Conference Material > Abstract
Arago M, Mangue M, Cumbi N, Zamudio AG, Loarec A, et al.
MSF Scientific Days International 2021: Innovation. 2021 May 20
WHAT CHALLENGE OR OPPORTUNITY DID YOU TRY TO ADDRESS? WERE EXISTING SOLUTIONS NOT AVAILABLE OR NOT GOOD ENOUGH?
Ototoxicity is an unfortunate side-effect of second-line injectable drugs for drug-resistant tuberculosis (DRTB), including aminoglycosides and peptides. Worldwide, up to 15% of patients on treatment regimens containing these drugs develop a degree of ototoxicity. Patients who experience ototoxicity are generally switched to an oral treatment regimen. Although regular audiological evaluations are recommended for patients receiving these drugs, there is limited access to these services, and few patients with noticeable hearing problems are referred for confirmation and follow-up.
WHY DOES THIS CHALLENGE OR OPPORTUNITY MATTER – WHY SHOULD MSF ADDRESS IT?
Before the introduction of this digital tool, the MSF DRTB project in Mozambique had to refer patients to the Central Hospital in Maputo. This limited the number of patients screened and referred for testing, curtailing the potential to switch treatment early for those showing mild-to-moderate hearing loss.
DESCRIBE YOUR INNOVATION AND WHAT MAKES IT INNOVATIVE
In 2018, the team piloted a way to simplify monitoring of hearing using a clinically approved mobile tablet-based tool that has been found to be comparable with traditional audiometry measurements in children and adults. MSF acquired three kits of CE-marked and FDA-certified iOS-based audiometry kits from SHOEBOX® Audiometry systems. The units were comprised of calibrated headphones and tablet-based software that have acceptable accuracy (±10dB) with 90% sensitivity and specificity. The portable units were deployed in rotation in six health centres over two years; a total of 673 audiometry tests were performed in MSF-supported public health centres in Maputo. Patients were tested at baseline during their first consultation and then monthly while on treatment regimens that included injectable drugs.
WHO WILL BENEFIT (WHOSE LIFE / WORK WILL IT IMPROVE?) AND WERE THEY INVOLVED IN THE DESIGN?
The 2018 Mozambique National TB Committee approved treatment without injectable drugs in patients who had any degree of hearing impairment before the initiation of treatment. Patients screened using the digital tool directly benefitted from switching to oral DRTB treatment if they exhibited any hearing loss, without requiring hospital referral.
WHAT OBJECTIVES DID YOU SET FOR THE PROJECT – WHAT DID YOU WANT TO ACHIEVE AND HOW DID YOU DEFINE AND MEASURE SUCCESS (IMPROVED SERVICE, LOWER COST, BETTER EFFICIENCY, BETTER USER EXPERIENCE, ETC.)?
We describe the implementation and use of a mobile audiometry system for patients with treatment-related ototoxicity in the MSF DRTB project in Mozambique, and consider its potential for easily assessing hearing deterioration in this cohort.
WHAT DATA DID YOU COLLECT TO MEASURE THE INNOVATION AGAINST THESE INDICATORS AND HOW DID YOU COLLECT IT? INCLUDE IF YOU DECIDED TO CHANGE THE INDICATORS AND WHY
Routinely collected data were evaluated.
WERE THERE ANY LIMITATIONS TO THE DATA YOU COLLECTED, HOW YOU COLLECTED IT OR HOW YOU ANALYSED IT, OR WERE THERE ANY UNFORESEEN FACTORS THAT MAY HAVE INTERFERED WITH YOUR RESULTS?
Data were analysed retrospectively from routine records and may not be exhaustive. Separate analysis of baseline and follow-up was not possible.
WHAT RESULTS DID YOU GET?
Of the 673 audiometry tests conducted using the digital tool, 480 (71%) showed normal hearing, 65 (10%) mild hearing loss, 81 (12%) moderate hearing loss, and 47 (7%) severe-to-profound hearing loss.
