Conference Material > Poster
Ashakin KA, Hadiuzzaman M, Firuz W, Rahman A, Ben-Farhat J, et al.
Epicentre Scientific Day 2024. 23 May 2024
Conference Material > Abstract
Schramm B, Hossain FN
Epicentre Scientific Day 2024. 23 May 2024
BACKGROUND
Hepatitis C virus (HCV) is a major cause of liver diseases globally. Transmission is primarily bloodborne through unsafe injections or healthcare practices. Effective treatment exists, yet access to diagnosis and treatment is limited. Few data indicated high HCV exposure among Rohingya refugees/FDMN residing in crowded camps in Cox’s Bazar District, Bangladesh, where Médecins Sans Frontières is pioneering HCV services. Representative information on the prevalence of active HCV infection and exposure risk factors was lacking.
METHODS
A cross-sectional survey was carried out in May-June 2023, including adults (≥18 years) by simple random geo-sampling (one participant per household, target sample 680), in seven camps (8W, 12, 13, 16, 17, 18, 19) in Cox’s Bazar District. Participants were screened with an HCV-antibody test (SD Bioline), and active infection assessed with Xpert® HCV Viral Load test (Cepheid) if seropositive. A structured questionnaire was administered to identify risk factors of exposure.
RESULTS
Of the 641 participants, median age was 34 years [IQR 28, 46], 66.3% were female. The estimated prevalence of HCV-seropositivity was 29.7% (95%CI: 26.0-22.8), and the prevalence of active infection was 19.6% (16.4-23.2). Multivariable regression revealed higher odds of HCV-seropositivity for female (adjusted odds ratio (aOR)=1.7 (1.0-2.6)), age groups ≥25 years old (aORs ranging from 2.3 to 2.9), reported medical injection(s) (aOR=1.7 (95% CI: 1.0-2.6)) or surgery (aOR=4.7 (95%CI: 1.3-16.7). Half of participants never heard about Hepatitis C, 4.0% of viremic participants reported previous HCV treatment.
CONCLUSION
The survey revealed a significant burden of active HCV infection among adult Rohingya camp residents, which, extrapolated may affect an estimated 86,000 individuals. Urgent action is required to expand diagnosis and treatment to prevent advanced liver disease and transmission. A collaborative task force with camp-based health stakeholders is now underway for a mass screening and treatment initiative, as well as a camp-wide HCV awareness campaign.
Conference Material > Poster
Firuz W, Ashakin KA, Schramm B, Camelique O, Duka M, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/b7c62AO2c
Journal Article > ResearchFull Text
Public Health Action. 21 June 2023; Volume 13 (Issue 2); 60-64.; DOI:10.5588/pha.22.0062
Kurbaniyazova G, Msibi F, Bogati H, Kal M, Sofa A, et al.
Public Health Action. 21 June 2023; Volume 13 (Issue 2); 60-64.; DOI:10.5588/pha.22.0062
English
Français
SETTING
Papua New Guinea (PNG) has one of the world’s highest TB incidence rates. It is difficult for patients to access TB care in remote provinces due to insufficient infrastructure and challenging terrain, making varied, targeted delivery models for treating TB necessary.
OBJECTIVE
To assess treatment outcomes using self-administered treatment (SAT), family-supported treatment and community-based directly observed therapy (DOT) via treatment supporter (TS) in the PNG context.
DESIGN
A retrospective, descriptive analysis of routinely collected data from 360 patients at two sites in 2019–2020. All patients were assigned a treatment model based on risk factors (adherence or default) and offered patient education and counselling (PEC), family counselling and transportation fees. End-of-treatment outcomes were assessed for each model.
RESULTS
Treatment success rates among drug-susceptible TB (DS-TB) were good overall: 91.1% for SAT, 81.4% for family-supported treatment and 77% for DOT patients. SAT was strongly associated with favourable outcomes (OR 5.7, 95% CI 1.7–19.3), as were PEC sessions (OR 4.3, 95% CI 2.5–7.2).
