Conference Material > Poster
Ashakin KA, Hadiuzzaman M, Firuz W, Rahman A, Ben-Farhat J, et al.
Epicentre Scientific Day 2024. 2024 May 23
Journal Article > ResearchFull Text
PLOS One. 2021 March 10; Volume 16 (Issue 3); DOI:10.1371/journal.pone.0248408
Das M, Mathur T, Ravi S, Meneguim A, Iyer AS, et al.
PLOS One. 2021 March 10; 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. 2021 May 19
Journal Article > ResearchFull Text
Clin Infect Dis. 2021 November 2; 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. 2021 November 2; 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.
Journal Article > ResearchFull Text
Public Health Action. 2023 June 21; 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. 2023 June 21; 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.
Conference Material > Video
Hossain FN
MSF Scientific Days Asia 2021. 2021 August 26
Conference Material > Abstract
Das M, Mathur T, Ravi S, Meneguim A, Iyer AS, et al.
MSF Scientific Days International 2021: Research. 2021 May 19
INTRODUCTION
Drug-resistant TB (DR-TB) still affects around 25,000 children every year worldwide. Although treatment success rates for DR-TB in children are higher than in adults, children and adolescents face unique hurdles during DR-TB treatment. We aimed to understand the perspectives of patients, guardians, and healthcare providers in relation to the DR-TB treatment journey for children, adolescents, and their caregivers.
METHODS
We did a qualitative study involving in-depth interviews of purposively selected adolescents (n=6; who had received more than one year of DR-TB treatment or were cured at the time of interview), patients’ guardians (for children and adolescents, n=5) and healthcare providers (n=8) for patients attending a MSF clinic in Mumbai, India. The adolescents and guardians were identified by the patient support (counsellor) team. In-depth face-to-face interviews were conducted in English or Hindi, using interview guides during September-November 2019, and audio was recorded following informed consent. Assent was obtained from adolescents (aged under 18 years), in addition to their guardians’ consent. Thematic network analysis was used to summarize textual data. ATLAS.ti, version 7, was used for analysis.
ETHICS
This study was approved by the MSF Ethics Review Board and by the Institutional Review Board, Tata Institute of Social Sciences, Mumbai, India.
RESULTS
Adolescents interviewed were aged 15-19 years, and four of them were female. Five guardians (of three child and two adolescent patients) and eight healthcare providers were interviewed, including two clinicians, two directly observed treatment providers, two counsellors, and two programme managers. Our analysis fell under the overarching theme of “challenging DR-TB treatment journey”, with four sub-themes identified. The four sub-themes covered physical trauma; emotional trauma; unavailability of social support; and poorly adapted healthcare services. Family and peer support was identified as the cornerstone for successful treatment completion. Adherence issues and treatment interruptions were more commonly reported in adolescents than children. It was also noted that treatment decisions (e.g., relating to regimen or provider) for children and adolescents relied heavily on the input of patients’ families and/or caregivers. Though the challenging experiences of patients and caregivers during DR-TB treatment varied within and between age categories, most patients and caregivers reported the experience of treatment fatigue and burnout. Participants offered recommendations for developing child/adolescent-friendly care during DR-TB treatment. These included providing injectable free regimens, palatable medications, meaningful interaction and information sharing with healthcare providers, peer-support platforms, patient-friendly counselling/adherence tools, and improved TB awareness in families, schools and communities.
CONCLUSION
TB programmes for adolescents and children must consider the patient and family as one unit when designing packages of care. Development of child- and adolescent-friendly services, such as pediatric formulations, age-specific counselling tools, and regular interaction with patients and caregivers, will help minimize burnout in patients and caregivers.
Drug-resistant TB (DR-TB) still affects around 25,000 children every year worldwide. Although treatment success rates for DR-TB in children are higher than in adults, children and adolescents face unique hurdles during DR-TB treatment. We aimed to understand the perspectives of patients, guardians, and healthcare providers in relation to the DR-TB treatment journey for children, adolescents, and their caregivers.
