Journal Article > Short ReportFull Text
Clin Infect Dis. 2019 November 2; Volume 71 (Issue 2); 415-418.; DOI:10.1093/cid/ciz1084
Seung KJ, Khan PY, Franke MF, Ahmed SM, Aiylchiev S, et al.
Clin Infect Dis. 2019 November 2; Volume 71 (Issue 2); 415-418.; DOI:10.1093/cid/ciz1084
Delamanid should be effective against highly resistant strains of Mycobacterium tuberculosis, but uptake has been slow globally. In the endTB (expand new drug markets for TB) Observational Study, which enrolled a large, heterogeneous cohorts of patients receiving delamanid as part of a multidrug regimen, 80% of participants experienced sputum culture conversion within 6 months.
Conference Material > Abstract
Hopkins S, Hazel A, Pourtois J, Chamberlin A, Gajewski Z, et al.
MSF Scientific Day International 2023. 2023 June 7; DOI:10.57740/vj1f-v594
INTRODUCTION
An undervalued role of rural healthcare provision is its impact on forests and carbon balance. In addition to the effects of healthcare provision and livelihood programmes on improved human health, these programmes can also reduce forest degradation and prevent deforestation-related carbon emissions, since unaffordable healthcare drives logging as a source of rescue income. Shocks such as the Covid-19 pandemic may exacerbate this dynamic. Health In Harmony and Planet Indonesia are two planetary health non-governmental organisations (NGO’s) that work together with communities living in and around tropical rainforests in West Kalimantan, Indonesia.
METHODS
We used a cross-sectional mixed-methods survey in November-December 2021 to evaluate healthcare access and livelihoods in 1,016 households across six NGO-affiliated villages and four unaffiliated control villages. Additionally, satellite-generated imagery retrieved between January 2018 and December 2021 was used to contrast relative deforestation rates in 28 NGO-affiliated and 1,421 unaffiliated control villages bordering protected rainforests across Kalimantan.
ETHICS
This study was approved by the Stanford University Institutional Review Board and by the Institut Pertanian Bogor Ethical Review Board.
RESULTS
After accounting for environmental variables that affect deforestation, satellite analysis suggested that prior to the Covid-19 pandemic, average weekly deforestation rates in NGO-affiliated villages (0.018%; 95% confidence interval (CI), 0.012-0.026%) were 70% lower than in unaffiliated villages (0.062%; 95%CI, 0.045-0.078%; p<0.0001). Following the WHO pandemic declaration, deforestation rates dropped and then gradually rebounded in both NGO-affiliated and unaffiliated villages, with NGO-affiliated villages maintaining significantly lower average deforestation rates (0.008%; 95%CI, 0.005-0.011%) during the pandemic than unaffiliated villages (0.026%; 95%CI, 0.019-0.032%; p<0.01). Survey results indicated that clinic visits, out-of-pocket healthcare spending, and the proportion of households unable to access healthcare increased across all villages during the pandemic. The main reasons given for access problems were around fears of contracting Covid-19, unaffordability, or clinic closure. Throughout the pandemic, households affiliated with Health In Harmony, which runs a health clinic, were less likely to report barriers to affordable clinic access than households in unaffiliated villages (14% vs. 29%; odds ratio (OR); 0.41,95%CI, 0.2-0.69). Households in NGO-affiliated villages were more likely to do jobs with low environmental impact (e.g., small-scale farming, conservation; OR 1.61,95%CI, 1.15-2.24). Half of households in both groups reported income loss from at least one source during the pandemic, but households in NGO-affiliated villages were more likely to gain alternative income from multiple job types, especially resource-neutral jobs (e.g., public servant, sales, services). Additionally, households in NGO-affiliated villages had more sources of economic support, such as government programmes, co-operatives, family and NGO’s (OR 1.36, 95%CI, 1.11-1.69).
CONCLUSION
Communities with better access to healthcare and livelihood support were associated with significantly lower deforestation rates prior to the Covid-19 pandemic, and this lower reliance on forest-degrading income was resilient to the pandemic shock.
CONFLICTS OF INTEREST
None declared.
An undervalued role of rural healthcare provision is its impact on forests and carbon balance. In addition to the effects of healthcare provision and livelihood programmes on improved human health, these programmes can also reduce forest degradation and prevent deforestation-related carbon emissions, since unaffordable healthcare drives logging as a source of rescue income. Shocks such as the Covid-19 pandemic may exacerbate this dynamic. Health In Harmony and Planet Indonesia are two planetary health non-governmental organisations (NGO’s) that work together with communities living in and around tropical rainforests in West Kalimantan, Indonesia.
