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Single-Dose Cholera Vaccine in Response to an Outbreak in Zambia

Title: Single-Dose Cholera Vaccine in Response to an Outbreak in Zambia Authors: Ferreras, E; Chizema-Kawesha, E; Blake, A; Chewe, O; Mwaba, J; Zulu, G; Poncin, M; Rakesh, A; Page, AL; Stoitsova, S; Voute, C; Uzzeni, F; Robert, H; Serafini, M; Matapo, B; Eiros, JM; Quilici, ML; Pezzoli, L; Azman, AS; Cohuet, S; Ciglenecki, I; Malama, K; Luquero, FJ

Long-term clinical, immunological and virological outcomes of patients on antiretroviral therapy in southern Myanmar

Title: Long-term clinical, immunological and virological outcomes of patients on antiretroviral therapy in southern Myanmar Authors: Bermúdez-Aza, EH; Shetty, S; Ousley, J; Kyaw, NTT; Soe, TT; Soe, K; Mon, PE; Tun, KT; Ciglenecki, I; Cristofani, S; Fernandez, M Abstract: To study the long-term clinical, immunological and virological outcomes among people living with HIV on antiretroviral therapy (ART) in Myanmar.

Efficacy of artesunate-amodiaquine, dihydroartemisinin-piperaquine and artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Maradi, Niger

Title: Efficacy of artesunate-amodiaquine, dihydroartemisinin-piperaquine and artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Maradi, Niger Authors: Grandesso, Francesco; Guindo, Ousmane; Woi Messe, Lynda; Makarimi, Rockyath; Traore, Aliou; Dama, Souleymane; Laminou, Ibrahim Maman; Rigal, Jean; de Smet, Martin; Ouwe Missi Oukem-Boyer, Odile; Doumbo, Ogobara K; Djimdé, Abdoulaye; Etard, Jean-François Abstract: Malaria endemic countries need to assess efficacy of anti-malarial treatments on a regular basis. Moreover, resistance to artemisinin that is established across mainland South-East Asia represents today a major threat to global health. Monitoring the efficacy of artemisinin-based combination therapies is of paramount importance to detect as early as possible the emergence of resistance in African countries that toll the highest burden of malaria morbidity and mortality.

Navigating the risks of prevention of mother to child transmission (PMTCT) of HIV services in Kibera, Kenya: Barriers to engaging and remaining in care

Title: Navigating the risks of prevention of mother to child transmission (PMTCT) of HIV services in Kibera, Kenya: Barriers to engaging and remaining in care Authors: Thomson, Kerry A; Telfer, Barbara; Opondo Awiti, Patricia; Munge, Jane; Ngunga, Mathew; Reid, Anthony Abstract: Within the first year of implementation, 43% of women who tested HIV positive at their first antenatal care visit were no longer retained and being followed in the free prevention of mother to child transmission (PMTCT) of HIV program offered by the Kenyan Ministry of Health and Médecins Sans Frontières in the informal settlement of Kibera, Nairobi. This study aimed to explore barriers to enrolling and remaining engaged in PMTCT services throughout the pregnancy and postpartum periods. Qualitative data from 31 focus group discussions and 35 in-depth interviews across six stakeholder groups that included women, men, and PMTCT service providers were analyzed. Using an inductive exploratory approach, four researchers coded the data and identified key themes. Five themes emerged from the data that may influence attrition from PMTCT service in this setting: 1) HIV in the context of Kibera, 2) knowledge of HIV status, 3) knowledge of PMTCT, 4) disclosure of HIV status, and 5) male partner support for PMTCT services. A new HIV diagnosis during pregnancy immediately triggered an ongoing risk assessment of perceived hazards in the home, community, and clinic environments that could occur as a result of female participation in PMTCT services. Male partners were a major influence in this risk assessment, but were generally unaware of PMTCT services. To preserve relationships with male partners, meet community expectations of womanhood, and maintain confidentiality while following recommendations of healthcare providers, women had to continuously weigh the risks and benefits of PMTCT services and interventions. Community-based HIV testing and PMTCT education, male involvement in antenatal care, and counseling customized to assist each woman in her own unique risk assessment, may improve uptake of and retention in care and optimize the HIV prevention benefit of PMTCT interventions.

