Conference Material > Abstract
Ann Oncol
ESMO open.European Society for Medical Oncology (ESMO) 2023. 1 October 2023; Volume 34 (Issue Supplement 2); S941.; DOI:10.1016/j.annonc.2023.09.2685
Polozov S, Marijon Jourdier H, Shkavron-Filippenko R, Boulay M, Taconet A, et al.
Ann Oncol
ESMO open.European Society for Medical Oncology (ESMO) 2023. 1 October 2023; Volume 34 (Issue Supplement 2); S941.; DOI:10.1016/j.annonc.2023.09.2685
BACKGROUND
Since the outbreak of the Russian Federation invasion, the border city of Kharkiv has come under bombardments leading to disruptions of the medical supply chain. Mission Kharkiv (MK) is a non-governmental organization (NGO) created in 2022 by Ukrainian volunteers to organize a consistent supply of chronic medications, especially anticancer drugs, in the area of Kharkiv.
METHODS
A partnership was created between MK and MSF in June 2022. MSF decided a donation of 12 anticancer drugs, all registered on the World Health Organization list of essential medicines. The supplies were dispensed to MK by MSF teams in Ukraine. MK was in charge of the storage and the distribution of the drugs to patients meeting eligibility criteria determined with Ukrainian oncologists. Digital database was created to allow traceability of every medication from its donation to its dispensation.
RESULTS
From October 2022 to April 2023, platinum compounds, taxanes, fluorouracil, trastuzumab, doxorubicin and hormone therapies were given to MK. Drugs were stocked in a warehouse unit equipped with cold chain facilities. 749 patients met eligibility criteria and were registered on the database to receive a whole course of treatment prescribed by Ukrainian oncologists. >99% of patients were ECOG 0-2. The largest types of cancers were digestive cancers (200 patients with gastrointestinal cancer, 21 with pancreatic cancer and 2 with biliary tract cancer representing 29.7% of all patients), breast cancers (206 women – 27.5%), gynaecologic cancers (151 women – 20.2%) followed by lung cancers (49 patients – 6.5%), hematologic malignancies (44 patients – 5.7%) and head and neck cancers (44 patients – 5.4%). Disease stage was reported in 723 patients. 32% were diagnosed with stage I-II, 33% with stage III and 35% with stage IV. Included patients received an average of 4.5 cycles of chemotherapy.
CONCLUSIONS
This model of humanitarian cancer medication release, coupled with cooperation between NGOs and a high level of digital traceability, has proven to be efficient. This approach could be scaled up in the future, enabling more cancer patients suffering from the consequences of war to benefit from this humanitarian program.
Since the outbreak of the Russian Federation invasion, the border city of Kharkiv has come under bombardments leading to disruptions of the medical supply chain. Mission Kharkiv (MK) is a non-governmental organization (NGO) created in 2022 by Ukrainian volunteers to organize a consistent supply of chronic medications, especially anticancer drugs, in the area of Kharkiv.
METHODS
A partnership was created between MK and MSF in June 2022. MSF decided a donation of 12 anticancer drugs, all registered on the World Health Organization list of essential medicines. The supplies were dispensed to MK by MSF teams in Ukraine. MK was in charge of the storage and the distribution of the drugs to patients meeting eligibility criteria determined with Ukrainian oncologists. Digital database was created to allow traceability of every medication from its donation to its dispensation.
RESULTS
From October 2022 to April 2023, platinum compounds, taxanes, fluorouracil, trastuzumab, doxorubicin and hormone therapies were given to MK. Drugs were stocked in a warehouse unit equipped with cold chain facilities. 749 patients met eligibility criteria and were registered on the database to receive a whole course of treatment prescribed by Ukrainian oncologists. >99% of patients were ECOG 0-2. The largest types of cancers were digestive cancers (200 patients with gastrointestinal cancer, 21 with pancreatic cancer and 2 with biliary tract cancer representing 29.7% of all patients), breast cancers (206 women – 27.5%), gynaecologic cancers (151 women – 20.2%) followed by lung cancers (49 patients – 6.5%), hematologic malignancies (44 patients – 5.7%) and head and neck cancers (44 patients – 5.4%). Disease stage was reported in 723 patients. 32% were diagnosed with stage I-II, 33% with stage III and 35% with stage IV. Included patients received an average of 4.5 cycles of chemotherapy.