METHODS
We used a cross-sectional mixed-methods survey in November-December 2021 to evaluate healthcare access and livelihoods in 1,016 households across six NGO-affiliated villages and four unaffiliated control villages. Additionally, satellite-generated imagery retrieved between January 2018 and December 2021 was used to contrast relative deforestation rates in 28 NGO-affiliated and 1,421 unaffiliated control villages bordering protected rainforests across Kalimantan.
ETHICS
This study was approved by the Stanford University Institutional Review Board and by the Institut Pertanian Bogor Ethical Review Board.
RESULTS
After accounting for environmental variables that affect deforestation, satellite analysis suggested that prior to the Covid-19 pandemic, average weekly deforestation rates in NGO-affiliated villages (0.018%; 95% confidence interval (CI), 0.012-0.026%) were 70% lower than in unaffiliated villages (0.062%; 95%CI, 0.045-0.078%; p<0.0001). Following the WHO pandemic declaration, deforestation rates dropped and then gradually rebounded in both NGO-affiliated and unaffiliated villages, with NGO-affiliated villages maintaining significantly lower average deforestation rates (0.008%; 95%CI, 0.005-0.011%) during the pandemic than unaffiliated villages (0.026%; 95%CI, 0.019-0.032%; p<0.01). Survey results indicated that clinic visits, out-of-pocket healthcare spending, and the proportion of households unable to access healthcare increased across all villages during the pandemic. The main reasons given for access problems were around fears of contracting Covid-19, unaffordability, or clinic closure. Throughout the pandemic, households affiliated with Health In Harmony, which runs a health clinic, were less likely to report barriers to affordable clinic access than households in unaffiliated villages (14% vs. 29%; odds ratio (OR); 0.41,95%CI, 0.2-0.69). Households in NGO-affiliated villages were more likely to do jobs with low environmental impact (e.g., small-scale farming, conservation; OR 1.61,95%CI, 1.15-2.24). Half of households in both groups reported income loss from at least one source during the pandemic, but households in NGO-affiliated villages were more likely to gain alternative income from multiple job types, especially resource-neutral jobs (e.g., public servant, sales, services). Additionally, households in NGO-affiliated villages had more sources of economic support, such as government programmes, co-operatives, family and NGO’s (OR 1.36, 95%CI, 1.11-1.69).
CONCLUSION
Communities with better access to healthcare and livelihood support were associated with significantly lower deforestation rates prior to the Covid-19 pandemic, and this lower reliance on forest-degrading income was resilient to the pandemic shock.
CONFLICTS OF INTEREST
None declared.
Journal Article > ResearchFull Text
Parasit Vectors. 2010 August 11; Volume 3 (Issue 1); DOI:10.1186/1756-3305-3-70
Bhullar N, Maikere J, Grais RF
Parasit Vectors. 2010 August 11; Volume 3 (Issue 1); DOI:10.1186/1756-3305-3-70
ABSTRACT: BACKGROUND: The World Health Organization (WHO) Global Program to Eliminate Lymphatic Filariasis relies on mass drug administration (MDA) of two drugs annually for 4 to 6 years. The goal is to reduce the reservoir of microfilariae in the blood to a level insufficient to maintain transmission by the mosquito vector. In 2008, the international medical aid organization Medecins Sans Frontieres (MSF) performed the first round of a MDA in the high-burden area of Asmat district, in Papua, Indonesia. We report the challenges faced in this MDA on a remote Indonesian island and propose solutions to overcome these hurdles in similar future contexts. RESULTS: During the MDA, we encountered difficult challenges in accessing as well as persuading the patient population to take the antifilarial drugs. Health promotion activities supporting treatment need to be adapted and repetitive, with adequate time and resources allocated for accessing and communicating with local, seminomadic populations. Distribution of bednets resulted in an increase in MDA coverage, but it was still below the 80-85% target. CONCLUSIONS: MDA for lymphatic filariasis is how the WHO has planned to eliminate the disease from endemic areas. Our programmatic experience will hopefully help inform future campaign planning in difficult-to-access, high-burden areas of the world to achieve target MDA coverage for elimination of lymphatic filariasis.
Journal Article > ResearchFull Text
Int J Tuberc Lung Dis. 2023 January 1; Volume 27 (Issue 1); 34-40.; DOI:10.5588/ijtld.22.0324
Zeng C, Mitnick CD, Hewison CCH, Bastard M, Khan PY, et al.
Int J Tuberc Lung Dis. 2023 January 1; Volume 27 (Issue 1); 34-40.; DOI:10.5588/ijtld.22.0324
BACKGROUND
The WHO provides standardized outcome definitions for rifampicin-resistant (RR) and multidrug-resistant (MDR) TB. However, operationalizing these definitions can be challenging in some clinical settings, and incorrect classification may generate bias in reporting and research. Outcomes calculated by algorithms can increase standardization and be adapted to suit the research question. We evaluated concordance between clinician-assigned treatment outcomes and outcomes calculated based on one of two standardized algorithms, one which identified failure at its earliest possible recurrence (i.e., failure-dominant algorithm), and one which calculated the outcome based on culture results at the end of treatment, regardless of early occurrence of failure (i.e., success-dominant algorithm).