CONCLUSION
By considering risk factors when determining their treatment delivery model, strong outcomes were seen in all three groups. Multiple modes of treatment administration, tailored to individuals’ needs and risk factors, is a feasible, effective, patient-centred care model for hard-to-reach, resource-limited settings.
Papua New Guinea (PNG) has one of the world’s highest TB incidence rates. It is difficult for patients to access TB care in remote provinces due to insufficient infrastructure and challenging terrain, making varied, targeted delivery models for treating TB necessary.
OBJECTIVE
To assess treatment outcomes using self-administered treatment (SAT), family-supported treatment and community-based directly observed therapy (DOT) via treatment supporter (TS) in the PNG context.
DESIGN
A retrospective, descriptive analysis of routinely collected data from 360 patients at two sites in 2019–2020. All patients were assigned a treatment model based on risk factors (adherence or default) and offered patient education and counselling (PEC), family counselling and transportation fees. End-of-treatment outcomes were assessed for each model.
RESULTS
Treatment success rates among drug-susceptible TB (DS-TB) were good overall: 91.1% for SAT, 81.4% for family-supported treatment and 77% for DOT patients. SAT was strongly associated with favourable outcomes (OR 5.7, 95% CI 1.7–19.3), as were PEC sessions (OR 4.3, 95% CI 2.5–7.2).
CONCLUSION
By considering risk factors when determining their treatment delivery model, strong outcomes were seen in all three groups. Multiple modes of treatment administration, tailored to individuals’ needs and risk factors, is a feasible, effective, patient-centred care model for hard-to-reach, resource-limited settings.
Journal Article > ResearchFull Text
Bull World Health Organ. 1 April 2023; Volume 101 (Issue 04); 262-270.; DOI:10.2471/BLT.22.288956
O’Keefe D, Samley K, Bunreth V, Marquardt T, Bobi SE, et al.
Bull World Health Organ. 1 April 2023; Volume 101 (Issue 04); 262-270.; DOI:10.2471/BLT.22.288956
English
Français
Español
عَرَبِيّ
中文
Русский
OBJECTIVE
To determine whether a nurse-led model of care for patients with hepatitis C virus (HCV) infections can provide safe and effective diagnosis and treatment in a resource-poor setting in rural Cambodia.
METHODS
The nurse-led initiation pilot project was implemented by Médecins Sans Frontières in collaboration with the Cambodian health ministry in two operational districts in Battambang Province between 1 June and 30 September 2020. Nursing staff at 27 rural health centres were trained to identify signs of decompensated liver cirrhosis and to provide HCV treatment. Patients without decompensated cirrhosis or another comorbidity were initiated at health centres onto combined treatment with sofosbuvir, 400 mg/day, and daclatasvir, 60 mg/day, orally for 12 weeks. Treatment adherence and effectiveness were assessed during follow-up.
FINDINGS
Of 10 960 individuals screened, 547 had HCV viraemia (i.e. viral load = 1000 IU/mL). Of the 547, 329 were eligible for treatment initiation at health centres through the pilot project. All 329 (100%) completed treatment and 310 (94%; 95% confidence interval: 91-96) achieved a sustained virological response 12 weeks post-treatment. Depending on patient subgroups, this response varied from 89% to 100%. Only two adverse events were recorded; both were determined as unrelated to treatment.
CONCLUSION
The safety and effectiveness of direct-acting antiviral medication has previously been demonstrated. Models of HCV care now need to enable greater access for patients. The nurse-led initiation pilot project provides a model for use in other resource-poor settings to scale up national programmes.
To determine whether a nurse-led model of care for patients with hepatitis C virus (HCV) infections can provide safe and effective diagnosis and treatment in a resource-poor setting in rural Cambodia.
METHODS
The nurse-led initiation pilot project was implemented by Médecins Sans Frontières in collaboration with the Cambodian health ministry in two operational districts in Battambang Province between 1 June and 30 September 2020. Nursing staff at 27 rural health centres were trained to identify signs of decompensated liver cirrhosis and to provide HCV treatment. Patients without decompensated cirrhosis or another comorbidity were initiated at health centres onto combined treatment with sofosbuvir, 400 mg/day, and daclatasvir, 60 mg/day, orally for 12 weeks. Treatment adherence and effectiveness were assessed during follow-up.