Unreported cases in the 2014-2016 Ebola epidemic: Spatiotemporal variation, and implications for estimating transmission

Title: Unreported cases in the 2014-2016 Ebola epidemic: Spatiotemporal variation, and implications for estimating transmission Authors: Dalziel, Benjamin D; Lau, Max S Y; Tiffany, Amanda; McClelland, Amanda; Zelner, Jon; Bliss, Jessica R; Grenfell, Bryan T Abstract: In the recent 2014-2016 Ebola epidemic in West Africa, non-hospitalized cases were an important component of the chain of transmission. However, non-hospitalized cases are at increased risk of going unreported because of barriers to access to healthcare. Furthermore, underreporting rates may fluctuate over space and time, biasing estimates of disease transmission rates, which are important for understanding spread and planning control measures. We performed a retrospective analysis on community deaths during the recent Ebola epidemic in Sierra Leone to estimate the number of unreported non-hospitalized cases, and to quantify how Ebola reporting rates varied across locations and over time. We then tested if variation in reporting rates affected the estimates of disease transmission rates that were used in surveillance and response. We found significant variation in reporting rates among districts, and district-specific rates of increases in reporting over time. Correcting time series of numbers of cases for variable reporting rates led, in some instances, to different estimates of the time-varying reproduction number of the epidemic, particularly outside the capital. Future analyses that compare Ebola transmission rates over time and across locations may be improved by considering the impacts of differential reporting rates.

Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV

Title: Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV Authors: Gils, T; Bossard, C; Verdonck, K; Owiti, P; Casteels, I; Mashako, M; Van Cutsem, G; Ellman, T Abstract: Stockouts of HIV commodities increase the risk of treatment interruption, antiretroviral resistance, treatment failure, morbidity and mortality. The study objective was to assess the magnitude and duration of stockouts of HIV medicines and diagnostic tests in public facilities in Kinshasa, Democratic Republic of the Congo. This was a cross-sectional survey involving visits to facilities and warehouses in April and May 2015. All zonal warehouses, all public facilities with more than 200 patients on antiretroviral treatment (ART) (high-burden facilities) and a purposive sample of facilities with 200 or fewer patients (low-burden facilities) in Kinshasa were selected. We focused on three adult ART formulations, cotrimoxazole tablets, and HIV diagnostic tests. Availability of items was determined by physical check, while stockout duration until the day of the survey visit was verified with stock cards. In case of ART stockouts, we asked the pharmacist in charge what the facility coping strategy was for patients needing those medicines. The study included 28 high-burden facilities and 64 low-burden facilities, together serving around 22000 ART patients. During the study period, a national shortage of the newly introduced first-line regimen Tenofovir-Lamivudine-Efavirenz resulted in stockouts of this regimen in 56% of high-burden and 43% of low-burden facilities, lasting a median of 36 (interquartile range 29-90) and 44 days (interquartile range 24-90) until the day of the survey visit, respectively. Each of the other investigated commodities were found out of stock in at least two low-burden and two high-burden facilities. In 30/41 (73%) of stockout cases, the commodity was absent at the facility but present at the upstream warehouse. In 30/57 (54%) of ART stockout cases, patients did not receive any medicines. In some cases, patients were switched to different ART formulations or regimens. Stockouts of HIV commodities were common in the visited facilities. Introduction of new ART regimens needs additional planning.

Single low-dose primaquine for blocking transmission of Plasmodium falciparum malaria - a proposed model-derived age-based regimen for sub-Saharan Africa

Title: Single low-dose primaquine for blocking transmission of Plasmodium falciparum malaria - a proposed model-derived age-based regimen for sub-Saharan Africa Authors: Taylor, WR; Naw, HK; Maitland, K; Williams, TN; Kapulu, M; D'Alessandro, U; Berkley, JA; Bejon, P; Okebe, J; Achan, J; Amambua, AN; Affara, M; Nwakanma, D; van Geertruyden, JP; Mavoko, M; Lutumba, P; Matangila, J; Brasseur, P; Piola, P; Randremanana, R; Lasry, E; Fanello, C; Onyamboko, M; Schramm, B; Yah, Z; Jones, J; Fairhurst, RM; Diakite, M; Malenga, G; Molyneux, M; Rwagacondo, C; Obonyo, C; Gadisa, E; Aseffa, A; Loolpapit, M; Henry, MC; Dorsey, G; John, C; Sirima, SB; Barnes, KI; Kremsner, P; Day, NP; White, NJ; Mukaka, M Abstract: In 2012, the World Health Organization recommended blocking the transmission of Plasmodium falciparum with single low-dose primaquine (SLDPQ, target dose 0.25 mg base/kg body weight), without testing for glucose-6-phosphate dehydrogenase deficiency (G6PDd), when treating patients with uncomplicated falciparum malaria. We sought to develop an age-based SLDPQ regimen that would be suitable for sub-Saharan Africa.

