Title: High Seroconversion Rates in Trypanosoma Cruzi Chronic Infection Treated with Benznidazole in People Under 16 Years in Guatemala Authors: Brum-Soares, L; Cubides, JC; Burgos, I; Monroy, C; Castillo, L; González, S; Viñas, PA; Urrutia, PP Abstract: Geographical, epidemiological, and environmental differences associated with therapeutic response to Chagas etiological treatment have been previously discussed. This study describes high seroconversion rates 72 months after benznidazole treatment in patients under 16 years from a project implemented by Doctors without Borders in Guatemala.
Title: Health Care Workers' Perceptions of Point-of-Care Testing in a Low-Income Country-A Qualitative Study in Southwestern Uganda Authors: Rasti, R; Nanjebe, D; Karlström, J; Muchunguzi, C; Mwanga-Amumpaire, J; Gantelius, J; Mårtensson, A; Rivas, L; Galban, F; Reuterswärd, P; Andersson Svahn, H; Alvesson, H; Boum, Y; Alfvén, T Abstract: Point-of-care (POC) tests have become increasingly available and more widely used in recent years. They have been of particular importance to low-income settings, enabling them with clinical capacities that had previously been limited. POC testing programs hold a great potential for significant improvement in low-income health systems. However, as most POC tests are developed in high-income countries, disengagement between developers and end-users inhibit their full potential. This study explores perceptions of POC test end-users in a low-income setting, aiming to support the development of novel POC tests for low-income countries.
Title: Combined Interventions to Reduce HIV Incidence in KwaZulu-Natal: A Modelling Study Authors: Blaizot, S; Huerga, H; Riche, B; Ellman, T; Shroufi, A; Etard, J; Ecochard, R Abstract: Combined prevention interventions, including early antiretroviral therapy initiation, may substantially reduce HIV incidence in hyperendemic settings. Our aim was to assess the potential short-term impact of combined interventions on HIV spreading in the adult population of Mbongolwane and Eshowe (KwaZulu-Natal, South Africa) using sex- and age-specific scenarios, and age-targeted interventions.
Title: Designing HIV Testing Algorithms Based on 2015 WHO Guidelines Using Data from Six Sites in sub-Saharan Africa Authors: Kosack, C; Shanks, L; Beelaert, G; Benson, T; Savane, A; Ng'ang'a, A; Andre, B; Zahinda, J; Fransen, K; Page, A Abstract: Our objective was to evaluate the performance of HIV testing algorithms based on WHO recommendations, using data from specimens collected at six HIV testing and counselling sites in sub-Saharan Africa (Guinea, Conakry; Kitgum and Arua, Uganda; Homa Bay, Kenya; Douala, Cameroun; Baraka, Democratic Republic of Congo). A total of 2780 samples, including 1306 HIV-positive, were included in the analysis. HIV testing algorithms were designed using Determine as a first test. Second and third rapid diagnostic tests (RDT) were selected based on site-specific performance, adhering where possible to the WHO-recommended minimum requirements of sensitivity and specificity of ≥99%. The threshold for specificity was reduced to 98% or 96% if necessary. We also simulated algorithms consisting of one RDT followed by a simple confirmatory assay. The positive predictive values (PPV) of the simulated algorithms varied from 75.8%-100% using strategies recommended for high-prevalence settings; 98.7%-100% using strategies recommended for low-prevalence settings; and 98.1%-100% using a rapid test followed by a simple confirmatory assay. Although we were able to design algorithms that met the recommended PPV of ≥99% in five of six sites using the applicable high prevalence strategy, options were often very limited due to sub-optimal performance of individual RDTs and to shared false-reactive results. These results underscore the impact of the sequence of HIV tests and of shared false-reactivity on algorithm performance. Where it is not possible to identify tests that meet WHO-recommended specifications, the low-prevalence strategy may be more suitable.