FINDINGS
Of 10 960 individuals screened, 547 had HCV viraemia (i.e. viral load = 1000 IU/mL). Of the 547, 329 were eligible for treatment initiation at health centres through the pilot project. All 329 (100%) completed treatment and 310 (94%; 95% confidence interval: 91-96) achieved a sustained virological response 12 weeks post-treatment. Depending on patient subgroups, this response varied from 89% to 100%. Only two adverse events were recorded; both were determined as unrelated to treatment.
CONCLUSION
The safety and effectiveness of direct-acting antiviral medication has previously been demonstrated. Models of HCV care now need to enable greater access for patients. The nurse-led initiation pilot project provides a model for use in other resource-poor settings to scale up national programmes.
Journal Article > ResearchFull Text
J Glob Antimicrob Resist. 1 June 2022; Volume S2213-7165 (Issue 22); 00157-6.; DOI:10.1016/j.jgar.2022.06.022
M'Aiber S, Maamari K, Williams A, Albakry Z, Taher AQM, et al.
J Glob Antimicrob Resist. 1 June 2022; Volume S2213-7165 (Issue 22); 00157-6.; DOI:10.1016/j.jgar.2022.06.022
BACKGROUND
Iraq has suffered unrest and conflicts in the past decades leaving behind a weakened healthcare system. In 2018, Médecins Sans Frontières (MSF) opened a tertiary orthopaedic care centre in Mosul providing reconstructive surgery with access to microbiological analysis.
METHODS
A retrospective cross-sectional analysis of microbiological and clinical data of patients admitted between April 2018 - December 2019.
RESULTS
There were 174 patients who were included in this study; there were more males than females (135 to 38 respectively), and the mean age was 32.6 years. Of the 174 patients, the majority had more than one bacterial isolate detected (n= 122, 70.1%); 141 (81.0%) had at least one multi-drug resistant (MDR) isolate detected during their hospital stay. Staphylococcus aureus (n=197, 48.2%) was the most common organism isolated. Overall, most isolates detected were MDR (n=352, 86%), mostly MRSA (n=186, 52.8%) or ESBL-producing Enterobacterales (n=117, 33.2%). Among patients admitted to the Operating Department (n=111, 63.7%), 81.1% (n=90) were admitted for violent trauma injuries. Patients who had more than one procedure performed per surgery had significantly increased odds of having at least one MDR organism isolated (OR 8.66, CI 1.10-68.20, p=0.03).
CONCLUSION
This study describes a high prevalence of antibiotic resistance in patients with trauma-related wounds in Mosul, Iraq. It highlights the importance of microbiological analysis and ongoing surveillance to provide optimal treatment. Additionally, it underscores the importance of infection prevention and control measures and antibiotic stewardship.
Iraq has suffered unrest and conflicts in the past decades leaving behind a weakened healthcare system. In 2018, Médecins Sans Frontières (MSF) opened a tertiary orthopaedic care centre in Mosul providing reconstructive surgery with access to microbiological analysis.
METHODS
A retrospective cross-sectional analysis of microbiological and clinical data of patients admitted between April 2018 - December 2019.
RESULTS
There were 174 patients who were included in this study; there were more males than females (135 to 38 respectively), and the mean age was 32.6 years. Of the 174 patients, the majority had more than one bacterial isolate detected (n= 122, 70.1%); 141 (81.0%) had at least one multi-drug resistant (MDR) isolate detected during their hospital stay. Staphylococcus aureus (n=197, 48.2%) was the most common organism isolated. Overall, most isolates detected were MDR (n=352, 86%), mostly MRSA (n=186, 52.8%) or ESBL-producing Enterobacterales (n=117, 33.2%). Among patients admitted to the Operating Department (n=111, 63.7%), 81.1% (n=90) were admitted for violent trauma injuries. Patients who had more than one procedure performed per surgery had significantly increased odds of having at least one MDR organism isolated (OR 8.66, CI 1.10-68.20, p=0.03).