Higher Art Adherence is Associated with Lower Systemic Inflammation in Treatment-Naïve Ugandans Who Achieve Virologic Suppression

Title: Higher Art Adherence is Associated with Lower Systemic Inflammation in Treatment-Naïve Ugandans Who Achieve Virologic Suppression Authors: Castillo-Mancilla, JR; Morrow, M; Boum, Y; Byakwaga, H; Haberer, JE; Martin, JN; Bangsberg, D; Mawhinney, S; Musinguzi, N; Huang, Y; Tracy, RP; Burdo, TH; Williams, K; Muzoora, C; Hunt, PW; Siedner, MJ Abstract: Residual systemic inflammation persists despite suppressive antiretroviral therapy (ART) and is associated with non-AIDS clinical outcomes. We aimed to evaluate the association between ART adherence and inflammation in Ugandans living with HIV who were predominantly receiving nevirapine-based ART with a thymidine analog backbone and were virologically suppressed by conventional assays. Description: We regret that this article is behind a paywall.

Seasonal variations in tuberculosis diagnosis among HIV-positive individuals in Southern Africa: analysis of cohort studies at antiretroviral treatment programmes

Title: Seasonal variations in tuberculosis diagnosis among HIV-positive individuals in Southern Africa: analysis of cohort studies at antiretroviral treatment programmes Authors: Ballif, M; Zürcher, K; Reid, SE; Boulle, A; Fox, MP; Prozesky, HW; Chimbetete, C; Zwahlen, M; Egger, M; Fenner, L Abstract: Seasonal variations in tuberculosis diagnoses have been attributed to seasonal climatic changes and indoor crowding during colder winter months. We investigated trends in pulmonary tuberculosis (PTB) diagnosis at antiretroviral therapy (ART) programmes in Southern Africa.

Cost and affordability of non-communicable disease screening, diagnosis and treatment in Kenya: Patient payments in the private and public sectors

Title: Cost and affordability of non-communicable disease screening, diagnosis and treatment in Kenya: Patient payments in the private and public sectors Authors: Subramanian, S; Gakunga, R; Kibachio, J; Gathecha, G; Edwards, P; Ogola, E; Yonga, G; Busakhala, N; Munyoro, E; Chakaya, J; Ngugi, N; Mwangi, N; Von Rege, D; Wangari, LM; Wata, D; Makori, R; Mwangi, J; Mwanda, W Abstract: The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries, including Kenya, disproportionately to the rest of the world. Our objective was to quantify patient payments to obtain NCD screening, diagnosis, and treatment services in the public and private sector in Kenya and evaluate patients' ability to pay for the services.

Improving mapping for Ebola response through mobilising a local community with self-owned smartphones: Tonkolili District, Sierra Leone, January 2015

Title: Improving mapping for Ebola response through mobilising a local community with self-owned smartphones: Tonkolili District, Sierra Leone, January 2015 Authors: Nic Lochlainn, LM; Gayton, I; Theocharopoulos, G; Edwards, R; Danis, K; Kremer, R; Kleijer, K; Tejan, SM; Sankoh, M; Jimissa, A; Greig, J; Caleo, G Abstract: During the 2014-16 Ebola virus disease (EVD) outbreak, the Magburaka Ebola Management Centre (EMC) operated by Médecins Sans Frontières (MSF) in Tonkolili District, Sierra Leone, identified that available district maps lacked up-to-date village information to facilitate timely implementation of EVD control strategies. In January 2015, we undertook a survey in chiefdoms within the MSF EMC catchment area to collect mapping and village data. We explore the feasibility and cost to mobilise a local community for this survey, describe validation against existing mapping sources and use of the data to prioritise areas for interventions, and lessons learned.

Alarming prevalence and clustering of Modifiable Noncommunicable Disease risk factors among adults in Bhutan: a nationwide cross-sectional community survey

Title: Alarming prevalence and clustering of Modifiable Noncommunicable Disease risk factors among adults in Bhutan: a nationwide cross-sectional community survey Authors: Pelzom, D; Isaakidis, P; Oo, MM; Gurung, MS; Yangchen, P Abstract: Bhutan is currently facing a double burden of non-communicable (NCDs) and communicable diseases, with rising trends of NCDs. The 2014 STEPS survey identified high prevalence of several NCD risk factors; however, associations with socio-demographic characteristics as well as clustering of risk factors were not assessed. This study aimed to determine the distribution and clustering of modifiable NCD risk factors among adults in Bhutan and their demographic and social determinants.