COMPARING THE RESULTS FROM YOUR DATA ANALYSIS TO YOUR OBJECTIVES, EXPLAIN WHY YOU CONSIDER YOUR INNOVATION A SUCCESS OR FAILURE?
This decentralised approach does not need specialised setup, which may lead to increased screening, proper follow-up, and more potential for early switching of drug regimens.
TO WHAT EXTENT DID THE INNOVATION BENEFIT PEOPLE’S LIVES / WORK?
Decreasing the need for hospital referrals improved time and transport costs for patients.
IS THERE ANYTHING THAT YOU WOULD DO DIFFERENTLY IF YOU WERE TO DO THE WORK AGAIN?:
A cost-benefit analysis to compare the mobile audiometry system to referrals would be beneficial for programmatic decisions.
WHAT ARE THE NEXT STEPS FOR THE INNOVATION ITSELF (SCALE UP, IMPLEMENTATION, FURTHER DEVELOPMENT, DISCONTINUED)?
In December 2019, the project was phased out as there was a protocol change in which injectable drugs were replaced with more potent and fully oral regimens that made monitoring for ototoxicity unnecessary for most patients.
IS THE INNOVATION TRANSFERABLE OR ADAPTABLE TO OTHER SETTINGS OR DOMAINS?
The tools adapted are clinically approved for screening activities for any programmes that deal with hearing loss.
WHAT BROADER IMPLICATIONS ARE THERE FROM THE INNOVATION FOR MSF AND / OR OTHERS (CHANGE IN PRACTICE, CHANGE IN POLICY, CHANGE IN GUIDELINES, PARADIGM SHIFT)?
The project demonstrates the potential to improve follow-up and detect complications early for patients who take ototoxic medications.
WHAT OTHER LEARNINGS FROM YOUR WORK ARE IMPORTANT TO SHARE?
User-friendly and automated audiometry systems that are mobile and do not require audiologists or sound-insulated booths could be extremely useful to various medical projects using potentially ototoxic drugs such as aminoglycosides. They may also be beneficial for environmental projects with noise and toxic pollutions. The high cost of the license could present a limitation necessitating a cost-benefit analysis before contemplating scale-up.
ETHICS
This description and evaluation of an innovation project involved human participants or their data, and has had ethics oversight from Monica Rull, Medical Director, Operational Centre Geneva, MSF.
Ototoxicity is an unfortunate side-effect of second-line injectable drugs for drug-resistant tuberculosis (DRTB), including aminoglycosides and peptides. Worldwide, up to 15% of patients on treatment regimens containing these drugs develop a degree of ototoxicity. Patients who experience ototoxicity are generally switched to an oral treatment regimen. Although regular audiological evaluations are recommended for patients receiving these drugs, there is limited access to these services, and few patients with noticeable hearing problems are referred for confirmation and follow-up.
WHY DOES THIS CHALLENGE OR OPPORTUNITY MATTER – WHY SHOULD MSF ADDRESS IT?
Before the introduction of this digital tool, the MSF DRTB project in Mozambique had to refer patients to the Central Hospital in Maputo. This limited the number of patients screened and referred for testing, curtailing the potential to switch treatment early for those showing mild-to-moderate hearing loss.
DESCRIBE YOUR INNOVATION AND WHAT MAKES IT INNOVATIVE
In 2018, the team piloted a way to simplify monitoring of hearing using a clinically approved mobile tablet-based tool that has been found to be comparable with traditional audiometry measurements in children and adults. MSF acquired three kits of CE-marked and FDA-certified iOS-based audiometry kits from SHOEBOX® Audiometry systems. The units were comprised of calibrated headphones and tablet-based software that have acceptable accuracy (±10dB) with 90% sensitivity and specificity. The portable units were deployed in rotation in six health centres over two years; a total of 673 audiometry tests were performed in MSF-supported public health centres in Maputo. Patients were tested at baseline during their first consultation and then monthly while on treatment regimens that included injectable drugs.