METHODS
Among 2,525 patients enrolled in the multi-country endTB observational study, we calculated the frequencies of concordance using cross-tabulations of clinician-assigned and algorithm-assigned outcomes. We summarized the common discrepancies.
RESULTS
Treatment success calculated by algorithms had high concordance with treatment success assigned by clinicians (95.8 and 97.7% for failure-dominant and success-dominant algorithms, respectively). The frequency and pattern of the most common discrepancies varied by country.
CONCLUSION
High concordance was found between clinician-assigned and algorithm-assigned outcomes. Heterogeneity in discrepancies across settings suggests that using algorithms to calculate outcomes may minimize bias.
The WHO provides standardized outcome definitions for rifampicin-resistant (RR) and multidrug-resistant (MDR) TB. However, operationalizing these definitions can be challenging in some clinical settings, and incorrect classification may generate bias in reporting and research. Outcomes calculated by algorithms can increase standardization and be adapted to suit the research question. We evaluated concordance between clinician-assigned treatment outcomes and outcomes calculated based on one of two standardized algorithms, one which identified failure at its earliest possible recurrence (i.e., failure-dominant algorithm), and one which calculated the outcome based on culture results at the end of treatment, regardless of early occurrence of failure (i.e., success-dominant algorithm).
METHODS
Among 2,525 patients enrolled in the multi-country endTB observational study, we calculated the frequencies of concordance using cross-tabulations of clinician-assigned and algorithm-assigned outcomes. We summarized the common discrepancies.
RESULTS
Treatment success calculated by algorithms had high concordance with treatment success assigned by clinicians (95.8 and 97.7% for failure-dominant and success-dominant algorithms, respectively). The frequency and pattern of the most common discrepancies varied by country.
CONCLUSION
High concordance was found between clinician-assigned and algorithm-assigned outcomes. Heterogeneity in discrepancies across settings suggests that using algorithms to calculate outcomes may minimize bias.
Journal Article > ResearchFull Text
Archives of Surgery/JAMA Surgery. 2010 August 1; Volume 145 (Issue 8); DOI:10.1001/archsurg.2010.137
Chu KM, Ford NP, Trelles M
Archives of Surgery/JAMA Surgery. 2010 August 1; Volume 145 (Issue 8); DOI:10.1001/archsurg.2010.137
OBJECTIVE: To determine operative mortality in surgical programs from resource-limited settings. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of 17 surgical programs in 13 developing countries by 1 humanitarian organization, Médecins Sans Frontières, was performed between January 1, 2001, and December 31, 2008. Participants included patients undergoing surgical procedures. MAIN OUTCOME MEASURE: Operative mortality. Determinants of mortality were modeled using logistic regression. RESULTS: Between 2001 and 2008, 19,643 procedures were performed on 18,653 patients. Among these, 8329 procedures (42%) were emergent; 7933 (40%) were for obstetric-related pathology procedures and 2767 (14%) were trauma related. Operative mortality was 0.2% (31 deaths) and was associated with programs in conflict settings (adjusted odds ratio [AOR] = 4.6; P = .001), procedures performed under emergency conditions (AOR = 20.1; P = .004), abdominal surgical procedures (AOR = 3.4; P = .003), hysterectomy (AOR = 12.3; P = .001), and American Society of Anesthesiologists classifications of 3 to 5 (AOR = 20.2; P < .001). CONCLUSIONS: Surgical care can be provided safely in resource-limited settings with appropriate minimum standards and protocols. Studies on the burden of surgical disease in these populations are needed to improve service planning and delivery. Quality improvement programs are needed for the various stakeholders involved in surgical delivery in these settings.
Protocol > Research Study
BMC Infect Dis. 2019 August 20; Volume 19 (Issue 1); 733.; DOI:10.1186/s12879-019-4378-4
Khan UT, Huerga H, Khan AS, Mitnick CD, Hewison CCH, et al.
BMC Infect Dis. 2019 August 20; Volume 19 (Issue 1); 733.; DOI:10.1186/s12879-019-4378-4
BACKGROUND
At a time when programs were struggling to design effective regimens for the treatment of multidrug-resistant tuberculosis (MDR-TB), the marketing authorization of bedaquiline and delamanid was a critical development in the MDR-TB treatment landscape. However, despite their availability for routine programmatic use, the uptake of these drugs has remained slow; concerns included a lack of evidence on safety and efficacy and the need to protect the new drugs from the development of acquired resistance. As part of the endTB Project, we aimed to address these barriers by generating evidence on safety and efficacy of bedaquiline or delamanid based MDR-TB regimens.