CONCLUSIONS
This model of humanitarian cancer medication release, coupled with cooperation between NGOs and a high level of digital traceability, has proven to be efficient. This approach could be scaled up in the future, enabling more cancer patients suffering from the consequences of war to benefit from this humanitarian program.
Journal Article > ResearchFull Text
JAMA Netw Open. 23 June 2023; Volume 6 (Issue 6); e2319726.; DOI:10.1001/jamanetworkopen.2023.19726
Walravens S, Zharkova A, De Weggheleire A, Burton M, Cabrol JC, et al.
JAMA Netw Open. 23 June 2023; Volume 6 (Issue 6); e2319726.; DOI:10.1001/jamanetworkopen.2023.19726
IMPORTANCE
The 2022 war in Ukraine severely affected access to health care for patients in the conflict-affected regions and limited options for medical evacuation. Air transport, a common method of medical evacuation in war zones, was unsafe due to the conflict of 2 modernized military forces that were in possession of aircraft and surface-to-air weapons; therefore, Médecins Sans Frontières, in collaboration with the Ukrainian railway company and Ukrainian health agencies, addressed this by initiating medical evacuation via medically customized trains.
OBJECTIVE
To describe the implementation of medical evacuation trains aimed at improving the access to health care for war-affected patients.
DESIGN, SETTING, AND PARTICIPANTS
This case series describes the remodeling of 2 trains used for medical evacuation in a conflict zone during the war in Ukraine. The study was conducted from March 30 to November 30, 2022. One train had minimal adjustments and could be rapidly deployed to address the most pressing humanitarian needs, while the other underwent major structural modifications to provide intensive care capacity. The report details the medical capabilities of the trains, the organization of referrals, and operational challenges encountered. Additionally, it includes a case series on the characteristics of patients transported in the initial 8 months, based on routinely collected programmatic descriptive data of all patients transported by the medical trains.
RESULTS
In 8 months, 2481 patients (male-female ratio, 1.07; male, 1136 [46%]; female 1058 [43%]; missing data, 287 [12%]; median age, 63 years [range, 0-98 years]) were evacuated from 11 cities near the Ukrainian conflict frontline to safer areas. Initially, the trains predominantly evacuated trauma patients, but over the course of the war, the patient characteristics changed with more medical and nonacute conditions, and fewer trauma patients. The main reason for entry into the intensive care unit train carriage was for close monitoring and observation, and the main interventions performed were primarily for respiratory failure.
CONCLUSIONS AND RELEVANCE
The findings of this study suggest that medical evacuation in a war zone by converted trains is possible and can improve access to health care for war-affected patients. The presence of intensive care capacity on board allows for transport of more severely ill or injured individuals. However, the target population should not be limited to trauma patients, as health care institutions affected host a much broader population whose needs and urgency for evacuation may change over time.
The 2022 war in Ukraine severely affected access to health care for patients in the conflict-affected regions and limited options for medical evacuation. Air transport, a common method of medical evacuation in war zones, was unsafe due to the conflict of 2 modernized military forces that were in possession of aircraft and surface-to-air weapons; therefore, Médecins Sans Frontières, in collaboration with the Ukrainian railway company and Ukrainian health agencies, addressed this by initiating medical evacuation via medically customized trains.
OBJECTIVE
To describe the implementation of medical evacuation trains aimed at improving the access to health care for war-affected patients.
