Journal Article > LetterFull Text
Confl Health. 21 September 2016; Volume 10; 19.; DOI:10.1186/s13031-016-0086-5
Schulte-Hillen C, Staderini N, Saint-Sauveur JF
Confl Health. 21 September 2016; Volume 10; 19.; DOI:10.1186/s13031-016-0086-5
MSF responds to needs for the termination of pregnancy, including on request (TPR); it is part of the organization's work aimed at reducing maternal mortality and suffering; and preventing unsafe abortions in the countries where we work. Following the publication of "Why don't humanitarian organizations provide safe abortion care?" we offer an insight into MSF's experience over the past few years. The article looks at the legal concerns and proposes that the importance of addressing maternal mortality should replace them and the operational set-up and action organized in a way that mitigates risks. MSF took a policy decision on safe abortion care in 2004; the fact that care did not expand rapidly to relevant MSF projects came as a surprise, reflecting the important weight social norms around abortion have everywhere. The need to engage in an open dialogue with staff, relevant medical actors and at community level became more obvious. Finally the article looks some key lessons that have emerged for the organization as part of the effort to prevent ill health, maternal death and suffering caused by unwanted pregnancy and unsafe abortion.
Journal Article > ResearchFull Text
PLOS One. 5 June 2013; Volume 8 (Issue 6); DOI:10.1371/journal.pone.0064717
Shroufi A, Mafara E, Saint-Sauveur JF, Taziwa F, Vinoles MC
PLOS One. 5 June 2013; Volume 8 (Issue 6); DOI:10.1371/journal.pone.0064717
Introduction Mother-to-Mother (M2M) or “Mentor Mother” programmes utilise HIV positive mothers to provide support and advice to HIV positive pregnant women and mothers of HIV exposed babies. Médecins Sans Frontières (MSF) supported a Mentor Mother programme in Bulawayo, Zimbabwe from 2009 to 2012; with programme beneficiaries observed to have far higher retention at 6–8 weeks (99% vs 50%, p<0.0005) and to have higher adherence to Prevention of Mother to Child Transmission (PMTCT) guidelines, compared to those not opting in. In this study we explore how the M2M progamme may have contributed to these findings. Methods In this qualitative study we used thematic analysis of in-depth interviews (n = 79). This study was conducted in 2 urban districts of Bulawayo, Zimbabwe’s second largest city. Results Interviews were completed by 14 mentor mothers, 10 mentor mother family members, 30 beneficiaries (women enrolled both in PMTCT and M2M), 10 beneficiary family members, 5 women enrolled in PMTCT but who had declined to take part in the M2M programme and 10 health care staff members. All beneficiaries and health care staff reported that the programme had improved retention and provided rich information on how this was achieved. Additionally respondents described how the programme had helped bring about beneficial behaviour change. Conclusions M2M programmes offer great potential to empower communities affected by HIV to catalyse positive behaviour change. Our results illustrate how M2M involvement may increase retention in PMTCT programmes. Non-disclosure to one’s partner, as well as some cultural practices prevalent in Zimbabwe appear to be major barriers to participation in M2M programmes.
Conference Material > Abstract
Kumar M, Schulte-Hillen C, de Plecker E, Jamet C, de Vigne B, et al.
MSF Scientific Days UK 2019: Innovation. 10 May 2019
INTRODUCTION
Unsafe abortion is one of the main causes of maternal death and suffering worldwide. Since 2004, MSF policy has stated that safe abortion care (SAC) be provided as part of reproductive health care. Over the following decade, field teams have struggled to provide termination of pregnancy (TOP). MSF’s Working Group (WG) for reproductive health and sexual violence considered that internal barriers constituted a major obstacle to SAC provision. In 2015, to address the gap between ambition and action, the WG proposed an intersectional, multi-departmental, field-based initiative overseen by medical and operational directors, termed the “Task Force for Support to the Implementation of SAC.”
METHODS
Between Mar 2017 and May 2018, the Task Force conducted field support visits to 10 MSF projects in sub-Saharan Africa. The Task Force utilized a systematic and comprehensive approach, including: 1) Exploring Values and Attitudes (EVA) workshops; 2) clinical training; 3) discussions with local interlocutors; 4) threat and risk assessment; 5) implementation strategy; 6) data collection and monitoring.
ETHICS
This innovation project did not involve human participants or their data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.
RESULTS
In Feb 2018, before the Task Force started, no projects reported providing TOP. Following the Task Force visits, all 10 projects reported a steady increase in TOP provision, with a total of 768 TOP provided by Jul 2018. 662 (86.5%) patients were 18 years or older, and 103 (13.5%) were less than 18 years. 632 (83%) had pregnancies at or under 13 weeks gestation, and 134 (17%) were beyond 13 weeks. 762 (99.2%) TOP were provided via the medication method (“abortion pills”). There were no severe medical complications and no major security incidents reported. The Task Force facilitated 40 EVA workshops for 746 MSF field staff. Pre- and post-survey results demonstrate increased understanding and support for MSF action regarding SAC after EVA workshops.