Impact of War on Child Health in Northern Syria: the experience of Médecins Sans Frontières

Title: Impact of War on Child Health in Northern Syria: the experience of Médecins Sans Frontières Authors: Meiqari, L; Hoetjes, M; Baxter, L; Lenglet, A Abstract: Few data are available to evaluate the impact of Syrian war on civilian population; to describe this impact on child health, this article uses data from Médecins Sans Frontières-Operational Centre Amsterdam's activities in Tal-Abyad and Kobane cities, northern Syria (2013-2016). Data were obtained from routine medical datasets and narrative reports, for out-patient clinics, immunisation, nutritional monitoring and assessments, and in-patient care, and were analysed quantitatively and qualitatively. Infections were the largest contributor to morbidity. The proportion of < 5 year out-patient consultations of infectious diseases that are listed for outbreak monitoring in emergencies was 15% in 2013, 51% in 2014, 75% in 2015 and 70% in 2016. Thalassemia was recorded in 0.5% of 2014 < 5 year out-patient consultations and 3.4% of 2013-2014 < 18-year in-patient admissions. Measles immunisation activities and routine Extended Programme for Immunisation were re-activated across northern Syria; however, immunisation coverage could not be calculated. Results from our routine data must be compared cautiously, due to differences in settings and disease categories.

Six-monthly appointment spacing for clinical visits as a model for retention in HIV Care in Conakry-Guinea: a cohort study

Title: Six-monthly appointment spacing for clinical visits as a model for retention in HIV Care in Conakry-Guinea: a cohort study Authors: Bekolo, CE; Diallo, A; Philips, M; Yuma, JD; Di Stefano, L; Drèze, S; Mouton, J; Koita, Y; Tiomtore, OW Abstract: The outbreak of the Ebola virus disease (EVD) in 2014 led to massive dropouts in HIV care in Guinea. Meanwhile, Médecins Sans Frontières (MSF) was implementing a six-monthly appointment spacing approach adapted locally as Rendez-vous de Six Mois (R6M) with an objective to improve retention in care. We sought to evaluate this innovative model of ART delivery in circumstances where access to healthcare is restricted.

High Prevalence of Shigella or Enteroinvasive Escherichia coli Carriage among Residents of an Internally Displaced Persons Camp in South Sudan

Title: High Prevalence of Shigella or Enteroinvasive Escherichia coli Carriage among Residents of an Internally Displaced Persons Camp in South Sudan Authors: Bliss, J; Bouhenia, M; Hale, P; Couturier, BA; Iyer, AS; Rumunu, J; Martin, S; Wamala, JF; Abubakar, A; Sack, DA; Luquero, FJ; Couturier, MR; Azman, AS; Leung, DT Abstract: Displaced persons living in camps are at an increased risk of diarrheal diseases. Subclinical carriage of pathogens may contribute to the spread of disease, especially for microbes that require a low infectious dose. Multiplex real-time polymerase chain reaction was performed to detect a panel of 20 bacterial, viral, and protozoal targets, and we report a high prevalence of enteropathogen carriage, including Shigella spp. or enteroinvasive Escherichia coli in 14%, among a sample of 88 asymptomatic individuals in an internally displaced persons camp in South Sudan. Further studies are needed to determine the contribution of such carriage to the spread of disease. Description: We regret that this article is behind a paywall.

Assessing the outcomes of HIV-infected persons receiving treatment for Kaposi sarcoma in Conakry-Guinea

Title: Assessing the outcomes of HIV-infected persons receiving treatment for Kaposi sarcoma in Conakry-Guinea Authors: Bekolo, CE; Soumah, MM; Tiemtore, OW; Diallo, A; Yuma, JD; Di Stefano, L; Metcalf, C; Cisse, M Abstract: Médecins Sans Frontières is supporting comprehensive HIV care and treatment for Kaposi Sarcoma (KS) in Guinea, where antiretroviral coverage is low and access to KS treatment is very limited. We aimed to evaluate treatment response and survival outcomes of epidemic KS in this setting.

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