METHODS
This is a protocol for a multi-center prospective cohort study to enroll 2600 patients from April 2015 through September 2018 in 17 countries. The protocol describes inclusion of patients started on treatment with bedaquiline- or delamanid- containing regimens under routine care, who consented to participate in the endTB observational study. Patient follow-up was according to routine monitoring schedules recommended for patients receiving bedaquiline or delamanid as implemented at each endTB site. Therefore, no additional tests were performed as a part of the study. Data were to be collected in a customized, open-source electronic medical record (EMR) system developed as a part of the endTB Project across all 17 countries.
DISCUSSION
The endTB observational study will generate evidence on safety and efficacy of bedaquiline- and delamanid-containing regimens in a large, extremely heterogeneous group of MDR-TB patients, from 17 epidemiologically diverse countries. The systematic, prospective data collection of repeated effectiveness and safety measures, and analyses performed on these data, will improve the quality of evidence available to inform MDR-TB treatment and policy decisions. Further, the resources available to countries through implementation of the endTB project will have permitted countries to: gain experience with the use of these drugs in MDR-TB regimens, improve local capacity to record and report adverse events (pharmacovigilance), and enhance significantly the body of data available for safety evaluation of these drugs and other novel treatments.
At a time when programs were struggling to design effective regimens for the treatment of multidrug-resistant tuberculosis (MDR-TB), the marketing authorization of bedaquiline and delamanid was a critical development in the MDR-TB treatment landscape. However, despite their availability for routine programmatic use, the uptake of these drugs has remained slow; concerns included a lack of evidence on safety and efficacy and the need to protect the new drugs from the development of acquired resistance. As part of the endTB Project, we aimed to address these barriers by generating evidence on safety and efficacy of bedaquiline or delamanid based MDR-TB regimens.
METHODS
This is a protocol for a multi-center prospective cohort study to enroll 2600 patients from April 2015 through September 2018 in 17 countries. The protocol describes inclusion of patients started on treatment with bedaquiline- or delamanid- containing regimens under routine care, who consented to participate in the endTB observational study. Patient follow-up was according to routine monitoring schedules recommended for patients receiving bedaquiline or delamanid as implemented at each endTB site. Therefore, no additional tests were performed as a part of the study. Data were to be collected in a customized, open-source electronic medical record (EMR) system developed as a part of the endTB Project across all 17 countries.
DISCUSSION
The endTB observational study will generate evidence on safety and efficacy of bedaquiline- and delamanid-containing regimens in a large, extremely heterogeneous group of MDR-TB patients, from 17 epidemiologically diverse countries. The systematic, prospective data collection of repeated effectiveness and safety measures, and analyses performed on these data, will improve the quality of evidence available to inform MDR-TB treatment and policy decisions. Further, the resources available to countries through implementation of the endTB project will have permitted countries to: gain experience with the use of these drugs in MDR-TB regimens, improve local capacity to record and report adverse events (pharmacovigilance), and enhance significantly the body of data available for safety evaluation of these drugs and other novel treatments.
Journal Article > Meta-AnalysisFull Text
PLoS Curr. 2013 June 7
Ververs MT, Antierens A, Sackl A, Staderini N, Captier V
PLoS Curr. 2013 June 7
Journal Article > ReviewFull Text
Curr Opin HIV AIDS. 2019 January 1; Volume 14 (Issue 1); DOI:10.1097/COH.0000000000000514
Khwairakpam G, Burry J
Curr Opin HIV AIDS. 2019 January 1; Volume 14 (Issue 1); DOI:10.1097/COH.0000000000000514
With increasing availability of generic direct-acting antivirals (DAAs) and associated price reductions, various governments, multilateral institutions, and donors have started providing testing and treatment for hepatitis C virus (HCV) infection. More data on the quality of these generic medicines and on cost-effectiveness of their use are becoming widely available. This review seeks to describe some of the treatment programs for HCV that are evolving in Cambodia, India, Indonesia, Malaysia, Myanmar, and Thailand.
Conference Material > Video (talk)
Burza S
MSF Scientific Day International 2023. 2023 June 7; DOI:10.57740/kn2v-0h76
Journal Article > ResearchFull Text
J Int AIDS Soc. 2011 April 8; Volume 14 (Issue 1); DOI:10.1186/1758-2652-14-7
van Cutsem G, Saphonn V, Saramony S, Vibol U, Zhang FJ, et al.
J Int AIDS Soc. 2011 April 8; Volume 14 (Issue 1); DOI:10.1186/1758-2652-14-7
To better understand the need for paediatric second-line antiretroviral therapy (ART), an ART management survey and a cross-sectional analysis of second-line ART use were conducted in the TREAT Asia Paediatric HIV Observational Database and the IeDEA Southern Africa (International Epidemiologic Databases to Evaluate AIDS) regional cohorts.