Title: Implications of Differentiated Care for Successful ART Scale-Up in a Concentrated HIV Epidemic in Yangon, Myanmar Authors: Mesic, A; Fontaine, J; Aye, T; Greig, J; Thwe, T; Moretó-Planas, L; Kliesckova, J; Khin, K; Zarkua, N; Gonzales, L; Guillergan, E; O’Brien, D Abstract: Introduction: National AIDS Programme in Myanmar has made significant progress in scaling up antiretroviral treatment (ART) services and recognizes the importance of differentiated care for people living with HIV. Indeed, long centred around the hospital and reliant on physicians, the country’s HIV response is undergoing a process of successful decentralization with HIV care increasingly being integrated into other health services as part of a systematic effort to expand access to HIV treatment. This study describes implementation of differentiated care in Médecins Sans Frontières (MSF)-supported programmes and reports its outcomes. Methods: A descriptive cohort analysis of adult patients on antiretroviral treatment was performed. We assessed stability of patients as of 31 December 2014 and introduced an intervention of reduced frequency of physicians’ consultations for stable patients, and fast tract ART refills. We measured a number of saved physician’s visits as the result of this intervention. Main outcomes, remained under care, death, lost to follow up, treatment failure, were assessed on 31 December 2015 and reported as rates for different stable groups. Results: On 31 December 2014, our programme counted 16, 272 adult patients enrolled in HIV care, of whom 80.34% were stable. The model allowed for an increase in the average number of patients one medical team could care for – from 745 patients in 2011 to 1, 627 in 2014 – and, thus, a reduction in the number of teams needed. An assessment of stable patients enrolled on ART one year after the implementation of the new model revealed excellent outcomes, aggregated for stable patients as 98.7% remaining in care, 0.4% dead, 0.8% lost to follow-up, 0.8% clinical treatment failure and 5.8% with immunological treatment failure. Conclusions: Implementation of a differentiated model reduced the number of visits between stable clients and physicians, reduced the medical resources required for treatment and enabled integrated treatment of the main co-morbidities. We hope that these findings will encourage other stakeholders to implement innovative models of HIV care in Myanmar, further expediting the scale up of ART services, the decentralization of treatment and the integration of care for the main HIV co-morbidities in this context.
Title: Protection Against Cholera From Killed Whole-Cell Oral Cholera Vaccines: A Systematic Review and Meta-Analysis Authors: Bi, Q; Ferreras, E; Pezzoli, L; Legros, D; Ivers, L; Date, K; Qadri, F; Digilio, L; Sack, D; Ali, M; Lessler, J; Luquero, F; Azman, A Abstract: Killed whole-cell oral cholera vaccines (kOCVs) are becoming a standard cholera control and prevention tool. However, vaccine efficacy and direct effectiveness estimates have varied, with differences in study design, location, follow-up duration, and vaccine composition posing challenges for public health decision making. We did a systematic review and meta-analysis to generate average estimates of kOCV efficacy and direct effectiveness from the available literature.
Title: Cardiovascular Disease Risk and Prevention Amongst Syrian Refugees: Mixed Methods Study of Médecins Sans Frontières Programme in Jordan Authors: Collins, D; Jobanputra, K; Frost, T; Muhammed, S; Ward, A; Shafei, A; Fardous, T; Gabashneh, S; Heneghan, C Abstract: The growing burden of non-communicable diseases (NCDs) presented new challenges for medical humanitarian aid and little was known about primary health care approaches for these diseases in humanitarian response. We aimed to evaluate Médecins Sans Frontières (MSF's) use of total CVD risk based prevention strategies amongst Syrian refugees in northern Jordan to identify opportunities to improve total CVD risk based guidance for humanitarian settings.
Title: HIV Misdiagnosis in Sub-Saharan Africa: Performance of Diagnostic Algorithms at Six Testing Sites Authors: Kosack, C; Shanks, L; Beelaert, G; Benson, T; Savane, A; Ng'ang'a, A; Andre, B; Zahinda, J; Fransen, K; Page, A Abstract: We evaluated the diagnostic accuracy of HIV testing algorithms at six programmes in five sub-Saharan African countries.
