Journal Article > CommentaryFull Text
Southern African Journal of HIV medicine. 2012 March 1
Andrieux-Meyer I, Clayden P, Collins S, Geffen N, Goemaere E, et al.
Southern African Journal of HIV medicine. 2012 March 1
Journal Article > ResearchFull Text
Trans R Soc Trop Med Hyg. 2009 June 1; Volume 103 (Issue 6); DOI:10.1016/j.trstmh.2008.09.019
Zachariah R, Ford NP, Philips M, Lynch S, Massaquoi M, et al.
Trans R Soc Trop Med Hyg. 2009 June 1; Volume 103 (Issue 6); DOI:10.1016/j.trstmh.2008.09.019
Sub-Saharan Africa is facing a crisis in human health resources due to a critical shortage of health workers. The shortage is compounded by a high burden of infectious diseases; emigration of trained professionals; difficult working conditions and low motivation. In particular, the burden of HIV/AIDS has led to the concept of task shifting being increasingly promoted as a way of rapidly expanding human resource capacity. This refers to the delegation of medical and health service responsibilities from higher to lower cadres of health staff, in some cases non-professionals. This paper, drawing on Médecins Sans Frontières' experience of scaling-up antiretroviral treatment in three sub-Saharan African countries (Malawi, South Africa and Lesotho) and supplemented by a review of the literature, highlights the main opportunities and challenges posed by task shifting and proposes specific actions to tackle the challenges. The opportunities include: increasing access to life-saving treatment; improving the workforce skills mix and health-system efficiency; enhancing the role of the community; cost advantages and reducing attrition and international 'brain drain'. The challenges include: maintaining quality and safety; addressing professional and institutional resistance; sustaining motivation and performance and preventing deaths of health workers from HIV/AIDS. Task shifting should not undermine the primary objective of improving patient benefits and public health outcomes.
Journal Article > CommentaryFull Text
J Int AIDS Soc. 2012 September 18; Volume 15; DOI:10.7448/IAS.15.2.17986
Andrieux-Meyer I, Calmy A, Cahn P, Clayden P, Raguin G, et al.
J Int AIDS Soc. 2012 September 18; Volume 15; DOI:10.7448/IAS.15.2.17986
Global commitments aim to provide antiretroviral therapy (ART) to 15 million people living with HIV by 2015, and recent studies have demonstrated the potential for widespread ART to prevent HIV transmission. Increasingly, countries are adapting their national guidelines to start ART earlier, for both clinical and preventive benefits. To maximize the benefits of ART in resource-limited settings, six key principles need to guide ART choice: simplicity, tolerability and safety, durability, universal applicability, affordability and heat stability. Currently available drugs, combined with those in late-stage clinical development, hold great promise to simplify treatment in the short term. Over the longer-term, newer technologies, such as long-acting formulations and nanotechnology, could radically alter the treatment paradigm. This commentary reviews recommendations made in an expert consultation on treatment scale up in resource-limited settings.
Journal Article > LetterFull Text
Int J Tuberc Lung Dis. 2021 October 1; Volume 25 (Issue 10); 864-865.; DOI:10.5588/ijtld.21.0222
Deborggraeve S, Menghaney L, Lynch S, McKenna L, Branigan D
Int J Tuberc Lung Dis. 2021 October 1; Volume 25 (Issue 10); 864-865.; DOI:10.5588/ijtld.21.0222
Journal Article > ResearchSubscription Only
JAMA. 2008 September 3; Volume 300 (Issue 9); 1024.; DOI:10.1001/jama.300.9.1024-a
Lynch S, Lethola P, Ford NP
JAMA. 2008 September 3; Volume 300 (Issue 9); 1024.; DOI:10.1001/jama.300.9.1024-a
Journal Article > Short ReportFull Text
J Int AIDS Soc. 2009 October 8; Volume 12 (Issue 1); DOI:10.1186/1758-2652-12-23
Cohen RM, Lynch S, Bygrave H, Eggers E, Vlahakis N, et al.