CONCLUSION
Today, more women in MSF projects have access to safe abortion care than ever before – including women of all ages and in the first and second trimester. The Task Force developed specific tools and integrated them into a comprehensive implementation strategy for field teams. The multi-level, field-based approach of the Task Force has contributed to the successful provision of safe abortion care in targeted MSF projects, thus creating movement on an issue where there had been roadblocks for many years. EVA workshops in particular are thought to be one of the keys in overcoming organizational inertia by opening up space for dialogue and understanding on a sensitive issue.
CONFLICTS OF INTEREST
None declared.
Unsafe abortion is one of the main causes of maternal death and suffering worldwide. Since 2004, MSF policy has stated that safe abortion care (SAC) be provided as part of reproductive health care. Over the following decade, field teams have struggled to provide termination of pregnancy (TOP). MSF’s Working Group (WG) for reproductive health and sexual violence considered that internal barriers constituted a major obstacle to SAC provision. In 2015, to address the gap between ambition and action, the WG proposed an intersectional, multi-departmental, field-based initiative overseen by medical and operational directors, termed the “Task Force for Support to the Implementation of SAC.”
METHODS
Between Mar 2017 and May 2018, the Task Force conducted field support visits to 10 MSF projects in sub-Saharan Africa. The Task Force utilized a systematic and comprehensive approach, including: 1) Exploring Values and Attitudes (EVA) workshops; 2) clinical training; 3) discussions with local interlocutors; 4) threat and risk assessment; 5) implementation strategy; 6) data collection and monitoring.
ETHICS
This innovation project did not involve human participants or their data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.
RESULTS
In Feb 2018, before the Task Force started, no projects reported providing TOP. Following the Task Force visits, all 10 projects reported a steady increase in TOP provision, with a total of 768 TOP provided by Jul 2018. 662 (86.5%) patients were 18 years or older, and 103 (13.5%) were less than 18 years. 632 (83%) had pregnancies at or under 13 weeks gestation, and 134 (17%) were beyond 13 weeks. 762 (99.2%) TOP were provided via the medication method (“abortion pills”). There were no severe medical complications and no major security incidents reported. The Task Force facilitated 40 EVA workshops for 746 MSF field staff. Pre- and post-survey results demonstrate increased understanding and support for MSF action regarding SAC after EVA workshops.
CONCLUSION
Today, more women in MSF projects have access to safe abortion care than ever before – including women of all ages and in the first and second trimester. The Task Force developed specific tools and integrated them into a comprehensive implementation strategy for field teams. The multi-level, field-based approach of the Task Force has contributed to the successful provision of safe abortion care in targeted MSF projects, thus creating movement on an issue where there had been roadblocks for many years. EVA workshops in particular are thought to be one of the keys in overcoming organizational inertia by opening up space for dialogue and understanding on a sensitive issue.
CONFLICTS OF INTEREST
None declared.
Journal Article > ResearchFull Text
AIDS. 21 March 2013; Volume 27 (Issue 12); 1971-1978.; DOI:10.1097/QAD.0b013e32836149ea
Shroufi A, Gunguwo H, Dixon M, Nyathi M, Ndebele W, et al.
AIDS. 21 March 2013; Volume 27 (Issue 12); 1971-1978.; DOI:10.1097/QAD.0b013e32836149ea
OBJECTIVES
In this study we examine whether adolescents treated for HIV/AIDS in southern Africa can achieve similar treatment outcomes to adults.
DESIGN
We have used a retrospective cohort study design to compare outcomes for adolescents and adults commencing antiretroviral therapy (ART) between 2004 and 2010 in a public sector hospital clinic in Bulawayo, Zimbabwe.
METHODS
Cox proportional hazards modelling was used to investigate risk factors for death and loss to follow-up (LTFU) (defined as missing a scheduled appointment by ≥3months).
RESULTS
One thousand, seven hundred and seventy-six adolescents commenced ART, 94% having had no previous history of ART. The median age at ART initiation was 13.3 years. HIV diagnosis in 97% of adolescents occurred after presentation with clinical disease and a higher proportion had advanced HIV disease at presentation compared with adults [WHO Stage 3/4 disease (79.3 versus 65.2%, P < 0.001)]. Despite this, adolescents had no worse mortality than adults, assuming 50% mortality among those LTFU (6.4 versus 7.3 per 100 person-years, P = 0.75) with rates of loss to follow-up significantly lower than in adults (4.8 versus 9.2 per 100 person-years, P < 0.001). Among those who were followed for 5 years or more, 5.8% of adolescents switched to a second-line regimen as a result of treatment failure, compared with 2.1% of adults (P < 0.001).
CONCLUSION
With adolescent-focused services, it is feasible to achieve good outcomes for adolescents in large-scale ART programs in sub-Saharan Africa. However, adolescents are at high risk of treatment failure, which compromises future drug options. Interventions to address poor adherence in adolescence should be prioritized.