Title: Educating Nurses in Resource-Poor Areas Authors: Defranciscis, J Abstract: Jai Defranciscis is an Australian nurse with a passion for paediatrics and education in resource-poor settings. Last year she joined the international medical aid organisation M decins Sans Fronti res (MSF) - also known as Doctors Without Borders - heading to South Sudan for a year, working with refugees fleeing fighting between armed groups. This is her account.
Title: Standardised Mortality Surveys Authors: MSF Description: Mortality Survey Protocol - standardised, ERB approved, intersectional This collection of files includes an overview of the whole process of conducting a mortality survey and templates for concept papers, the protocol, questionnaires and consent and other related forms. Surveys that use this standardised intersectional protocol do not require MSF Ethics Review Board (ERB) review if the Medical Director of the relevant section takes responsibility for addressing the ethics issues. The exemption criteria of the MSF ERB for standardised intersectional survey protocols must be followed. See http://fieldresearch.msf.org/msf/bitstream/10144/618943/4/Exemption+Criteria+Document+Standardized+Surveys+V1+%281%29.pdf
Title: Standardised Vaccination Coverage Surveys Authors: MSF Description: Vaccination Coverage Survey Protocol - standardised, ERB approved, intersectional This collection of files includes an overview of the whole process of conducting a vaccination coverage survey and templates for concept papers, the protocol, questionnaires and consent and other related forms. Surveys that use this standardised intersectional protocol do not require MSF Ethics Review Board (ERB) review if the Medical Director of the relevant section takes responsibility for addressing the ethics issues. The exemption criteria of the MSF ERB for standardised intersectional survey protocols must be followed. See http://fieldresearch.msf.org/msf/bitstream/10144/618943/4/Exemption+Criteria+Document+Standardized+Surveys+V1+%281%29.pdf
Title: Cryptococcal Meningitis: A Neglected NTD? Authors: Molloy, S; Chiller, T; Greene, G; Burry, J; Govender, N; Kanyama, C; Mfinanga, S; Lesikari, S; Mapoure, Y; Kouanfack, C; Sini, V; Temfack, E; Boulware, D; Dromer, F; Denning, D; Day, J; Stone, N; Bicanic, T; Jarvis, J; Lortholary, O; Harrison, T; Jaffar, S; Loyse, A
Title: Ciprofloxacin for Contacts of Cases of Meningococcal Meningitis as an Epidemic Response: Study Protocol for a Cluster-Randomized Trial Authors: Coldiron, M; Alcoba, G; Ciglenecki, I; Hitchings, M; Djibo, A; Page, A; Langendorf, C; Grais, R Abstract: Epidemics of meningococcal meningitis are common in the "African meningitis belt." Current response strategies include reactive vaccination campaigns, which are often organized too late to have maximal impact. A novel strain of Neisseria meningitidis serogroup C has been circulating in recent years, and vaccine supplies are limited. An evaluation of chemoprophylaxis with single-dose ciprofloxacin for household contacts of meningitis cases has therefore been recommended.
Title: Diabetes Care in a Complex Humanitarian Emergency Setting: A Qualitative Evaluation Authors: Murphy, A; Biringanine, M; Roberts, B; Stringer, B; Perel, P; Jobanputra, K Abstract: Evidence is urgently needed from complex emergency settings to support efforts to respond to the increasing burden of diabetes mellitus (DM). We conducted a qualitative study of a new model of DM health care (Integrated Diabetic Clinic within an Outpatient Department [IDC-OPD]) implemented by Médecins Sans Frontières (MSF) in Mweso Hospital in eastern Democratic Republic of Congo (DRC). We aimed to explore patient and provider perspectives on the model in order to identify factors that may support or impede it.
Title: Estimating the Number of Secondary Ebola Cases Resulting From an Unsafe Burial and Risk Factors for Transmission During the West Africica Ebola Epidemic Authors: Tiffany, A; Dalziel, B; Kagume N; Johnson, G; Nugba Ballah, R; James, D; Wone, A; Bedford, J; McClelland, A Abstract: Safely burying Ebola infected individuals is acknowledged to be important for controlling Ebola epidemics and was a major component of the 2013-2016 West Africa Ebola response. Yet, in order to understand the impact of safe burial programs it is necessary to elucidate the role of unsafe burials in sustaining chains of Ebola transmission and how the risk posed by activities surrounding unsafe burials, including care provided at home prior to death, vary with human behavior and geography.
