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'When Ebola enters a home, a family, a community': A qualitative study of population perspectives on Ebola control measures in rural and urban areas of Sierra Leone

Title: 'When Ebola enters a home, a family, a community': A qualitative study of population perspectives on Ebola control measures in rural and urban areas of Sierra Leone Authors: Gray, N; Stringer, B; Bark, G; Heller Perache, A; Jephcott, F; Broeder, R; Kremer, R; Jimissa, AS; Samba, TT Abstract: During the West Africa Ebola outbreak, cultural practices have been described as hindering response efforts. The acceptance of control measures improved during the outbreak, but little is known about how and why this occurred. We conducted a qualitative study in two administrative districts of Sierra Leone to understand Ebola survivor, community, and health worker perspectives on Ebola control measures. We aimed to gain an understanding of community interactions with the Ebola response to inform future intervention strategies.

Hepatitis C Virus Diagnosis and the Holy Grail

Title: Hepatitis C Virus Diagnosis and the Holy Grail Authors: Applegate, TL; Fajardo, E; Sacks, JA Abstract: The world has embraced the call for global elimination of hepatitis C virus by 2030. The unprecedented speed of therapeutic development and increased access to direct-acting antivirals has made elimination a possibility. We must screen hundreds of millions of people to diagnose and treat those currently infected. Global access to hepatitis C virus diagnostics will be a keystone to success. Key challenges must be overcome and systems optimized to ensure widespread access to existing diagnostics. Although promising technologies may soon transform the landscape, innovative strategies are needed to stimulate investment and accelerate the development of point-of-care hepatitis C virus diagnostics.

Evaluation of the SD Bioline Cholera Rapid Diagnostic Test During the 2016 Cholera Outbreak in Lusaka, Zambia

Title: Evaluation of the SD Bioline Cholera Rapid Diagnostic Test During the 2016 Cholera Outbreak in Lusaka, Zambia Authors: Mwaba, J; Ferreras, E; Chizema-Kawesa, E; Mwimbe, D; Tafirenyika, F; Rauzier, J; Blake, A; Rakesh, A; Poncin, M; Stoitsova, S; Kwenda, G; Azman, AS; Chewe, O; Serafini, M; Lukwesa-Musyani, C; Cohuet, S; Quilici, M; Luquero, FJ; Page, A Abstract: To assess the performance of the SD Bioline Cholera Ag O1/O139 rapid diagnostic test (RDT) compared to a reference standard combining culture and PCR for the diagnosis of cholera cases during an outbreak.

Wishful thinking versus operational commitment: is the international guidance on priority sexual and reproductive health interventions in humanitarian settings becoming unrealistic?

Title: Wishful thinking versus operational commitment: is the international guidance on priority sexual and reproductive health interventions in humanitarian settings becoming unrealistic? Authors: Tran, NT; Schulte-Hillen, C Abstract: Twenty-one years ago, a global consortium of like-minded institutions designed the landmark Minimum Initial Service Package (MISP) for sexual and reproductive health (SRH) to guide national and international humanitarian first responders in preventing morbidity and mortality at the onset of chaos, destruction, and high insecurity caused by disasters or conflicts. Since then, the MISP has undergone limited change and has become an international reference in humanitarian response. This article discusses our perspectives regarding the 2018 changes to the MISP that have created division among humanitarian field practitioners, academics, advocates, and development agencies. With more than 50 pages, the new MISP chapter dilutes key guidance and messages on the most life-saving activities, leaving actors with excessive room for interpretation as to which priority activities need to be first implemented. Consequently, non-life-saving interventions may take precedence over essential ones. Insecurity, scarce human and financial resources, logistics constrains, and other limitations imposed by field reality at the onset of a crisis must be considered. We strongly recommend that an institution with the mandate, legitimacy, and technical expertise in the review of guidelines reexamines the 2018 edition of the MISP. We urge experienced first-line responders, national actors, and relevant agencies to join efforts to ensure that the MISP remains focused on a very limited set of essential activities and supplies that are pragmatic, field-oriented, and, most importantly, immediately life-saving for people in need.

When Helping Babies Breathe Is Not Enough: Designing a Novel, Mid-Level Neonatal Resuscitation Algorithm for Médecins Sans Frontières Field Teams Working in Low-Resource Hospital Settings

Title: When Helping Babies Breathe Is Not Enough: Designing a Novel, Mid-Level Neonatal Resuscitation Algorithm for Médecins Sans Frontières Field Teams Working in Low-Resource Hospital Settings Authors: Umphrey, L; Breindahl, M; Brown, A; Saugstad, OD; Thio, M; Trevisanuto, D; Roehrg, CC; Blennow, M Abstract: Neonatal resuscitation (NR) combines a set of life-saving interventions in order to stabilize compromised newborns at birth or when critically ill. Médecins Sans Frontières/Doctors Without Borders (MSF), as an international medical-humanitarian organization working particularly in low-resource settings (LRS), assisted over 250,000 births in obstetric and newborn care aid projects in 2016 and provides thousands of newborn resuscitations annually. The Helping Babies Breathe (HBB) program has been used as formal guidance for basic resuscitation since 2012. However, in some MSF projects with the capacity to provide more advanced NR interventions but a lack of adapted guidance, staff have felt prompted to create their own advanced algorithms, which runs counter to the organization's aim for standardized protocols in all aspects of its care.

