Conference Material > Video (talk)
Farber J
MSF Scientific Days International 2021: Innovation. 2021 May 20
Conference Material > Video (talk)
Broban A
Epicentre Scientific Day Paris 2021. 2021 August 4
Conference Material > Video (talk)
Arnikov A, Agan S
MSF Scientific Days LatAm 2022. 2022 November 30
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Conference Material > Abstract
Ben-Farhat J
Epicentre Scientific Day Paris 2022. 2022 June 1
INTRODUCTION
The COVID-19 pandemic and the measures taken to limit its spread have severely disrupted health systems and medical care. People living with HIV (PLHIV) suffer from high levels of comorbidities and stigma, and often faced challenges in access to care prior to the pandemic. The aim of this study was to explore the extent to which the pandemic and the public health measures have affected medical care for PLHIV. The study took place in two different contexts in terms of care and experience of the pandemic where MSF operates, in Arua (Uganda) and Chiradzulu (Malawi).
METHODS
We conducted a multicentric mixed-methods study . The quantitative component explored patients’ retention in care and viral suppression using programmatic data routinely collected from January 2018 to April 2021 . The qualitative study investigated patient perspectives and perceptions of the impact of Covid-19 and the public health and social measures on their lives and ability to manage their health, and on HIV care. The interviews with patients were conducted from January to June 2021.
RESULTS
From 2020 to 2021, we observed a 15% decrease in active cohort among adults on any regimen and a 17% decrease among children and adolescents in Arua. During the same period in Chiradzulu, the first- and second-line cohorts decreased in size (10% drop and 12% drop, respectively). In addition, we observed a reduction in ART initiations and in clinical consultations at the start of pandemic (50% and 68% in Arua and 34% and 60% in Chiradzulu, respectively) and a gradual decrease in viral load coverage. In Uganda, the lockdown affected patients’ and caregivers’ livelihoods, education, access to food and psychosocial wellbeing negatively, which at times affected their ability to manage HIV condition at home and to adhere. Adolescents lost support, experienced increasing HIV stigma, and started to provide for themselves. In Malawi, patients and caregivers emphasized the impact of the pandemic and public health measures on livelihoods and food security and noted the reduction or absence of MSF social support activities during this time. Also, the fear of COVID at health facilities and the confusion and lack of communication about regarding day-to-day changes in activities was disturbing to both patients and staff.
CONCLUSION
The COVID-19 epidemic and public health measures had an important negative impact on HIV care in the health facilities and in the community in Arua and Chiradzulu. To ensure a conducive environment for patients’ access to essential HIV care and treatment during potential future outbreaks requires continued collaboration with the national authorities and advocacy for more non-violent and less authoritarian ways of implementing restrictions. In addition, innovative public health information campaigns about COVID-19 and care services, to reduce fear of disease and to dispel rumours and misinformation are recommended.
KEY MESSAGE
COVID-19 has severely disrupted access to health systems and treatment. The measures put in place to limit the spread of the epidemic have altered people's bearings. How has the pandemic in Arua and Chiradzulu affected PLHIV, who already suffer from higher levels of mental health problems, comorbidities and stigma?
This abstract is not to be quoted for publication.
The COVID-19 pandemic and the measures taken to limit its spread have severely disrupted health systems and medical care. People living with HIV (PLHIV) suffer from high levels of comorbidities and stigma, and often faced challenges in access to care prior to the pandemic. The aim of this study was to explore the extent to which the pandemic and the public health measures have affected medical care for PLHIV. The study took place in two different contexts in terms of care and experience of the pandemic where MSF operates, in Arua (Uganda) and Chiradzulu (Malawi).
METHODS
We conducted a multicentric mixed-methods study . The quantitative component explored patients’ retention in care and viral suppression using programmatic data routinely collected from January 2018 to April 2021 . The qualitative study investigated patient perspectives and perceptions of the impact of Covid-19 and the public health and social measures on their lives and ability to manage their health, and on HIV care. The interviews with patients were conducted from January to June 2021.