WHO WILL BENEFIT (WHOSE LIFE / WORK WILL IT IMPROVE?) AND WERE THEY INVOLVED IN THE DESIGN?
The 2018 Mozambique National TB Committee approved treatment without injectable drugs in patients who had any degree of hearing impairment before the initiation of treatment. Patients screened using the digital tool directly benefitted from switching to oral DRTB treatment if they exhibited any hearing loss, without requiring hospital referral.
WHAT OBJECTIVES DID YOU SET FOR THE PROJECT – WHAT DID YOU WANT TO ACHIEVE AND HOW DID YOU DEFINE AND MEASURE SUCCESS (IMPROVED SERVICE, LOWER COST, BETTER EFFICIENCY, BETTER USER EXPERIENCE, ETC.)?
We describe the implementation and use of a mobile audiometry system for patients with treatment-related ototoxicity in the MSF DRTB project in Mozambique, and consider its potential for easily assessing hearing deterioration in this cohort.
WHAT DATA DID YOU COLLECT TO MEASURE THE INNOVATION AGAINST THESE INDICATORS AND HOW DID YOU COLLECT IT? INCLUDE IF YOU DECIDED TO CHANGE THE INDICATORS AND WHY
Routinely collected data were evaluated.
WERE THERE ANY LIMITATIONS TO THE DATA YOU COLLECTED, HOW YOU COLLECTED IT OR HOW YOU ANALYSED IT, OR WERE THERE ANY UNFORESEEN FACTORS THAT MAY HAVE INTERFERED WITH YOUR RESULTS?
Data were analysed retrospectively from routine records and may not be exhaustive. Separate analysis of baseline and follow-up was not possible.
WHAT RESULTS DID YOU GET?
Of the 673 audiometry tests conducted using the digital tool, 480 (71%) showed normal hearing, 65 (10%) mild hearing loss, 81 (12%) moderate hearing loss, and 47 (7%) severe-to-profound hearing loss.
COMPARING THE RESULTS FROM YOUR DATA ANALYSIS TO YOUR OBJECTIVES, EXPLAIN WHY YOU CONSIDER YOUR INNOVATION A SUCCESS OR FAILURE?
This decentralised approach does not need specialised setup, which may lead to increased screening, proper follow-up, and more potential for early switching of drug regimens.
TO WHAT EXTENT DID THE INNOVATION BENEFIT PEOPLE’S LIVES / WORK?
Decreasing the need for hospital referrals improved time and transport costs for patients.
IS THERE ANYTHING THAT YOU WOULD DO DIFFERENTLY IF YOU WERE TO DO THE WORK AGAIN?:
A cost-benefit analysis to compare the mobile audiometry system to referrals would be beneficial for programmatic decisions.
WHAT ARE THE NEXT STEPS FOR THE INNOVATION ITSELF (SCALE UP, IMPLEMENTATION, FURTHER DEVELOPMENT, DISCONTINUED)?
In December 2019, the project was phased out as there was a protocol change in which injectable drugs were replaced with more potent and fully oral regimens that made monitoring for ototoxicity unnecessary for most patients.
IS THE INNOVATION TRANSFERABLE OR ADAPTABLE TO OTHER SETTINGS OR DOMAINS?
The tools adapted are clinically approved for screening activities for any programmes that deal with hearing loss.
WHAT BROADER IMPLICATIONS ARE THERE FROM THE INNOVATION FOR MSF AND / OR OTHERS (CHANGE IN PRACTICE, CHANGE IN POLICY, CHANGE IN GUIDELINES, PARADIGM SHIFT)?
The project demonstrates the potential to improve follow-up and detect complications early for patients who take ototoxic medications.
WHAT OTHER LEARNINGS FROM YOUR WORK ARE IMPORTANT TO SHARE?
