Personal Statement
I am an NIHR Professor of Clinical Pharmacology and Global Health. My NIHR Global Health Research Professorship is a partnership between the University of Liverpool and the Infectious Diseases Institute, Makerere University, Uganda. The Maternal and Infant Lactation pharmacoKinetics Centre of Excellence for lactatioN Therapeutics Research and Engagement (MILK-CENTRE) aims to understand the safe, effective use of a range of medications in breastfeeding mothers and their infants. This is a challenge which affects women in every community worldwide, and we aim to produce the necessary evidence required to inform clinical decision making.

This builds upon my Wellcome Clinical Research Career Development Fellowship, MILK: Maternal and Infant Lactation pharmacoKinetics. The focus of all my research is to provide evidence for the safe and effective use of medication in the populations who will require these drugs, to do this in the most ethical and efficient ways, and to build capacity to undertake such work in the regions where these diseases are prevalent. Furthermore, we seek to engage a diverse range of communities in all phases of research, from establishment of priorities through to dissemination of final results.

Research Overview
Breastfeeding mothers who require medication lack access to the evidence necessary to make truly informed choices for themselves and their infant. Lactation pharmacokinetic studies are few, and often have methodological limitations. There is demand from regulators that research must become more inclusive, and that lactation studies should be done in a timely manner, but such studies are still rare.

The complexity of the population makes the design, delivery and interpretation of lactation pharmacokinetic studies challenging. I plan to leverage my work in Uganda over the past decade to build a globally-relevant, internationally credible centre of excellence for lactation pharmacology, the MILK-CENTRE (Maternal and Infant Lactation pharmacoKinetics: Centre of Excellence for lactatioN Therapeutics Research and Engagement). The centre will have capability to respond to changing epidemiology and global threats, provide capacity building and support for partners, foster increasing industry relationships and influence global policy.

My Wellcome Clinical Research Career Development Fellowship (parts 1 and 2) increased understanding of the transfer of medication through breastmilk from mother to infant. Priority drugs studied were antiretrovirals, antimalarials, anti-tuberculosis drugs (both drug-sensitive and drug-resistant tuberculosis) and antibacterials. This work was undertaken between the Infectious Diseases Institute, Makerere University College of Health Sciences in Kampala, Uganda, the University of Cape Town, South Africa and the University of Liverpool. An accompanying Public Engagement Enrichment grant, ATtaining EQUity of Access TO Reseach (At The EQUATOR) ensured the priorities of communities were addressed, study design and methods were discussed and results were communicated in an appropriate and timely manner.

I was Chief Investigator on the EDCTP-funded VirTUAL Consortium which combined pharmacometric techniques (physiologically-based pharmacokinetic modelling and population pharmacokinetic modelling) with a clinical trial and observational pharmacokinetic studies to understand the drug-drug interactions between antiretrovirals and anti-tuberculosis drugs, including among individuals who are often excluded from clinical trials. In addition to the primary data, this enabled integration of clinical and pharmacometric methods and provides a valuable paradigm to use for future evaluation of complex pharmacology in complex populations. To build capacity in pharmacometric approaches, I am a member of the leadership team of Pharmacometrics Africa (www.pmxafrica.org) and the Uganda chapter was launched in September 2021.