RESULTS
From 2020 to 2021, we observed a 15% decrease in active cohort among adults on any regimen and a 17% decrease among children and adolescents in Arua. During the same period in Chiradzulu, the first- and second-line cohorts decreased in size (10% drop and 12% drop, respectively). In addition, we observed a reduction in ART initiations and in clinical consultations at the start of pandemic (50% and 68% in Arua and 34% and 60% in Chiradzulu, respectively) and a gradual decrease in viral load coverage. In Uganda, the lockdown affected patients’ and caregivers’ livelihoods, education, access to food and psychosocial wellbeing negatively, which at times affected their ability to manage HIV condition at home and to adhere. Adolescents lost support, experienced increasing HIV stigma, and started to provide for themselves. In Malawi, patients and caregivers emphasized the impact of the pandemic and public health measures on livelihoods and food security and noted the reduction or absence of MSF social support activities during this time. Also, the fear of COVID at health facilities and the confusion and lack of communication about regarding day-to-day changes in activities was disturbing to both patients and staff.
CONCLUSION
The COVID-19 epidemic and public health measures had an important negative impact on HIV care in the health facilities and in the community in Arua and Chiradzulu. To ensure a conducive environment for patients’ access to essential HIV care and treatment during potential future outbreaks requires continued collaboration with the national authorities and advocacy for more non-violent and less authoritarian ways of implementing restrictions. In addition, innovative public health information campaigns about COVID-19 and care services, to reduce fear of disease and to dispel rumours and misinformation are recommended.
KEY MESSAGE
COVID-19 has severely disrupted access to health systems and treatment. The measures put in place to limit the spread of the epidemic have altered people's bearings. How has the pandemic in Arua and Chiradzulu affected PLHIV, who already suffer from higher levels of mental health problems, comorbidities and stigma?
This abstract is not to be quoted for publication.
Conference Material > Abstract
Haider A, Finger F
Epicentre Scientific Day Paris 2021. 2021 June 10
In this presentation, we provide an overview of the evolution of the COVID-19 pandemic in Yemen and Afghanistan and describe the characteristics of patients seen selected MSF health facilities.
YEMEN
The true burden of the COVID-19 pandemic in Yemen is largely underestimated. The official surveillance data is limited to the southern governorates only. The country has experienced two waves so far and until May 31 2021, the total number of confirmed cases reported was 6 746 with 1 322 associated deaths. With limited testing capacity, PCR tests are spared for suspect cases presenting with severe symptoms only. MSF has been operating several COVID-19 projects in the southern and northern parts since the beginning of the pandemic. To date, MSF France has treated 2 138 COVID-19 patients. The in-hospital mortality was 30%. This presentation provides an overview of the evolution of the pandemic in Yemen and a description of patients seen at MSF health facilities.
AFGHANISTAN
Afghanistan is currently experiencing a third wave of COVID-19. To date (31 May 2021) a total of nearly 73 000 confirmed cases and 3 000 deaths have been reported. The PCR testing capacity remains limited, particularly outside the national capital, and the characteristics of suspected patients are poorly described. MSF has bee supporting the pandemic response in Herat, the regional capital of Western Afghanistan, by running a COVID-19 triage at the Herat Regional Hospital and through case management. To date, over 31 000 patients have been received at the triage, and, if required, oriented towards appropriate care. In addition, patient data collected at the triage facility are a valuable surveillance tool since they allow to follow epidemic trends and to describe patient characteristics. Here we give an update about the current situation in Afghanistan and Herat and describe the characteristics of patients through the three epidemic waves.
YEMEN
The true burden of the COVID-19 pandemic in Yemen is largely underestimated. The official surveillance data is limited to the southern governorates only. The country has experienced two waves so far and until May 31 2021, the total number of confirmed cases reported was 6 746 with 1 322 associated deaths. With limited testing capacity, PCR tests are spared for suspect cases presenting with severe symptoms only. MSF has been operating several COVID-19 projects in the southern and northern parts since the beginning of the pandemic. To date, MSF France has treated 2 138 COVID-19 patients. The in-hospital mortality was 30%. This presentation provides an overview of the evolution of the pandemic in Yemen and a description of patients seen at MSF health facilities.