New insights into leishmaniasis in the immunosuppressed

Title: New insights into leishmaniasis in the immunosuppressed Authors: Akuffo, H; Costa, C; van Griensven, J; Burza, S; Moreno, J; Herrero, M Abstract: Immunosuppression contributes significantly to the caseload of visceral leishmaniasis (VL). HIV coinfection, solid organ transplantation, malnutrition, and helminth infections are the most important immunosuppression-related factors. This review briefly describes the challenges of these associations. East Africa and the Indian subcontinent are the places where HIV imposes the highest burden in VL. In the highlands of Northern Ethiopia, migrant rural workers are at a greater risk of coinfection and malnutrition, while in India, HIV reduces the sustainability of a successful elimination programme. As shown from a longitudinal cohort in Madrid, VL is an additional threat to solid organ transplantation. The association with malnutrition is more complex since it can be both a cause and a consequence of VL. Different regimes for therapy and secondary prevention are discussed as well as the role of nutrients on the prophylaxis of VL in poverty-stricken endemic areas.

Serological evaluation for Chagas disease in migrants from Latin American countries resident in Rome, Italy

Title: Serological evaluation for Chagas disease in migrants from Latin American countries resident in Rome, Italy Authors: Pane, S; Giancola, ML; Piselli, P; Corpolongo, A; Repetto, E; Bellagamba, R; Cimaglia, C; Carrara, S; Ghirga, P; Oliva, A; Bevilacqua, N; Al Rousan, A; Nisii, C; Ippolito, G; Nicastri, E Abstract: Chagas disease (CD) is a systemic parasitic infection caused by the protozoan Trypanosoma cruzi, whose chronic phase may lead to cardiac and intestinal disorders. Endemic in Latin America where it is transmitted mainly by vectors, large-scale migrations to other countries have turned CD into a global health problem because of its alternative transmission routes through blood transfusion, tissue transplantation, or congenital. Aim of this study was to compare the performance of two commercially available tests for serological diagnosis of CD in a group of Latin American migrants living in a non-endemic setting (Rome, Italy). The study was based on a cross-sectional analysis of seroprevalence in this group. Epidemiological risk factors associated to CD were also evaluated in this study population.

Voluntary Community Human Immunodeficiency Virus Testing, Linkage, and Retention in Care Interventions in Kenya: Modeling the Clinical Impact and Cost-effectiveness

Title: Voluntary Community Human Immunodeficiency Virus Testing, Linkage, and Retention in Care Interventions in Kenya: Modeling the Clinical Impact and Cost-effectiveness Authors: Luong Nguyen, LB; Yazdanpanah, Y; Maman, D; Wanjala, S; Vandenbulcke, A; Price, J; Parker, RA; Hennequin, W; Mendiharat, P; Freedberg, KA Abstract: In southwest Kenya, the prevalence of human immunodeficiency virus (HIV) infection is about 25%. Médecins Sans Frontières has implemented a voluntary community testing (VCT) program, with linkage to care and retention interventions, to achieve the Joint United Nations Program on HIV and AIDS (UNAIDS) 90-90-90 targets by 2017. We assessed the effectiveness and cost-effectiveness of these interventions.

Safety of a heat-stable rotavirus vaccine among children in Niger: Data from a phase 3, randomized, double-blind, placebo-controlled trial

Title: Safety of a heat-stable rotavirus vaccine among children in Niger: Data from a phase 3, randomized, double-blind, placebo-controlled trial Authors: Coldiron, ME; Guindo, O; Makarimi, R; Soumana, I; Matar Seck, A; Garba, S; Macher, E; Isanaka, S; Grais, RF Abstract: Rotavirus remains a major cause of diarrhea among children under 5 years of age. The efficacy of RotaSIIL, a pentavalent rotavirus vaccine, was shown in an event-driven trial in Niger. We describe the two-year safety follow-up of this trial.