DESIGN, SETTING, AND PARTICIPANTS
This case series describes the remodeling of 2 trains used for medical evacuation in a conflict zone during the war in Ukraine. The study was conducted from March 30 to November 30, 2022. One train had minimal adjustments and could be rapidly deployed to address the most pressing humanitarian needs, while the other underwent major structural modifications to provide intensive care capacity. The report details the medical capabilities of the trains, the organization of referrals, and operational challenges encountered. Additionally, it includes a case series on the characteristics of patients transported in the initial 8 months, based on routinely collected programmatic descriptive data of all patients transported by the medical trains.
RESULTS
In 8 months, 2481 patients (male-female ratio, 1.07; male, 1136 [46%]; female 1058 [43%]; missing data, 287 [12%]; median age, 63 years [range, 0-98 years]) were evacuated from 11 cities near the Ukrainian conflict frontline to safer areas. Initially, the trains predominantly evacuated trauma patients, but over the course of the war, the patient characteristics changed with more medical and nonacute conditions, and fewer trauma patients. The main reason for entry into the intensive care unit train carriage was for close monitoring and observation, and the main interventions performed were primarily for respiratory failure.
CONCLUSIONS AND RELEVANCE
The findings of this study suggest that medical evacuation in a war zone by converted trains is possible and can improve access to health care for war-affected patients. The presence of intensive care capacity on board allows for transport of more severely ill or injured individuals. However, the target population should not be limited to trauma patients, as health care institutions affected host a much broader population whose needs and urgency for evacuation may change over time.
Journal Article > CommentaryFull Text
The Lancet Regional Health - Europe. 1 June 2022; Volume 17; 100403.; DOI:10.1016/j.lanepe.2022.100403
Kumar BN, James R, Hargreaves S, Bozorgmehr K, Mosca D, et al.
The Lancet Regional Health - Europe. 1 June 2022; Volume 17; 100403.; DOI:10.1016/j.lanepe.2022.100403
The invasion of Ukraine has unleashed a humanitarian crisis and the impact is devastating for millions displaced in Ukraine and for those fleeing the country. Receiving countries in Europe are reeling with shock and disbelief and trying at the same time to grapple with the reality of providing for a large, unplanned, unprecedented number of refugees mainly women and children on the move. Several calls for actions, comments and statements express outrage, the risks, and the impending consequences to life and health. There is a need to constantly assess the situation on the ground, identify priorities for health and provide guidance regarding how these needs could be addressed. Therefore, the Lancet Migration European Regional Hub conducted rapid interviews with key informants to identify these needs, and in collaboration with the World Health Organization Health and Migration Programme, summarized how these could be addressed. This viewpoint provides a summary of the situation in receiving countries and the technical guidance required that could be useful for providing assistance in the current refugee crisis.
Journal Article > CommentaryAbstract Only
Nat Rev Nephrol. 30 May 2022; DOI: 10.1038/s41581-022-00588-7
Vanholder R, De Weggheleire A, Ivanov DD, Luyckx VA, Slama S, et al.
Nat Rev Nephrol. 30 May 2022; DOI: 10.1038/s41581-022-00588-7
The devastating effects of war are far-reaching and particularly affect people with kidney disease. The Ukrainian conflict has highlighted problems encountered in the provision of support for this vulnerable group. On the basis of these and previous experiences in massive disasters, we propose a sustainable action plan to prepare for similar logistical challenges in future conflicts.
Journal Article > CommentaryAbstract Only
J Clin Endocrinol Metab
. 27 May 2022; Volume 107 (Issue 9); e3553-e3561.; DOI:10.1210/clinem/dgac331
Kehlenbrink S, Ansbro É, Besançon S, Hassan S, Roberts B, et al.
J Clin Endocrinol Metab
. 27 May 2022; Volume 107 (Issue 9); e3553-e3561.; DOI:10.1210/clinem/dgac331
Amid the growing global diabetes epidemic, the scale of forced displacement resulting from armed conflict and humanitarian crises is at record-high levels. More than 80% of the displaced population lives in lower- and middle-income countries, which also host 81% of the global population living with diabetes. Most crises are protracted, often lasting decades, and humanitarian aid organizations are providing long-term primary care to both the local and displaced populations. Humanitarian crises are extremely varied in nature and occur in contexts that are diverse and dynamic. The scope of providing diabetes care varies depending on the phase of the crisis. This paper describes key challenges and possible solutions to improving diabetes care in crisis settings. It focuses on (1) ensuring a reliable supply of life preserving medications and diagnostics, (2) restoring and maintaining access to health care, and (3) adapting service design to the context. These challenges are illustrated through case studies in Ukraine, Mali, the Central African Republic, and Jordan.