CONCLUSION
This study describes a high prevalence of antibiotic resistance in patients with trauma-related wounds in Mosul, Iraq. It highlights the importance of microbiological analysis and ongoing surveillance to provide optimal treatment. Additionally, it underscores the importance of infection prevention and control measures and antibiotic stewardship.
Journal Article > ResearchFull Text
PLOS One. 10 March 2021; Volume 16 (Issue 3); DOI:10.1371/journal.pone.0248408
Das M, Mathur T, Ravi S, Meneguim A, Iyer AS, et al.
PLOS One. 10 March 2021; Volume 16 (Issue 3); DOI:10.1371/journal.pone.0248408
Background: Childhood multidrug-resistant TB (MDR-TB) still affects around 25000 children every year across the globe. Though the treatment success rates for drug-resistant TB (DR-TB) in children are better than adults, children and adolescents face unique hurdles during DR-TB (MDR-TB, Pre-XDR TB and XDR-TB) treatment. This study aimed to understand the patients, guardians and healthcare providers' perspectives about DR-TB treatment journey of patients and caregivers.
Methods: This is a qualitative study involving in depth-interviews of purposively selected adolescents (n = 6), patients guardians (for children and adolescents, n = 5) and health care providers (n = 8) of Médecins Sans Frontières (MSF) clinic, Mumbai, India. In-depth face to face interviews were conducted in English or Hindi language using interview guides during September-November 2019. The interviews were audio-recorded after consent. Thematic network analysis was used to summarize textual data. ATLAS.ti (version 7) was used for analysis.
Result: The age of adolescent patients ranged from 15-19 years and four were female. Five guardians (of three child and two adolescent patients) and eight healthcare providers (including clinicians- 2, DOT providers-2, counselors-2 and programme managers-2) were interviewed. The overarching theme of the analysis was: Challenging DR-TB treatment journey which consisted of four sub-themes: 1) physical-trauma, 2) emotional-trauma, 3) unavailable social-support and 4) non-adapted healthcare services. Difficulties in compounding of drugs were noted for children while adolescents shared experiences around disruption in social life due to disease and treatment. Most of the patients and caregivers experienced treatment fatigue and burnout during the DR-TB treatment. Participants during interviews gave recommendations to improve care.
Discussion: The TB programmes must consider the patient and family as one unit when designing the package of care for paediatric DR-TB. Child and adolescent friendly services (paediatric-formulations, age-specific counselling tools and regular interaction with patients and caregivers) will help minimizing burnout in patients and caregivers.
Methods: This is a qualitative study involving in depth-interviews of purposively selected adolescents (n = 6), patients guardians (for children and adolescents, n = 5) and health care providers (n = 8) of Médecins Sans Frontières (MSF) clinic, Mumbai, India. In-depth face to face interviews were conducted in English or Hindi language using interview guides during September-November 2019. The interviews were audio-recorded after consent. Thematic network analysis was used to summarize textual data. ATLAS.ti (version 7) was used for analysis.
Result: The age of adolescent patients ranged from 15-19 years and four were female. Five guardians (of three child and two adolescent patients) and eight healthcare providers (including clinicians- 2, DOT providers-2, counselors-2 and programme managers-2) were interviewed. The overarching theme of the analysis was: Challenging DR-TB treatment journey which consisted of four sub-themes: 1) physical-trauma, 2) emotional-trauma, 3) unavailable social-support and 4) non-adapted healthcare services. Difficulties in compounding of drugs were noted for children while adolescents shared experiences around disruption in social life due to disease and treatment. Most of the patients and caregivers experienced treatment fatigue and burnout during the DR-TB treatment. Participants during interviews gave recommendations to improve care.
Discussion: The TB programmes must consider the patient and family as one unit when designing the package of care for paediatric DR-TB. Child and adolescent friendly services (paediatric-formulations, age-specific counselling tools and regular interaction with patients and caregivers) will help minimizing burnout in patients and caregivers.