User-friendly and automated audiometry systems that are mobile and do not require audiologists or sound-insulated booths could be extremely useful to various medical projects using potentially ototoxic drugs such as aminoglycosides. They may also be beneficial for environmental projects with noise and toxic pollutions. The high cost of the license could present a limitation necessitating a cost-benefit analysis before contemplating scale-up.
ETHICS
This description and evaluation of an innovation project involved human participants or their data, and has had ethics oversight from Monica Rull, Medical Director, Operational Centre Geneva, MSF.
Conference Material > Slide Presentation
Arago M, Mangue M, Cumbi N, Zamudio AG, Loarec A, et al.
MSF Scientific Days International 2021: Innovation. 2021 May 20
Conference Material > Abstract
Aung A, Daka M, Tamrat A, Gwitima T, Chidhuro T, et al.
MSF Scientific Days International 2021: Innovation. 2021 May 20
WHAT CHALLENGE OR OPPORTUNITY DID YOU TRY TO ADDRESS? WERE EXISTING SOLUTIONS NOT AVAILABLE OR NOT GOOD ENOUGH?
The COVID-19 pandemic has prompted lockdown measures in many places, but patients continued to travel for essential health services. Since COVID-19 has potentially adverse health outcomes among patients with drug-resistant tuberculosis (DR-TB), innovative strategies for medication adherence that minimise travel and the chance of exposure are needed.
WHY DOES THIS CHALLENGE OR OPPORTUNITY MATTER – WHY SHOULD MSF ADDRESS IT?
Historically, directly observed therapy (DOT) has been provided in health facilities, requiring patient travel, or by community treatment supporters (CTS), who travel to patients. The World Health Organisation (WHO) recommends the use of digital methods to support treatment adherence. In response to the COVID-19 pandemic and in collaboration with the National Tuberculosis Control Program (NTCP), we implemented video/virtually observed therapy (VOT) in Shiselweni, Eswatini in May 2020. This allowed the daily observation of patients taking their medication to be done using video messages rather than in-person.
DESCRIBE YOUR INNOVATION AND WHAT MAKES IT INNOVATIVE
The aim of VOT is to support patients with drug adherence using a secured smartphone application. Patients were provided with a sim-implanted, application-installed smartphone with monthly internet subscription and shown how to take and share videos. Nurses reviewed the videos through a web-based dashboard, assessed adherence, and provided feedback. Videos could not be recovered from the smartphone and were retained for a maximum of 45 days on the server.
WHO WILL BENEFIT (WHOSE LIFE / WORK WILL IT IMPROVE?) AND WERE THEY INVOLVED IN THE DESIGN?
Patients who were eligible for VOT (living in network coverage area, smartphone literate, and consented to share videos of themselves) were registered on the web-based platform, which generated login details for the application called SureAdhere©. Those that did not meet the eligibility criteria continued with DOT, provided by community treatment supporters or family treatment supporters.
WHAT OBJECTIVES DID YOU SET FOR THE PROJECT – WHAT DID YOU WANT TO ACHIEVE AND HOW DID YOU DEFINE AND MEASURE SUCCESS (IMPROVED SERVICE, LOWER COST, BETTER EFFICIENCY, BETTER USER EXPERIENCE, ETC.)?
We reviewed patient adherence every month and followed the user experience to understand future scale up. Medical teams and patients also benefitted from instant communication using the application.
WHAT DATA DID YOU COLLECT TO MEASURE THE INNOVATION AGAINST THESE INDICATORS AND HOW DID YOU COLLECT IT? INCLUDE IF YOU DECIDED TO CHANGE THE INDICATORS AND WHY.
The number of patients using VOT for adherence support was collected routinely in the monthly TB register. Individual adherence levels were shown in adherence calendars on the web-based dashboard and nurses produced monthly adherence levels for the VOT cohort.