METHODS
We did a qualitative study involving in-depth interviews of purposively selected adolescents (n=6; who had received more than one year of DR-TB treatment or were cured at the time of interview), patients’ guardians (for children and adolescents, n=5) and healthcare providers (n=8) for patients attending a MSF clinic in Mumbai, India. The adolescents and guardians were identified by the patient support (counsellor) team. In-depth face-to-face interviews were conducted in English or Hindi, using interview guides during September-November 2019, and audio was recorded following informed consent. Assent was obtained from adolescents (aged under 18 years), in addition to their guardians’ consent. Thematic network analysis was used to summarize textual data. ATLAS.ti, version 7, was used for analysis.
ETHICS
This study was approved by the MSF Ethics Review Board and by the Institutional Review Board, Tata Institute of Social Sciences, Mumbai, India.
RESULTS
Adolescents interviewed were aged 15-19 years, and four of them were female. Five guardians (of three child and two adolescent patients) and eight healthcare providers were interviewed, including two clinicians, two directly observed treatment providers, two counsellors, and two programme managers. Our analysis fell under the overarching theme of “challenging DR-TB treatment journey”, with four sub-themes identified. The four sub-themes covered physical trauma; emotional trauma; unavailability of social support; and poorly adapted healthcare services. Family and peer support was identified as the cornerstone for successful treatment completion. Adherence issues and treatment interruptions were more commonly reported in adolescents than children. It was also noted that treatment decisions (e.g., relating to regimen or provider) for children and adolescents relied heavily on the input of patients’ families and/or caregivers. Though the challenging experiences of patients and caregivers during DR-TB treatment varied within and between age categories, most patients and caregivers reported the experience of treatment fatigue and burnout. Participants offered recommendations for developing child/adolescent-friendly care during DR-TB treatment. These included providing injectable free regimens, palatable medications, meaningful interaction and information sharing with healthcare providers, peer-support platforms, patient-friendly counselling/adherence tools, and improved TB awareness in families, schools and communities.
CONCLUSION
TB programmes for adolescents and children must consider the patient and family as one unit when designing packages of care. Development of child- and adolescent-friendly services, such as pediatric formulations, age-specific counselling tools, and regular interaction with patients and caregivers, will help minimize burnout in patients and caregivers.
Journal Article > ResearchFull Text
Clin Infect Dis. 2020 October 20; DOI:10.1093/cid/ciaa1577
Das M, Dalal A, Laxmeshwar C, Ravi S, Mamnoon F, et al.
Clin Infect Dis. 2020 October 20; DOI:10.1093/cid/ciaa1577
Background
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 programme data. In clinic, treatment regimens are designed based on culture-drug sensitivity test patterns, previous drug-exposures and are provided for 20-22 months. The 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 February2016-February2018 were included.
Result
Of the 70 patients included, the median (IQR) age was 25(22-32) years and 56% were females. All except one were fluoroquinolone resistant. The median(IQR) duration of exposure to BDQ and DLM was 77(43-96) weeks. Thirty-nine episodes of serious-adverse-events(SAEs) were reported among 30(43%) patients, including five instances of QTc prolongation-assessed as possibly related to BDQ and/or DLM. 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.
Conclusion
The successful treatment outcomes of this cohort show that regimens including concomitant bedaquiline and delamanid for longer than 24 weeks are effective and can be safely administered on ambulatory basis. National TB programmes globally should scale up access to life saving DR-TB regimens with new drugs.
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 programme data. In clinic, treatment regimens are designed based on culture-drug sensitivity test patterns, previous drug-exposures and are provided for 20-22 months. The 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 February2016-February2018 were included.
Result
Of the 70 patients included, the median (IQR) age was 25(22-32) years and 56% were females. All except one were fluoroquinolone resistant. The median(IQR) duration of exposure to BDQ and DLM was 77(43-96) weeks. Thirty-nine episodes of serious-adverse-events(SAEs) were reported among 30(43%) patients, including five instances of QTc prolongation-assessed as possibly related to BDQ and/or DLM. 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.
Conclusion
The successful treatment outcomes of this cohort show that regimens including concomitant bedaquiline and delamanid for longer than 24 weeks are effective and can be safely administered on ambulatory basis. National TB programmes globally should scale up access to life saving DR-TB regimens with new drugs.
Journal Article > ResearchFull Text
J Glob Antimicrob Resist. 2022 June 1; 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. 2022 June 1; 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.
Conference Material > Poster
Firuz W, Ashakin KA, Schramm B, Camelique O, Duka M, et al.
MSF Scientific Day International 2024. 2024 May 16; DOI:10.57740/b7c62AO2c