Cholera epidemic in Yemen, 2016-18: an analysis of surveillance data

Title: Cholera epidemic in Yemen, 2016-18: an analysis of surveillance data Authors: Camacho, A; Bouhenia, M; Alyusfi, R; Alkohlani, A; Naji, MAM; de Radiguès, X; Abubakar, AM; Almoalmi, A; Seguin, C; Sagrado, MJ; Poncin, M; McRae, M; Musoke, M; Rakesh, A; Porten, K; Haskew, C; Atkins, KE; Eggo, RM; Azman, AS; Broekhuijsen, M; Saatcioglu, MA; Pezzoli, L; Quilici, ML; Al-Mesbahy, AR; Zagaria, N; Luquero, FJ Abstract: In war-torn Yemen, reports of confirmed cholera started in late September, 2016. The disease continues to plague Yemen today in what has become the largest documented cholera epidemic of modern times. We aimed to describe the key epidemiological features of this epidemic, including the drivers of cholera transmission during the outbreak.

Impact of pyrazinamide resistance on multidrug-resistant tuberculosis in Karakalpakstan, Uzbekistan

Title: Impact of pyrazinamide resistance on multidrug-resistant tuberculosis in Karakalpakstan, Uzbekistan Authors: Kuhlin, J; Smith, C; Khaemraev, A; Tigay, Z; Parpieva, N; Tillyashaykhov, M; Achar, J; Hajek, J; Greig, J; du Cros, P; Moore, D Abstract: The World Health Organization (WHO) recommends the inclusion of pyrazinamide (PZA) in treatment regimens for multidrug-resistant tuberculosis (MDR-TB) unless resistance has been confirmed.

Three parallel information systems for malaria elimination in Swaziland, 2010-2015: are the numbers the same?

Title: Three parallel information systems for malaria elimination in Swaziland, 2010-2015: are the numbers the same? Authors: Zulu, Z; Kunene, S; Mkhonta, N; Owiti, P; Sikhondze, W; Mhlanga, M; Simelane, Z; Geoffroy, E; Zachariah, R Abstract: Background: To be able to eliminate malaria, accurate, timely reporting and tracking of all confirmed malaria cases is crucial. Swaziland, a country in the process of eliminating malaria, has three parallel health information systems. Design: This was a cross-sectional study using country-wide programme data from 2010 to 2015. Methods: The Malaria Surveillance Database System (MSDS) is a comprehensive malaria database, the Immediate Disease Notification System (IDNS) is meant to provide early warning and trigger case investigations to prevent onward malaria transmission and potential epidemics, and the Health Management Information Systems (HMIS) reports on all morbidity at health facility level. Discrepancies were stratified by health facility level and type. Results: Consistent over-reporting of 9-85% was noticed in the HMIS, principally at the primary health care level (clinic and/or health centre). In the IDNS, the discrepancy went from under-reporting (12%) to over-reporting (32%); this was also seen at the primary care level. At the hospital level, there was under-reporting in both the HMIS and IDNS. Conclusions: There are considerable discrepancies in the numbers of confirmed malaria cases in the HMIS and IDNS in Swaziland. This may misrepresent the malaria burden and delay case investigation, predisposing the population to potential epidemics. There is an urgent need to improve data integrity in order to guide and evaluate efforts toward elimination.

Did microbial larviciding contribute to a reduction in malaria cases in eastern Botswana in 2012-2013?

Title: Did microbial larviciding contribute to a reduction in malaria cases in eastern Botswana in 2012-2013? Authors: Obopile, M; Segoea, G; Waniwa, K; Ntebela, DS; Moakofhi, K; Motlaleng, M; Mosweunyane, T; Edwards, JK; Namboze, J; Butt, W; Manzi, M; Takarinda, KC; Owiti, P Abstract: Setting: Larviciding has potential as a component of integrated vector management for the reduction of malaria transmission in Botswana by complementing long-lasting insecticide nets and indoor residual sprays. Objective: To evaluate the susceptibility of local Anopheles to commonly used larvicides. Design: This field test of the efficacy of Bacillus thuringiensis subsp. israliensis vs. Anopheles was performed by measuring larval density before treatment and 24 h and 48 h after treatment in seven sites of Bobirwa district, eastern Botswana, in 2012 and 2013. Vector density and malaria cases were compared between Bobirwa and Ngami (northwestern Botswana), with no larviciding in the control arm. Results: Larviciding reduced larval density by 95% in Bobirwa in 2012, with two cases of malaria, while in 2013 larval density reduction was 81%, with 11 cases. Adult mosquito density was zero for both years in Robelela village (Bobirwa), compared to respectively four and 26 adult mosquitoes per room in Shorobe village (Ngami) in 2012 and 2013. There were no cases of malaria in Robelela in either year, but in Shorobe there were 20 and 70 cases, respectively, in 2012 and 2013. Conclusion: Larviciding can reduce the larval density of mosquitoes and reduce malaria transmission in Botswana. Large-scale, targeted implementation of larviciding in districts at high risk for malaria is recommended.