HOW DID YOU ANALYSE THIS DATA TO UNDERSTAND TO WHAT EXTENT THE INNOVATION ACHIEVED ITS OBJECTIVES? DID THIS INCLUDE A COMPARISON TO THE STATUS QUO OR AN EXISTING SOLUTION?
We retrospectively analysed data to assess VOT uptake among the total DR-TB treatment cohort. Adherence was classified into levels: excellent (100%), good (>90%), or moderate (<90%).
WERE THERE ANY LIMITATIONS TO THE DATA YOU COLLECTED, HOW YOU COLLECTED IT OR HOW YOU ANALYSED IT, OR WERE THERE ANY UNFORESEEN FACTORS THAT MAY HAVE INTERFERED WITH YOUR RESULTS?
We were unable to compare our results with the adherence levels of patients using conventional DOT since routine DOT data was not collected electronically. Some delays in video transmission were experienced due to connectivity issues.
WHAT RESULTS DID YOU GET?
In May 2020, 18 (43%) of 42 patients fulfilled the eligibility criteria and started VOT, increasing to 25 (61%) of 41 patients in November 2020. Two patients using VOT completed treatment with successful outcomes. An adherence level of perfect was observed in all patients undergoing VOT during May and June 2020. Adherence decreased monthly until October 2020 at which 20 (77%) of 26 patients had excellent adherence, four (15%) had good adherence, and two (8%) had moderate adherence. In November 2020, 20 (80%) of 25 patients had perfect adherence and five (20%) had good adherence.
COMPARING THE RESULTS FROM YOUR DATA ANALYSIS TO YOUR OBJECTIVES, EXPLAIN WHY YOU CONSIDER YOUR INNOVATION A SUCCESS OR FAILURE?
We were able to provide adherence support despite the pandemic outbreak. Although average adherence levels did not remain excellent for all patients, the majority of patients achieved favourable adherence, and we were able to quantify adherence using this method.
TO WHAT EXTENT DID THE INNOVATION BENEFIT PEOPLE’S LIVES / WORK?
We implemented VOT relatively swiftly after lockdown measures began in Eswatini, thereby providing timely adherence support to patients with DR-TB.
WHAT ARE THE NEXT STEPS FOR THE INNOVATION ITSELF (SCALE UP, IMPLEMENTATION, FURTHER DEVELOPMENT, DISCONTINUED)?
Uptake of VOT among patients with DR-TB was improving although maintaining perfect adherence was difficult. VOT will be included as an adherence support method for all eligible patients in upcoming research on oral short-course treatment for DR-TB.
IS THE INNOVATION TRANSFERABLE OR ADAPTABLE TO OTHER SETTINGS OR DOMAINS?
The application is straightforward, and the dashboard can be used to easily identify adherence problems to allow for prompt patient support. It gives a clear overview of adherence levels and has enabled direct communication between the patients and healthcare workers.
WHAT BROADER IMPLICATIONS ARE THERE FROM THE INNOVATION FOR MSF AND / OR OTHERS (CHANGE IN PRACTICE, CHANGE IN POLICY, CHANGE IN GUIDELINES, PARADIGM SHIFT)?
In this context, VOT was used to minimise the possibility of physical exposure to SARS-CoV-2 and to overcome COVID-19 travel restrictions. However, the NTCP are interested in using VOT as the standard of care adherence monitoring method for eligible patients in DR-TB programmes.
WHAT OTHER LEARNINGS FROM YOUR WORK ARE IMPORTANT TO SHARE?
VOT was well-received by patients and healthcare workers, although a proportion of patients still preferred in-person DOT. Controlling monthly internet usage and restricting the use of other smartphone applications were required. Data protection advice was sought at headquarters level. Access to the VOT application is password-protected and we are confident that privacy and confidentiality have been respected according to ethics guidelines.