J Int AIDS Soc. 2009 October 8; Volume 12 (Issue 1); DOI:10.1186/1758-2652-12-23
ABSTRACT: INTRODUCTION: Lesotho has the third highest HIV prevalence in the world (an adult prevalence of 23.2%). Despite a lack of resources for health, the country has implemented state-of-the-art antiretroviral treatment guidelines, including early initiation of treatment (<350 cells/mm3), tenofovir in first line, and nurse-initiated and managed HIV care, including antiretroviral therapy (ART), at primary health care level. PROGRAMME APPROACH: We describe two-year outcomes of a decentralized HIV/AIDS care programme run by Doctors Without Borders/Médecins Sans Frontières, the Ministry of Health and Social Welfare, and the Christian Health Association of Lesotho in Scott catchment area, a rural health zone covering 14 clinics and one district hospital. Outcome data are described through a retrospective cohort analysis of adults and children initiated on ART between 2006 and 2008. DISCUSSION AND EVALUATION: Overall, 13,243 people have been enrolled in HIV care (5% children), and 5376 initiated on ART (6.5% children), 80% at primary care level. Between 2006 and 2008, annual enrolment more than doubled for adults and children, with no major external increase in human resources. The proportion of adults arriving sick (CD4 <50 cells/mm3) decreased from 22.2% in 2006 to 11.9% in 2008. Twelve-month outcomes are satisfactory in terms of mortality (11% for adults; 9% for children) and loss to follow up (8.8%). At 12 months, 80% of adults and 89% of children were alive and in care, meaning they were still taking their treatment; at 24 months, 77% of adults remained in care. CONCLUSION: Despite major resource constraints, Lesotho is comparing favourably with its better resourced neighbour, using the latest international ART recommendations. The successful two-year outcomes are further evidence that HIV/AIDS care and treatment can be provided effectively at the primary care level. The programme highlights how improving HIV care strengthened the primary health care system, and validates several critical areas for task shifting that are being considered by other countries in the region, including nurse-driven ART for adults and children, and lay counsellor-supported testing and counselling, adherence and case management.
Other > Pre-Print
bioRxiv. 2019 February 1; DOI:10.1101/533851
Saran K, Masini T, Chikwanha I, Paton G, Scourse R, et al.
bioRxiv. 2019 February 1; DOI:10.1101/533851
BACKGROUND
Tuberculosis (TB) poses a global health crisis requiring robust international and country-level action. Adopting and implementing TB policies from the World Health Organization (WHO) is essential to meeting global targets for reducing TB burden. However, many high TB burden countries lag in implementing WHO recommendations. Assessing the progress of implementation at national level can identify key gaps that must be addressed to expand and improve TB care.
METHODS
In 2016/2017, Médecins Sans Frontières and the Stop TB Partnership conducted a survey on adoption and implementation of 47 WHO TB policies in the national TB programs of 29 countries. Here we analyze a subset of 23 key policies in diagnosis, models of care, treatment, prevention, and drug regulation to provide a snapshot of national TB policy adoption and implementation. We examine progress since an analogous 2015 survey of 23 of the same countries.
RESULTS
At the time of the survey, many countries had not yet aligned their national guidelines with all WHO recommendations, although some progress was seen since 2015. For diagnosis, about half of surveyed countries had adopted the WHO-recommended initial rapid test (Xpert MTB/RIF). A majority of countries had adopted decentralized models of care, although one-third of them still required hospitalization for drug-resistant (DR-)TB. Recommended use of the newer drugs bedaquiline (registered in only 6 high-burden TB countries) and delamanid (not registered in any high-burden country) was adopted by 23 and 18 countries, respectively, but short-course (9-month) and newer pediatric regimens by only 13 and 14 countries, respectively. Guidelines in all countries included preventive treatment of latent TB infection for child TB contacts and people living with HIV/AIDS, but only four extended this to adult contacts.
CONCLUSION
To reach global TB targets, greater political will is needed to rapidly adopt and implement internationally recognized care guidelines.
Tuberculosis (TB) poses a global health crisis requiring robust international and country-level action. Adopting and implementing TB policies from the World Health Organization (WHO) is essential to meeting global targets for reducing TB burden. However, many high TB burden countries lag in implementing WHO recommendations. Assessing the progress of implementation at national level can identify key gaps that must be addressed to expand and improve TB care.
METHODS
In 2016/2017, Médecins Sans Frontières and the Stop TB Partnership conducted a survey on adoption and implementation of 47 WHO TB policies in the national TB programs of 29 countries. Here we analyze a subset of 23 key policies in diagnosis, models of care, treatment, prevention, and drug regulation to provide a snapshot of national TB policy adoption and implementation. We examine progress since an analogous 2015 survey of 23 of the same countries.