"Kala-Azar is a Dishonest Disease": Community Perspectives on Access Barriers to Visceral Leishmaniasis (Kala-Azar) Diagnosis and Care in Southern Gadarif, Sudan

Title: "Kala-Azar is a Dishonest Disease": Community Perspectives on Access Barriers to Visceral Leishmaniasis (Kala-Azar) Diagnosis and Care in Southern Gadarif, Sudan Authors: Sunyoto, T; Adam, GK; Atia, AM; Hamid, Y; Babiker, RA; Abdelrahman, N; Vander Kelen, C; Ritmeijer, K; Alcoba, G; den Boer, M; Picado, A; Boelaert, M Abstract: Early diagnosis and treatment is the principal strategy to control visceral leishmaniasis (VL), or kala-azar in East Africa. As VL strikes remote rural, sparsely populated areas, kala-azar care might not be accessed optimally or timely. We conducted a qualitative study to explore access barriers in a longstanding kala-azar endemic area in southern Gadarif, Sudan. Former kala-azar patients or caretakers, community leaders, and health-care providers were purposively sampled and thematic data analysis was used. Our study participants revealed the multitude of difficulties faced when seeking care. The disease is well known in the area, yet misconceptions about causes and transmission persist. The care-seeking itineraries were not always straightforward: "shopping around" for treatments are common, partly linked to difficulties in diagnosing kala-azar. Kala-azar is perceived to be "hiding," requiring multiple tests and other diseases must be treated first. Negative perceptions on quality of care in the public hospitals prevail, with the unavailability of drugs or staff as the main concern. Delay to seek care remains predominantly linked to economic constraint: albeit treatment is for free, patients have to pay out of pocket for everything else, pushing families further into poverty. Despite increased efforts to tackle the disease over the years, access to quality kala-azar care in this rural Sudanese context remains problematic. The barriers explored in this study are a compelling reminder of the need to boost efforts to address these barriers.

'I could not join because I had to work for pay.': A qualitative evaluation of falciparum malaria pro-active case detection in three rural Cambodian villages

Title: 'I could not join because I had to work for pay.': A qualitative evaluation of falciparum malaria pro-active case detection in three rural Cambodian villages Authors: Taffon, P; Rossi, G; Kindermans, JM; Van den Bergh, R; Nguon, C; Debackere, M; Vernaeve, L; De Smet, M; Venables, E Abstract: Pro-active case detection (Pro-ACD), in the form of voluntary screening and treatment (VSAT) following community mobilisation about 'asymptomatic malaria', is currently being evaluated as a tool for Plasmodium falciparum elimination in Preah Vihear Province, Cambodia.

Characteristics of human encounters and social mixing patterns relevant to infectious diseases spread by close contact: a survey in Southwest Uganda

Title: Characteristics of human encounters and social mixing patterns relevant to infectious diseases spread by close contact: a survey in Southwest Uganda Authors: le Polain de Waroux, O; Cohuet, S; Ndazima, D; Kucharski, AJ; Juan-Giner, A; Flasche, S; Tumwesigye, E; Arinaitwe, R; Mwanga-Amumpaire, J; Boum, Y; Nackers, F; Checchi, F; Grais, R F; Edmunds, WJ Abstract: Quantification of human interactions relevant to infectious disease transmission through social contact is central to predict disease dynamics, yet data from low-resource settings remain scarce.

Pharmacokinetics of efavirenz in patients on antituberculosis treatment in high HIV and tuberculosis burden countries: a systematic review

Title: Pharmacokinetics of efavirenz in patients on antituberculosis treatment in high HIV and tuberculosis burden countries: a systematic review Authors: Atwine, D; Bonnet, M; Taburet, AM Abstract: Efavirenz (EFV) and Rifampicin-Isoniazid (RH) are cornerstone drugs in HIV-tuberculosis (TB) co-infection treatment but with complex drug interactions, efficacy and safety challenges. We reviewed recent data on EFV and RH interaction in TB/HIV high-burden countries.

Breast tuberculosis in men: A systematic review

Title: Breast tuberculosis in men: A systematic review Authors: Quaglio, G; Pizzol, D; Bortolani, A; Manenti, F; Isaakidis, P; Putoto, G; Olliaro, PL Abstract: Breast tuberculosis in male is a rarely reported and poorly described condition.

Global programmatic use of bedaquiline and delamanid for the treatment of multidrug-resistant tuberculosis

Title: Global programmatic use of bedaquiline and delamanid for the treatment of multidrug-resistant tuberculosis Authors: Cox, V; Brigden, G; Crespo, RH; Lessem, E; Lynch, S; Rich, ML; Waning, B; Furin, J Abstract: The World Health Organization recommended two new drugs, bedaquiline (BDQ) and delamanid (DLM), for the treatment of multidrug-resistant tuberculosis (MDR-TB) in 2013 and 2014, respectively. An estimated one third of patients with MDR-TB would benefit from the inclusion of these drugs in their treatment regimens.

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