Journal Article > ResearchFull Text
Hum Resour Health. 2007 May 1; Volume 5 (Issue 1); DOI:10.1186/1478-4491-5-12
Van Damme W, Kheang ST, Janssens B, Kober K
Hum Resour Health. 2007 May 1; Volume 5 (Issue 1); DOI:10.1186/1478-4491-5-12
BACKGROUND: Funding for scaling-up antiretroviral treatment (ART) in low-income countries has increased substantially, but the lack of human resources for health (HRH) is increasingly being identified as an important constraint for scaling-up ART. METHODS: In a clinic run by Médecins Sans Frontières in Siem Reap, Cambodia, we documented the use of doctor-time for ART in September 2004 and in August 2005, for different phases in ART (pre-ART, ART initiation, ART follow-up Year 1, & ART follow-up Year 2). Based on these observations and using a variety of assumptions for survival of patients on ART (between 90 and 95% annually) and for further reductions in doctor-time per patient (between 0 and 10% annually), we estimated the need for doctors for the period 2004 till 2013 in the Siem Reap clinic, and in a hypothetical district in sub-Saharan Africa. RESULTS: In the Siem Reap clinic, we found that from 2004 to 2005 the doctor-time needed per patient was reduced by between 14% and 33%, thanks to a reduction in number of visits per patient and shorter consultation times. In 2004, 2.06 full-time equivalent (FTE) doctors were needed for 522 patients on ART, and in 2005 this was slightly reduced to 1.97 FTE doctors for 911 patients on ART. By 2013, Siem Reap clinic will need between 2 and 5 FTE doctors for ART. In a district in sub-Saharan Africa with 200,000 inhabitants and 20% adult HIV prevalence, using a similar doctor-based ART delivery model, between 4 and 11 FTE doctors would be needed to cover 50% of ART needs. CONCLUSION: ART is labour intensive. Important reductions in doctor-time per patient can be realized during scaling-up. The doctor-based ART delivery model analysed seems adequate for Cambodia. However, for many districts in sub-Saharan Africa a doctor-based ART delivery model may be incompatible with their HRH constraints.
Journal Article > LetterFull Text
Lancet. 1997 June 14; Volume 349 (Issue 9067); 1775.; DOI:10.1016/s0140-6736(05)62998-4
Boelaert M, Englebert M, Hanquet G, Van Damme W, Van der Stuyft P
Lancet. 1997 June 14; Volume 349 (Issue 9067); 1775.; DOI:10.1016/s0140-6736(05)62998-4
Conference Material > Video (demo)
Serneels S, Van Damme W, Sere F
MSF Scientific Days International 2021: Innovation. 2021 May 20
Journal Article > LetterSubscription Only
JAMA. 2002 February 20; Volume 287 (Issue 7); 840-843.; DOI:10.1001/jama.287.7.840
Boelaert M, Lynen L, Van Damme W, Colebunders R
JAMA. 2002 February 20; Volume 287 (Issue 7); 840-843.; DOI:10.1001/jama.287.7.840
Journal Article > EditorialFull Text
Trop Med Int Health. 2002 December 11; Volume 7 (Issue 12); 1001-1002.; DOI:10.1046/j.1365-3156.2002.00972.x
Boelaert M, Van Damme W, Meessen B, Van der Stuyft P
Trop Med Int Health. 2002 December 11; Volume 7 (Issue 12); 1001-1002.; DOI:10.1046/j.1365-3156.2002.00972.x
Journal Article > ResearchFull Text
Lancet. 1998 May 30; Volume 351 (Issue 9116); DOI:10.1016/S0140-6736(97)10348-8
Van Damme W, De Brouwere V, Boelaert M, Van Lerberghe W
Lancet. 1998 May 30; Volume 351 (Issue 9116); DOI:10.1016/S0140-6736(97)10348-8