ETHICS
This description and evaluation of an innovation project fulfilled the exemption criteria set by the MSF Ethics Review Board. It was conducted with permission from Monica Rull, Medical Director, Operational Centre Geneva, MSF
The COVID-19 pandemic has prompted lockdown measures in many places, but patients continued to travel for essential health services. Since COVID-19 has potentially adverse health outcomes among patients with drug-resistant tuberculosis (DR-TB), innovative strategies for medication adherence that minimise travel and the chance of exposure are needed.
WHY DOES THIS CHALLENGE OR OPPORTUNITY MATTER – WHY SHOULD MSF ADDRESS IT?
Historically, directly observed therapy (DOT) has been provided in health facilities, requiring patient travel, or by community treatment supporters (CTS), who travel to patients. The World Health Organisation (WHO) recommends the use of digital methods to support treatment adherence. In response to the COVID-19 pandemic and in collaboration with the National Tuberculosis Control Program (NTCP), we implemented video/virtually observed therapy (VOT) in Shiselweni, Eswatini in May 2020. This allowed the daily observation of patients taking their medication to be done using video messages rather than in-person.
DESCRIBE YOUR INNOVATION AND WHAT MAKES IT INNOVATIVE
The aim of VOT is to support patients with drug adherence using a secured smartphone application. Patients were provided with a sim-implanted, application-installed smartphone with monthly internet subscription and shown how to take and share videos. Nurses reviewed the videos through a web-based dashboard, assessed adherence, and provided feedback. Videos could not be recovered from the smartphone and were retained for a maximum of 45 days on the server.
WHO WILL BENEFIT (WHOSE LIFE / WORK WILL IT IMPROVE?) AND WERE THEY INVOLVED IN THE DESIGN?
Patients who were eligible for VOT (living in network coverage area, smartphone literate, and consented to share videos of themselves) were registered on the web-based platform, which generated login details for the application called SureAdhere©. Those that did not meet the eligibility criteria continued with DOT, provided by community treatment supporters or family treatment supporters.
WHAT OBJECTIVES DID YOU SET FOR THE PROJECT – WHAT DID YOU WANT TO ACHIEVE AND HOW DID YOU DEFINE AND MEASURE SUCCESS (IMPROVED SERVICE, LOWER COST, BETTER EFFICIENCY, BETTER USER EXPERIENCE, ETC.)?
We reviewed patient adherence every month and followed the user experience to understand future scale up. Medical teams and patients also benefitted from instant communication using the application.
WHAT DATA DID YOU COLLECT TO MEASURE THE INNOVATION AGAINST THESE INDICATORS AND HOW DID YOU COLLECT IT? INCLUDE IF YOU DECIDED TO CHANGE THE INDICATORS AND WHY.
The number of patients using VOT for adherence support was collected routinely in the monthly TB register. Individual adherence levels were shown in adherence calendars on the web-based dashboard and nurses produced monthly adherence levels for the VOT cohort.
HOW DID YOU ANALYSE THIS DATA TO UNDERSTAND TO WHAT EXTENT THE INNOVATION ACHIEVED ITS OBJECTIVES? DID THIS INCLUDE A COMPARISON TO THE STATUS QUO OR AN EXISTING SOLUTION?
We retrospectively analysed data to assess VOT uptake among the total DR-TB treatment cohort. Adherence was classified into levels: excellent (100%), good (>90%), or moderate (<90%).
WERE THERE ANY LIMITATIONS TO THE DATA YOU COLLECTED, HOW YOU COLLECTED IT OR HOW YOU ANALYSED IT, OR WERE THERE ANY UNFORESEEN FACTORS THAT MAY HAVE INTERFERED WITH YOUR RESULTS?
We were unable to compare our results with the adherence levels of patients using conventional DOT since routine DOT data was not collected electronically. Some delays in video transmission were experienced due to connectivity issues.
WHAT RESULTS DID YOU GET?