RESULTS
At the time of the survey, many countries had not yet aligned their national guidelines with all WHO recommendations, although some progress was seen since 2015. For diagnosis, about half of surveyed countries had adopted the WHO-recommended initial rapid test (Xpert MTB/RIF). A majority of countries had adopted decentralized models of care, although one-third of them still required hospitalization for drug-resistant (DR-)TB. Recommended use of the newer drugs bedaquiline (registered in only 6 high-burden TB countries) and delamanid (not registered in any high-burden country) was adopted by 23 and 18 countries, respectively, but short-course (9-month) and newer pediatric regimens by only 13 and 14 countries, respectively. Guidelines in all countries included preventive treatment of latent TB infection for child TB contacts and people living with HIV/AIDS, but only four extended this to adult contacts.
CONCLUSION
To reach global TB targets, greater political will is needed to rapidly adopt and implement internationally recognized care guidelines.
Journal Article > ResearchFull Text
Int J Tuberc Lung Dis. 2018 April 1; Volume 22 (Issue 4); 407-412.; DOI:10.5588/ijtld.17.0706
Cox V, Brigden G, Crespo RH, Lessem E, Lynch S, et al.
Int J Tuberc Lung Dis. 2018 April 1; Volume 22 (Issue 4); 407-412.; DOI:10.5588/ijtld.17.0706
SETTING
The World Health Organization recommended two new drugs, bedaquiline (BDQ) and delamanid (DLM), for the treatment of multidrug-resistant tuberculosis (MDR-TB) in 2013 and 2014, respectively. An estimated one third of patients with MDR-TB would benefit from the inclusion of these drugs in their treatment regimens.
DESIGN
A convenience sample of 36 countries voluntarily reported monthly data on cumulative programmatic use of new drugs to the Drug-Resistant TB Scale-Up Treatment Action Team between 1 July 2015 and 31 June 2017. Programmatic use was defined as treatment for MDR-TB with newer drugs outside of clinical trials or compassionate use.
RESULTS
A total of 10 164 persons were started on BDQ and 688 started on DLM during the reporting period. Only 15.7% of the 69 213 persons estimated to need newer drugs over the study period were reported to have received them.
CONCLUSION
While there has been significant progress in some countries, uptake of the newer drugs has not kept pace with a conservative estimate of need; fewer than 20% of persons likely to benefit from either BDQ or DLM have received them. Concerted efforts are needed to ensure that the newer drugs are made available more widely for persons with MDR-TB in need of these therapeutic options.
The World Health Organization recommended two new drugs, bedaquiline (BDQ) and delamanid (DLM), for the treatment of multidrug-resistant tuberculosis (MDR-TB) in 2013 and 2014, respectively. An estimated one third of patients with MDR-TB would benefit from the inclusion of these drugs in their treatment regimens.
DESIGN
A convenience sample of 36 countries voluntarily reported monthly data on cumulative programmatic use of new drugs to the Drug-Resistant TB Scale-Up Treatment Action Team between 1 July 2015 and 31 June 2017. Programmatic use was defined as treatment for MDR-TB with newer drugs outside of clinical trials or compassionate use.
RESULTS
A total of 10 164 persons were started on BDQ and 688 started on DLM during the reporting period. Only 15.7% of the 69 213 persons estimated to need newer drugs over the study period were reported to have received them.
CONCLUSION
While there has been significant progress in some countries, uptake of the newer drugs has not kept pace with a conservative estimate of need; fewer than 20% of persons likely to benefit from either BDQ or DLM have received them. Concerted efforts are needed to ensure that the newer drugs are made available more widely for persons with MDR-TB in need of these therapeutic options.
Journal Article > CommentaryFull Text
Science. 2012 July 20; Volume 337 (Issue 6092); 298-300.; DOI:10.1126/science.1225702
Lynch S, Ford NP, van Cutsem G, Bygrave H, Janssens B, et al.
Science. 2012 July 20; Volume 337 (Issue 6092); 298-300.; DOI:10.1126/science.1225702
The new understanding that antiretroviral therapy (ART) can significantly reduce HIV transmission has stimulated scientific and political leaders to claim that ending the AIDS epidemic is now a realistic goal. At the same time and despite last year's major international political commitments to put 15 million people on treatment by 2015, large funding gaps threaten the gains already made and limit the potential to capitalize on the latest scientific progress. Underresourced clinics are managing ever-increasing numbers of people on treatment, even though there is attrition all along the care continuum, from testing to treatment initiation and long-term retention in care.
Journal Article > CommentarySubscription Only
Nat Med. 2023 January 1; Volume 29 (Issue 1); 16-17.; DOI:10.1038/s41591-022-02136-z
McKenna L, Frick M, Angami K, Dubula V, Furin J, et al.
Nat Med. 2023 January 1; Volume 29 (Issue 1); 16-17.; DOI:10.1038/s41591-022-02136-z