BACKGROUND: Since 1990, 500000 people have fled from Liberia and Sierra Leone to Guinea, west Africa, where the government allowed them to settle freely, and provided medical assistance. We assessed whether the host population gained better access to hospital care during 1988-96. METHODS: In Guéckédou prefecture, we used data on major obstetric interventions performed in the district hospital between January, 1988, and August, 1996, and estimated the expected number of births to calculate the rate of major obstetric interventions for the host population. We calculated rates for 1988-90, 1991-93, and 1994-96 for three rural areas with different numbers of refugees. FINDINGS: Rates of major obstetric interventions for the host population increased from 0.03% (95% CI 0-0.09) to 1.06% (0.74-1.38) in the area with high numbers of refugees, from 0.34% (0.22-0.45) to 0.92% (0.74-1.11) in the area with medium numbers, and from 0.07% (0-0.17) to 0.27% (0.08-0.46) in the area with low numbers. The rate ratio over time was 4.35 (2.64-7.15), 1.70 (1.40-2.07), and 1.94 (0.97-3.87) for these areas, respectively. The rates of major obstetric interventions increased significantly more in the area with high numbers of refugees than in the other two areas. INTERPRETATION: In areas with high numbers of refugees, the refugee-assistance programme improved the health system and transport infrastructure. The presence of refugees also led to economic changes and a "refugee-induced demand". The non-directive refugee policy in Guinea made such changes possible and may be a cost-effective alternative to camps.
Journal Article > CommentaryFull Text
Lancet. 2011 July 16; Volume 378 (Issue 9787); 282-4.; DOI:10.1016/S0140-6736(10)62303-3
Schouten EJ, Jahn A, Midiani D, Makombe SD, Mnthambala A, et al.
Lancet. 2011 July 16; Volume 378 (Issue 9787); 282-4.; DOI:10.1016/S0140-6736(10)62303-3
Journal Article > Meta-AnalysisFull Text
J Int AIDS Soc. 2011 July 6; Volume 14; DOI:10.1186/1758-2652-14-S1-S7
Zachariah R, Van Damme W, Arendt V, Schmit JC, Harries AD
J Int AIDS Soc. 2011 July 6; Volume 14; DOI:10.1186/1758-2652-14-S1-S7
Journal Article > ResearchFull Text
Lancet. 1998 April 18; Volume 351 (Issue 9110); DOI:10.1016/S0140-6736(05)79169-8
Hilderbrand K, Boelaert M, Van Damme W, Van der Stuyft P
Lancet. 1998 April 18; Volume 351 (Issue 9110); DOI:10.1016/S0140-6736(05)79169-8
Journal Article > ResearchFull Text
Trop Med Int Health. 2007 February 1; Volume 12 (Issue 2); DOI:10.1111/j.1365-3156.2006.01786.x
Janssens B, Van Herp M, Goubert L, Chan S, Uong S, et al.
Trop Med Int Health. 2007 February 1; Volume 12 (Issue 2); DOI:10.1111/j.1365-3156.2006.01786.x
OBJECTIVES: To compare the efficacy and tolerability of dihydroartemisinin-piperaquine (DHA-PQP) with that of a 3-day regimen of mefloquine and artesunate (MAS3) for the treatment of uncomplicated falciparum malaria in Cambodia. METHOD: Randomized open-label non-inferiority study over 64 days. RESULTS: Four hundred and sixty-four patients were included in the study. The polymerase chain reaction genotyping-adjusted cure rates on day 63 were 97.5% (95% confidence interval, CI, 93.8-99.3) for DHA-PQP and 97.5% (95% CI, 93.8-99.3) for MAS3, P = 1. There were no serious adverse events, but significantly more episodes of vomiting (P = 0.03), dizziness (P = 0.002), palpitations (P = 0.04), and sleep disorders (P = 0.03) reported in the MAS3 treatment group, consistent with the side-effect profile of mefloquine. CONCLUSIONS: DHA-PQP was as efficacious as MAS3, but much better tolerated, making it more appropriate for use in a routine programme setting. This highly efficacious, safe and more affordable fixed-dose combination could become the treatment of choice for Plasmodium falciparum malaria in Cambodia.