Journal Article > ResearchFull Text
J Viral Hepat. 12 March 2022; Online ahead of print; DOI: 10.1111/jvh.13672
Morgan JR, Marsh E, Savinkina A, Shilton S, Shadaker S, et al.
J Viral Hepat. 12 March 2022; Online ahead of print; DOI: 10.1111/jvh.13672
Achieving global elimination of hepatitis C virus requires a substantial scale-up of testing. Point-of-care HCV viral load assays are available as an alternative to laboratory-based assays to promote access in hard to reach or marginalized populations. The diagnostic performance and lower limit of detection are important attributes of these new assays for both diagnosis and test of cure. Therefore, our objective was to determine an acceptable LLoD for detectable HCV viraemia as a test for cure, 12-weeks post-treatment (SVR12). We assembled a global dataset of patients with detectable viraemia at SVR12 from observational databases from 9 countries (Egypt, the United States, United Kingdom, Georgia, Ukraine, Myanmar, Cambodia, Pakistan, Mozambique), and two pharmaceutical-sponsored clinical trial registries. We examined the distribution of HCV viral load at SVR12 and presented the 90th , 95th, 97th, and 99th percentiles. We used logistic regression to assess characteristics associated with low-level virological treatment failure (defined as <1000 IU/mL). There were 5,973 cases of detectable viremia at SVR12 from the combined dataset. Median detectable HCV RNA at SVR12 was 287,986 IU/mL. The level of detection for the 95th percentile was 227 IU/mL (95% CI 170-276). Females and those with minimal fibrosis were more likely to experience low-level viremia at SVR12 compared to men (adjusted odds ratio AOR = 1.60 95% confidence interval [CI] 1.30-1.97 and those with cirrhosis (AOR=1.49 95% CI 1.15-1.93). In conclusion, an assay with a level of detection of 1000 IU/mL or greater may miss a proportion of those with low-level treatment failure
Journal Article > ResearchFull Text
BMC Health Serv Res. 21 September 2020; Volume 20 (Issue 1); DOI:10.1186/s12913-020-05735-z
Gils T, Laxmeshwar C, Duka M, Malakyan K, Siomak OV, et al.
BMC Health Serv Res. 21 September 2020; Volume 20 (Issue 1); DOI:10.1186/s12913-020-05735-z
BACKGROUND
Ukraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder, are common co-morbidities. One in five DR-TB patients has human immunodeficiency virus (HIV). As part of health reform, the country is moving from inpatient care to ambulatory primary care for tuberculosis (TB). In Zhytomyr oblast, Médecins Sans Frontières (MSF) is supporting care for DR-TB patients on all-oral short DR-TB regimens. This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine, to provide good quality ambulatory care.
METHODS
This is a retrospective analysis of routinely collected programme data. Before discharge of every patient from the hospital, MSF teams assess services available at outpatient facilities using a standardised questionnaire. The assessment evaluates access, human resources, availability of medicines, infection control measures, laboratory and diagnostic services, and psychosocial support.
RESULTS
We visited 68 outpatient facilities in 22 districts between June 2018 and September 2019. Twenty-seven health posts, 24 TB-units, 13 ambulatories, two family doctors and one polyclinic, serving 30% of DR-TB patients in the oblast by September 2019, were included. All facilities provided directly observed treatment, but only seven (10%) provided weekend-services. All facilities had at least one medical staff member, but TB-training was insufficient and mostly limited to TB-doctors. TB-treatment and adequate storage space were available in all facilities, but only five (8%) had ancillary medicines. HIV-positive patients had to visit a separate facility to access HIV-care. Personal protective equipment was unavailable in 32 (55%) facilities. Basic laboratory services were available in TB-units, but only four (17%) performed audiometry. Only ten (42%) TB-units had psychosocial support available, and nine (38%) offered psychiatric support.