In this study we examine whether adolescents treated for HIV/AIDS in southern Africa can achieve similar treatment outcomes to adults.
DESIGN
We have used a retrospective cohort study design to compare outcomes for adolescents and adults commencing antiretroviral therapy (ART) between 2004 and 2010 in a public sector hospital clinic in Bulawayo, Zimbabwe.
METHODS
Cox proportional hazards modelling was used to investigate risk factors for death and loss to follow-up (LTFU) (defined as missing a scheduled appointment by ≥3months).
RESULTS
One thousand, seven hundred and seventy-six adolescents commenced ART, 94% having had no previous history of ART. The median age at ART initiation was 13.3 years. HIV diagnosis in 97% of adolescents occurred after presentation with clinical disease and a higher proportion had advanced HIV disease at presentation compared with adults [WHO Stage 3/4 disease (79.3 versus 65.2%, P < 0.001)]. Despite this, adolescents had no worse mortality than adults, assuming 50% mortality among those LTFU (6.4 versus 7.3 per 100 person-years, P = 0.75) with rates of loss to follow-up significantly lower than in adults (4.8 versus 9.2 per 100 person-years, P < 0.001). Among those who were followed for 5 years or more, 5.8% of adolescents switched to a second-line regimen as a result of treatment failure, compared with 2.1% of adults (P < 0.001).
CONCLUSION
With adolescent-focused services, it is feasible to achieve good outcomes for adolescents in large-scale ART programs in sub-Saharan Africa. However, adolescents are at high risk of treatment failure, which compromises future drug options. Interventions to address poor adherence in adolescence should be prioritized.
Conference Material > Slide Presentation
Kumar M, Schulte-Hillen C, de Plecker E, Jamet C, de Vigne B, et al.
MSF Scientific Days UK 2019: Innovation. 10 May 2019; DOI:10.7490/f1000research.1116731.1
Journal Article > ResearchFull Text
Sex Reprod Health Matters. 1 December 2020; Volume 28 (Issue 1); 1852644.; DOI:10.1080/26410397.2020.1852644
Burtscher D, Schulte-Hillen C, Saint-Sauveur JF, de Plecker E, Nair MM, et al.
Sex Reprod Health Matters. 1 December 2020; Volume 28 (Issue 1); 1852644.; DOI:10.1080/26410397.2020.1852644
Unwanted pregnancy and unsafe abortion contribute significantly to the burden of maternal suffering, ill health and death in the Democratic Republic of Congo (DRC). This qualitative study examines the vulnerabilities of women and girls regarding unwanted pregnancy and abortion, to better understand their health-seeking behaviour and to identify barriers that hinder them from accessing care. Data were collected in three different areas in eastern DRC, using in-depth individual interviews, group interviews and focus group discussions. Respondents were purposively sampled. All interviews were audio recorded and transcribed verbatim. Transcriptions were screened for relevant information, manually coded and analysed using qualitative content analysis. Perceptions and attitudes towards unwanted pregnancy and abortion varied across the three study areas. In North Kivu, interviews predominantly reflected the view that abortions are morally reprehensible, which contrasts the widespread practice of abortion. In Ituri many perceive abortions as an appropriate solution for reducing maternal mortality. Legal constraints were cited as a barrier for health professionals to providing adequate medical care. In South Kivu, the general view was one of opposition to abortion, with some tolerance towards breastfeeding women. The main reasons women have abortions are related to stigma and shame, socio-demographics and finances, transactional sex and rape. Contrary to the prevailing critical narrative on abortion, this study highlights a significant need for safe abortion care services. The proverb “Better dead than being mocked” shows that women and girls prefer to risk dying through unsafe abortion, rather than staying pregnant and facing stigma for an unwanted pregnancy.
Journal Article > ResearchFull Text
Am J Trop Med Hyg. 1 August 2010; Volume 83 (Issue 2); 357-364.; DOI:10.4269/ajtmh.2010.10-0156
Sinha PK, Roddy P, Palma PP, Kociejowski A, Lima MA, et al.
Am J Trop Med Hyg. 1 August 2010; Volume 83 (Issue 2); 357-364.; DOI:10.4269/ajtmh.2010.10-0156
We evaluated, through the prospective monitoring of 251 patients at Sadar Hospital in Bihar, India, the effectiveness and safety of 20 mg/kg body weight of liposomal amphotericin B for the treatment of visceral leishmaniasis. The treatment success rates for the intention-to-treat, per protocol, and intention-to-treat worse-case scenario analyses were 98.8%, 99.6%, and 81.3%, respectively. Nearly one-half of patients experienced mild adverse events, but only 1% developed serious but non–life-threatening lips swelling. The lost to follow-up rate was 17.5%. Our findings indicate that the 20 mg/kg body weight treatment dosage is effective and safe under routine program conditions. Given that the exorbitant cost of liposomal amphotericin B is a barrier to its widespread use, we recommend further study to monitor and evaluate a lowered dosage and a shorter treatment course.