Conference Material > Slide Presentation
Das M, Mathur T, Ravi S, Meneguim A, Iyer AS, et al.
MSF Scientific Days International 2021: Research. 19 May 2021
Conference Material > Video
Hossain FN
MSF Scientific Days Asia 2021. 26 August 2021
Journal Article > ResearchFull Text
Clin Infect Dis. 2 November 2021; Volume 73 (Issue 9); e3496-e3504.; DOI:10.1093/cid/ciaa1577
Das M, Dalal A, Laxmeshwar C, Ravi S, Mamnoon F, et al.
Clin Infect Dis. 2 November 2021; Volume 73 (Issue 9); e3496-e3504.; DOI:10.1093/cid/ciaa1577
BACKGROUND
The Médecins Sans Frontières clinic in Mumbai, India, has been providing concomitant bedaquiline (BDQ) and delamanid (DLM) in treatment regimen for patients with drug-resistant tuberculosis (DR-TB) and limited therapeutic options, referred from other healthcare institutions, since 2016. The study documents the end-of-treatment outcomes, culture-conversion rates, and serious adverse events (SAEs) during treatment.
METHODS
This was a retrospective cohort study based on routinely collected program data. In clinic, treatment regimens are designed based on culture drug sensitivity test patterns and previous drug exposures, and are provided for 20-22 months. BDQ and DLM are extended beyond 24 weeks as off-label use. Patients who initiated DR-TB treatment including BDQ and DLM (concomitantly for at least 4 weeks) during February 2016-February 2018 were included.
RESULTS
Of the 70 patients included, the median age was 25 (interquartile range [IQR], 22-32) years and 56% were females. All except 1 were fluoroquinolone resistant. The median duration of exposure to BDQ and DLM was 77 (IQR, 43-96) weeks. Thirty-nine episodes of SAEs were reported among 30 (43%) patients, including 5 instances of QTc prolongation, assessed as possibly related to BDQ and/or DLM. The majority (69%) had culture conversion before 24 weeks of treatment. In 61 (87%), use of BDQ and DLM was extended beyond 24 weeks. Successful end-of-treatment outcomes were reported in 49 (70%) patients.
CONCLUSIONS
The successful treatment outcomes of this cohort show that regimens including concomitant BDQ and DLM for longer than 24 weeks are effective and can be safely administered on an ambulatory basis. National TB programs globally should scale up access to life-saving DR-TB regimens with new drugs.
The Médecins Sans Frontières clinic in Mumbai, India, has been providing concomitant bedaquiline (BDQ) and delamanid (DLM) in treatment regimen for patients with drug-resistant tuberculosis (DR-TB) and limited therapeutic options, referred from other healthcare institutions, since 2016. The study documents the end-of-treatment outcomes, culture-conversion rates, and serious adverse events (SAEs) during treatment.
METHODS
This was a retrospective cohort study based on routinely collected program data. In clinic, treatment regimens are designed based on culture drug sensitivity test patterns and previous drug exposures, and are provided for 20-22 months. BDQ and DLM are extended beyond 24 weeks as off-label use. Patients who initiated DR-TB treatment including BDQ and DLM (concomitantly for at least 4 weeks) during February 2016-February 2018 were included.
RESULTS
Of the 70 patients included, the median age was 25 (interquartile range [IQR], 22-32) years and 56% were females. All except 1 were fluoroquinolone resistant. The median duration of exposure to BDQ and DLM was 77 (IQR, 43-96) weeks. Thirty-nine episodes of SAEs were reported among 30 (43%) patients, including 5 instances of QTc prolongation, assessed as possibly related to BDQ and/or DLM. The majority (69%) had culture conversion before 24 weeks of treatment. In 61 (87%), use of BDQ and DLM was extended beyond 24 weeks. Successful end-of-treatment outcomes were reported in 49 (70%) patients.
CONCLUSIONS
The successful treatment outcomes of this cohort show that regimens including concomitant BDQ and DLM for longer than 24 weeks are effective and can be safely administered on an ambulatory basis. National TB programs globally should scale up access to life-saving DR-TB regimens with new drugs.