CONCLUSION
Outpatient facilities in Zhytomyr oblast are not yet prepared to provide comprehensive care for DR-TB patients. Capacity of all facilities needs strengthening with trainings, infection control measures and infrastructure. Integration of psychosocial services, treatment of co-morbidities and adverse events at the same facility are essential for successful decentralisation. The health reform is an opportunity to establish quality, patient-centred care.
Ukraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder, are common co-morbidities. One in five DR-TB patients has human immunodeficiency virus (HIV). As part of health reform, the country is moving from inpatient care to ambulatory primary care for tuberculosis (TB). In Zhytomyr oblast, Médecins Sans Frontières (MSF) is supporting care for DR-TB patients on all-oral short DR-TB regimens. This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine, to provide good quality ambulatory care.
METHODS
This is a retrospective analysis of routinely collected programme data. Before discharge of every patient from the hospital, MSF teams assess services available at outpatient facilities using a standardised questionnaire. The assessment evaluates access, human resources, availability of medicines, infection control measures, laboratory and diagnostic services, and psychosocial support.
RESULTS
We visited 68 outpatient facilities in 22 districts between June 2018 and September 2019. Twenty-seven health posts, 24 TB-units, 13 ambulatories, two family doctors and one polyclinic, serving 30% of DR-TB patients in the oblast by September 2019, were included. All facilities provided directly observed treatment, but only seven (10%) provided weekend-services. All facilities had at least one medical staff member, but TB-training was insufficient and mostly limited to TB-doctors. TB-treatment and adequate storage space were available in all facilities, but only five (8%) had ancillary medicines. HIV-positive patients had to visit a separate facility to access HIV-care. Personal protective equipment was unavailable in 32 (55%) facilities. Basic laboratory services were available in TB-units, but only four (17%) performed audiometry. Only ten (42%) TB-units had psychosocial support available, and nine (38%) offered psychiatric support.
CONCLUSION
Outpatient facilities in Zhytomyr oblast are not yet prepared to provide comprehensive care for DR-TB patients. Capacity of all facilities needs strengthening with trainings, infection control measures and infrastructure. Integration of psychosocial services, treatment of co-morbidities and adverse events at the same facility are essential for successful decentralisation. The health reform is an opportunity to establish quality, patient-centred care.
Journal Article > ResearchFull Text
Public Health Action. 21 September 2019
England K, Masini T, Fajardo E
Public Health Action. 21 September 2019
The World Health Organization (WHO) currently recommends Xpert® MTB/RIF as the initial test for all people with presumptive tuberculosis (TB). A number of challenges have been reported, however, in using this technology, particularly in low-resource settings. Here we examine these challenges, and provide our perspective of the barriers to Xpert scale-up as assessed through a survey in 16 TB burden countries in which the Médecins Sans Frontières is present. We observed that the key barriers to scale-up include a lack of policy adoption and implementation of WHO recommendations for the use of Xpert, resulting from high costs, poor sensitisation of clinical staff and a high turnover of trained laboratory
staff; insufficient service and maintenance provision provided by the manufacturer; and inadequate resources for sustainability and expansion. Funding is a critical issue as countries begin to transition out of support from the Global Fund. While it is clear that there is still an urgent need for research into and development of a rapid, affordable point-of-care test for TB that is truly adapted for use in low-resource settings, countries in the meantime need to develop functional and sustainable Xpert networks in order to close the existing diagnostic gap.
staff; insufficient service and maintenance provision provided by the manufacturer; and inadequate resources for sustainability and expansion. Funding is a critical issue as countries begin to transition out of support from the Global Fund. While it is clear that there is still an urgent need for research into and development of a rapid, affordable point-of-care test for TB that is truly adapted for use in low-resource settings, countries in the meantime need to develop functional and sustainable Xpert networks in order to close the existing diagnostic gap.