Title: High Burden of Malaria and Anemia Among Tribal Pregnant Women in a Chronic Conflict Corridor in India Authors: Corrêa, G; Das, M; Kovelamudi, R; Jaladi, N; Pignon, C; Vysyaraju, K; Yedla, U; Laxmi, V; Vemula, P; Gowthami, V; Sharma, H; Remartinez, D; Kalon, S; de Polnay, K; De Smet, M; Isaakidis, P Abstract: With more than 200 million cases a year, malaria is an important global health concern, especially among pregnant women. The forested tribal areas of Andhra Pradesh, Telangana and Chhattisgarh in India are affected by malaria and by an on-going chronic conflict which seriously limits access to health care. The burden of malaria and anemia among pregnant women in these areas is unknown; moreover there are no specific recommendations for pregnant women in the Indian national malaria policy. The aim of this study is to measure the burden of malaria and anemia among pregnant women presenting in mobile clinics for antenatal care in a conflict-affected corridor in India.
Title: Peripheral Neuropathy in a Diabetic Child Treated with Linezolid for Multidrug-Resistant Tuberculosis: A Case Report and Review of the Literature Authors: Swaminathan, A; du Cros, P; Seddon, J; Mirgayosieva, S; Asladdin, R; Dusmatova, Z Abstract: Extensively drug-resistant (XDR) tuberculosis (TB) and multidrug resistant (MDR)-TB with additional resistance to injectable agents or fluoroquinolones are challenging to treat due to lack of available, effective drugs. Linezolid is one of the few drugs that has shown promise in treating these conditions. Long-term linezolid use is associated with toxicities such as peripheral and optic neuropathies. Diabetes mellitus (DM), especially when uncontrolled, can also result in peripheral neuropathy. The global burden of DM is increasing, and DM has been associated with a three-fold increased risk of developing TB disease. TB and DM can be a challenging combination to treat. DM can inhibit the host immune response to tuberculosis infection; and TB and some anti-TB drugs can worsen glycaemic control. A child experiencing neuropathy that is a possible complication of both DM and linezolid used to treat TB has not been reported previously. We report peripheral neuropathy in a 15-year-old boy with type 1 DM, diagnosed with MDR-TB and additional resistance to injectable TB medications.
Title: Comparing Yield and Relative Costs of WHO TB Screening Algorithms in Selected Risk Groups Among People Aged 65 Years and Over in China, 2013 Authors: Zhang, C; Ruan, Y; Cheng, J; Zhao, F; Xia, Y; Zhang, H; Wilkinson, E; Das, M; Li, J; Chen, W; Hu, D; Jeyashree, K; Wang, L Abstract: To calculate the yield and cost per diagnosed tuberculosis (TB) case for three World Health Organization screening algorithms and one using the Chinese National TB program (NTP) TB suspect definitions, using data from a TB prevalence survey of people aged 65 years and over in China, 2013.
Title: Humanitarian Medicine is More Than a Technical Exercise Authors: Hawkins, V; Pérache, A
Title: Development and External Validation of a Clinical Prognostic Score for Death in Visceral Leishmaniasis Patients in a High HIV Co-Infection Burden Area in Ethiopia Authors: Abongomera, C; Ritmeijer, K; Vogt, F; Buyze, J; Mekonnen, Z; Admassu, H; Colebunders, R; Mohammed, R; Lynen, L; Diro, E; van Griensven, J Abstract: In Ethiopia, case fatality rates among subgroups of visceral leishmaniasis (VL) patients are high. A clinical prognostic score for death in VL patients could contribute to optimal management and reduction of these case fatality rates. We aimed to identify predictors of death from VL, and to develop and externally validate a clinical prognostic score for death in VL patients, in a high HIV co-infection burden area in Ethiopia.