In May 2020, 18 (43%) of 42 patients fulfilled the eligibility criteria and started VOT, increasing to 25 (61%) of 41 patients in November 2020. Two patients using VOT completed treatment with successful outcomes. An adherence level of perfect was observed in all patients undergoing VOT during May and June 2020. Adherence decreased monthly until October 2020 at which 20 (77%) of 26 patients had excellent adherence, four (15%) had good adherence, and two (8%) had moderate adherence. In November 2020, 20 (80%) of 25 patients had perfect adherence and five (20%) had good adherence.
COMPARING THE RESULTS FROM YOUR DATA ANALYSIS TO YOUR OBJECTIVES, EXPLAIN WHY YOU CONSIDER YOUR INNOVATION A SUCCESS OR FAILURE?
We were able to provide adherence support despite the pandemic outbreak. Although average adherence levels did not remain excellent for all patients, the majority of patients achieved favourable adherence, and we were able to quantify adherence using this method.
TO WHAT EXTENT DID THE INNOVATION BENEFIT PEOPLE’S LIVES / WORK?
We implemented VOT relatively swiftly after lockdown measures began in Eswatini, thereby providing timely adherence support to patients with DR-TB.
WHAT ARE THE NEXT STEPS FOR THE INNOVATION ITSELF (SCALE UP, IMPLEMENTATION, FURTHER DEVELOPMENT, DISCONTINUED)?
Uptake of VOT among patients with DR-TB was improving although maintaining perfect adherence was difficult. VOT will be included as an adherence support method for all eligible patients in upcoming research on oral short-course treatment for DR-TB.
IS THE INNOVATION TRANSFERABLE OR ADAPTABLE TO OTHER SETTINGS OR DOMAINS?
The application is straightforward, and the dashboard can be used to easily identify adherence problems to allow for prompt patient support. It gives a clear overview of adherence levels and has enabled direct communication between the patients and healthcare workers.
WHAT BROADER IMPLICATIONS ARE THERE FROM THE INNOVATION FOR MSF AND / OR OTHERS (CHANGE IN PRACTICE, CHANGE IN POLICY, CHANGE IN GUIDELINES, PARADIGM SHIFT)?
In this context, VOT was used to minimise the possibility of physical exposure to SARS-CoV-2 and to overcome COVID-19 travel restrictions. However, the NTCP are interested in using VOT as the standard of care adherence monitoring method for eligible patients in DR-TB programmes.
WHAT OTHER LEARNINGS FROM YOUR WORK ARE IMPORTANT TO SHARE?
VOT was well-received by patients and healthcare workers, although a proportion of patients still preferred in-person DOT. Controlling monthly internet usage and restricting the use of other smartphone applications were required. Data protection advice was sought at headquarters level. Access to the VOT application is password-protected and we are confident that privacy and confidentiality have been respected according to ethics guidelines.
ETHICS
This description and evaluation of an innovation project fulfilled the exemption criteria set by the MSF Ethics Review Board. It was conducted with permission from Monica Rull, Medical Director, Operational Centre Geneva, MSF
Journal Article > ResearchFull Text
Emerg Infect Dis. 2007 January 1
Guthmann JP, Bonnet MMB, Ahoua L, Dantoine F, Balkan S, et al.
Emerg Infect Dis. 2007 January 1
Death rates exceeded emergency thresholds at 4 sites during epidemics of Plasmodium falciparum malaria in Burundi (2000-2001) and in Ethiopia (2003-2004). Deaths likely from malaria ranged from 1,000 to 8,900, depending on site, and accounted for 52% to 78% of total deaths. Earlier detection of malaria and better case management are needed.
Conference Material > Slide Presentation
Phelan H, Tamrat A, Schneider F, Bryson LHM, Tanaka M
MSF Scientific Days International 2021: Innovation. 2021 May 20
Conference Material > Video
Phelan H, Tamrat A, Schneider F, Bryson LHM, Tanaka M
MSF Scientific Days International 2021: Innovation. 2021 May 20