Journal Blog > Perspective
Conflict in eastern Ukraine is a reminder that older people are especially vulnerable in emergencies
BMJ Opinion (blog). 4 June 2019
Simonyan G
BMJ Opinion (blog). 4 June 2019
Journal Article > ResearchFull Text
J Infect Dev Ctries. 29 September 2021; Volume 15 (Issue 9.1); 25S-33S.; DOI: 10.3855/jidc.13827
Plokhykh V, Duka M, Cassidy L, Chen CY, Malakyan K, et al.
J Infect Dev Ctries. 29 September 2021; Volume 15 (Issue 9.1); 25S-33S.; DOI: 10.3855/jidc.13827
INTRODUCTION
Despite concerted efforts, Ukraine is challenged by increasing rates of multidrug and rifampicin-resistant tuberculosis (MDR/RR-TB) comorbid with alcohol use disorder (AUD). This study describes a cohort of RR-TB patients with high alcohol consumption treated in MSF Zhytomyr Project, Ukraine.
METHODOLOGY
We used programmatic data for 73 RR-TB patients screened with the AUD Identification Test March-July 2019 and followed-up for culture conversion/TB treatment outcome till 31 January 2020. We described socio-demographic, behavioral, and clinical characteristics, the level of depressive symptoms, and TB treatment outcomes in three groups: 1) patients with AUD who received mental health interventions (MHI); 2) patients with AUD who did not receive MHI; 3) patients with no AUD. We also found three potential contributors to declining to receive MHI.
RESULTS
Main characteristics of the study groups did not differ substantially. Those receiving MHI (mean: nine sessions) were rated for alcohol consumption as 'hazardous' (41%), 'harmful' (43%) and 'dependence' (36%) and had higher depression scores versus the second (p=0.009) and third (p=0.095) groups at baseline. Depressive symptoms declined at 9-month follow-up for all patients. Culture conversion was seen at 77%, 73%, and 83% for each group respectively. We also found three reasons for declining from MHI.
CONCLUSIONS
We detected little differences across the groups. However, our study cohort demonstrated substantially higher adherence rates, culture conversion and reduction of depressive symptoms than reported globally. We recommend further research on the effectiveness of MHI in changing the drinking habits, quality of life and/or TB treatment outcomes of patients with AUD.
Despite concerted efforts, Ukraine is challenged by increasing rates of multidrug and rifampicin-resistant tuberculosis (MDR/RR-TB) comorbid with alcohol use disorder (AUD). This study describes a cohort of RR-TB patients with high alcohol consumption treated in MSF Zhytomyr Project, Ukraine.
METHODOLOGY
We used programmatic data for 73 RR-TB patients screened with the AUD Identification Test March-July 2019 and followed-up for culture conversion/TB treatment outcome till 31 January 2020. We described socio-demographic, behavioral, and clinical characteristics, the level of depressive symptoms, and TB treatment outcomes in three groups: 1) patients with AUD who received mental health interventions (MHI); 2) patients with AUD who did not receive MHI; 3) patients with no AUD. We also found three potential contributors to declining to receive MHI.
RESULTS
Main characteristics of the study groups did not differ substantially. Those receiving MHI (mean: nine sessions) were rated for alcohol consumption as 'hazardous' (41%), 'harmful' (43%) and 'dependence' (36%) and had higher depression scores versus the second (p=0.009) and third (p=0.095) groups at baseline. Depressive symptoms declined at 9-month follow-up for all patients. Culture conversion was seen at 77%, 73%, and 83% for each group respectively. We also found three reasons for declining from MHI.
CONCLUSIONS
We detected little differences across the groups. However, our study cohort demonstrated substantially higher adherence rates, culture conversion and reduction of depressive symptoms than reported globally. We recommend further research on the effectiveness of MHI in changing the drinking habits, quality of life and/or TB treatment outcomes of patients with AUD.