botswana. In settings such as Botswana where the syndromic approach for STIs predominates, there is a lack of data on the prevalence of STIs. This study will provide evidence to guide policymakers in Botswana and other LMICs on the value of investing in diagnostic STI screening for adolescent girls and young women. The BASE Study is an 18-months study funded by the Gates Foundation. 

The GETSA Study 

The Genomic epidemiology of Treponema pallidum in Southern Africa (GETSA) Study will determine the aetiology of genital ulcer disease in South Africa and Botswana and to conduct an analysis of Treponema pallidum genomes. There is paucity of epidemiological data of syphilis in the general population as most of the syphilis burden of disease estimates are derived from antenatal surveys and mathematical modelling. There is also a lack of Treponema pallidum genomic data from Sub-Saharan African with most genomes collected from Europe, the USA and Australia. Closing this gap and ensuring geographic inclusivity is urgently warranted. The GETSA Study is 4 year study funded by Open Philanthropy USA. 

The Maduo Study

Maduo (“Results” in Setswana) is a recently completed US National Institutes of Health (NIH)-funded study that determined the burden of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) among asymptomatic pregnant women and investigated the impact of chlamydia and gonorrhoea testing on post-delivery CT/NG prevalence and vertical CT/NG transmission to infants. The study also assessed acceptability and feasibility and cost-effectiveness of chlamydia and gonorrhoea testing and treatment during antenatal care, as well as partner notification preferences and experiences. 

The CODA Study

The Contraceptives and Dolutegravir-based ART (CODA) Study is investigating whether drug-drug interactions occur when levonorgestrel sub-dermal contraceptive implants or DMPA injectable contraceptives are concurrently used with dolutegravir (DTG)-based ART therapy. Provision of contraception is complicated in high HIV prevalence settings due to proven drug-drug interactions between some anti-retroviral therapy agents and hormonal contraceptives. DTG is highly effective in managing HIV and is a WHO recommended first-line agent. However there is little data on the effect of DTG on hormonal contraception. Rigorous and complete evidence on the risk of drug-drug interactions between hormonal contraceptives and DTG is needed to inform local and international guidance. The CODA Study, a 4-year project, is funded by ViiV Healthcare. 

PREPARE Study

The PRomoting Equity for Pregnant Adolescents in REsearch (PREPARE) is a multi-country study in Botswana, Malawi and the USA seeking to address questions and confusions around the ethical permissibility of including pregnant adolescents in HIV/co-infections research. The study is funded by the US National Institutes of Health (NIH) for 5 years and is being conducted in collaboration with the University of Northern California at Chapel Hill and Botswana-Baylor Children's Clinical Centre of Excellence. 

ADAPI Study

The ADAPI Study is Wellcome ECAT PhD project aiming to validate the Desire to Avoid Pregnancy (DAP) Scale, as a measure of pregnancy intention among women living with HIV in Botswana. Previous studies from Botswana have reported that almost half of pregnancies among women living with HIV are unintended. Work on improving pregnancy planning and prevention in Botswana, and similar low resource, high HIV burden settings, is needed. Better understanding pregnancy intention and implementation of valid measures that prospectively assess pregnancy preferences will enable the design of interventions and clinical services to help women meet their fertility goals and enhance reproductive rights.

Publications

Group members

Edinburgh-based team

Dr Elizabeth Wastnedge, ECAT Wellcome PhD Student

Botswana-based team

Dr Aamirah Mussa, Senior Programme Manager & Research Fellow

Dr Karen Shambira, Physician Reseach Coordinator

Dr Tlamelo Setshwaelo, Clinical Project Manager

Dr Bonolo Phinius, Postdoctoral Research Fellow

Yasmin Dunkley, Implementation Scientists & Capacity Strengthening Lead 

Bama Bame, Research Nurse Coordinator

Shelby Chakona, Research Nurse

Lawrence Selei, Research Nurse Midwife

Neo Zambe, Senior Admin Officer

Lefhela Tamuthiba, Senior Research Assistant 

Neo Ndlovu, Senior Research Assistant

Mbabi Bapabi, Senior Research Assistant

Neo Moshashane, Senior Research Assistant

Kehumile Ramontshonyana, Senior Research Assistant

Maipelo Tsuaneng, Research Assistant

Aratwa Tumagole, Research Assistant

Mavis Hengari, Research Assistant

George Marumo, Research Assistant

Dr Rebecca Ryan, Clinical Research Fellow

Dr Alexandria Chung, Volunteer Clinical Research Fellow

Dr Holly Lamden, Volunteer Clinical Research Fellow

Media and engagement

How to grapple with soaring world population an answer from down south - UK Guardian article

Falling fertility: lessons learned from Botswana – UK Guardian Science Weekly podcast

Collaborators

Internal

Prof Andrew Horne

Prof Sharon Cameron

Dr John Reynolds Wright

External

Dr Geraldine Barrett, University College London

Prof Dvora Joseph Davey, University of Cape Town

Dr Suzanne Day, University of North Carolina, Chapel Hill

Dr Sebastian Fuller, University of Oxford

Dr Bridget Freyne, University College Dublin

Prof Justus Hofmeyr, University of Botswana

Prof Saye Khoo, University of Liverpool

Prof Jeffrey Klausner, University of Southern California

Prof David Lissauer, Malawi Liverpool Wellcome Programme and University of Liverpool

Dr Rebecca Luckett, Botswana Harvard Health Partnership (BHP)

Prof Michael Marks, London School of Hygiene and Tropical Medicine

Prof Linda Mipando, Kamuzu University of Health Sciences and University of Liverpool

Prof Sikhulile Moyo, Botswana Harvard Health Partnership (BHP)

Prof Remco Peters, Foundation for Professional Development, South Africa and the WHO

Prof Sarah Pett, University College London

Prof Jillian Pintye, University of Washington

Prof Mark Polizzotto, The Australian National University

Prof Doreen Ramogola-Masire, University of Botswana

Prof Corinne Rocca, University of California, San Francisco

Dr Adriane Wynn, University of California, San Diego 

Dr Rebecca Zash, Harvard Medical School

Jhpiego Botswana

Bummhi Botswana

Funders

National Institute for Health and Care Research, UK

National Institutes of Health, Fogarty, USA

National Institutes of Health, NICHD, USA

National Institutes of Health, NIAID, USA

Gates Foundation

Government of Canada

Open Philanthropy USA 

The Wellcome Trust, UK

ViiV Healthcare

Merck

National Health and Medical Research Council, Australia

Norwegian University of Science and Technology