AFGHANISTAN
Afghanistan is currently experiencing a third wave of COVID-19. To date (31 May 2021) a total of nearly 73 000 confirmed cases and 3 000 deaths have been reported. The PCR testing capacity remains limited, particularly outside the national capital, and the characteristics of suspected patients are poorly described. MSF has bee supporting the pandemic response in Herat, the regional capital of Western Afghanistan, by running a COVID-19 triage at the Herat Regional Hospital and through case management. To date, over 31 000 patients have been received at the triage, and, if required, oriented towards appropriate care. In addition, patient data collected at the triage facility are a valuable surveillance tool since they allow to follow epidemic trends and to describe patient characteristics. Here we give an update about the current situation in Afghanistan and Herat and describe the characteristics of patients through the three epidemic waves.
Journal Article > ResearchFull Text
Vaccine. 2021 November 9; Volume 9 (Issue 11); 1303.; DOI:10.3390/vaccines9111303
Urrunaga-Pastor D, Herrera-Anazco P, Uyen-Cateriano A, Toro-Huamanchumo CJ, Rodriguez-Morales AJ, et al.
Vaccine. 2021 November 9; Volume 9 (Issue 11); 1303.; DOI:10.3390/vaccines9111303
We aimed to estimate the prevalence and factors associated with parents' non-intention to vaccinate their children and adolescents against COVID-19 in Latin America and the Caribbean (LAC). We performed a secondary analysis using a database generated by the University of Maryland and Facebook (Facebook, Inc., Menlo Park, CA, USA). We included adult (18 and over) Facebook users residing in LAC who responded to the survey between 20 May 2021 and 14 July 2021. We included sociodemographic characteristics, comorbidities, mental health, economic and food insecurity, compliance with mitigation strategies against COVID-19, and practices related to vaccination against this disease. We estimated the crude (cPR) and adjusted (aPR) prevalence ratios with their respective 95%CI. We analyzed a sample of 227,740 adults from 20 LAC countries. The prevalence of parents' non-intention to vaccinate their children and adolescents against COVID-19 was 7.8% (n = 15,196). An age above 35 years old, educational level above college, compliance with physical distancing, use of masks, having economic insecurity, having had COVID-19, anxiety symptoms, depressive symptoms, having a chronic condition or two or more comorbidities, and being vaccinated were associated with a lower prevalence of non-intention to vaccinate children and adolescents against COVID-19. Living in a town, a village, or a rural area was associated with a higher prevalence of non-intention to vaccinate children and adolescents against COVID-19. Approximately nine out of ten parents in LAC intended to vaccinate their children and adolescents against COVID-19. Our results allow for understanding parents' intentions to vaccinate children and adolescents and help promote and develop education strategies for national vaccination plans against COVID-19.
Journal Article > ResearchFull Text
BMJ Open. 2022 September 20; Volume 12 (Issue 9); e060276.; DOI:10.1136/bmjopen-2021-060276
Dujmovic M, Roederer T, Frison S, Melki C, Lauvin T, et al.
BMJ Open. 2022 September 20; Volume 12 (Issue 9); e060276.; DOI:10.1136/bmjopen-2021-060276
INTRODUCTION
French nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment.
METHODS
A cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021.
RESULTS
The average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff.
CONCLUSION
Despite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy, etc) that affected case fatality and residents’ and caregivers’ overall well-being and mental health.
French nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment.
METHODS
A cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021.
RESULTS
The average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff.
CONCLUSION
Despite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy, etc) that affected case fatality and residents’ and caregivers’ overall well-being and mental health.
Journal Article > ReviewFull Text
BMJ Glob Health. 2023 February 1; Volume 8 (Issue 2); e011431.; DOI:10.1136/bmjgh-2022-011431
Evaborhene NA, Udokanma EE, Adebisi YA, Okorie CE, Kafuko Z, et al.
BMJ Glob Health. 2023 February 1; Volume 8 (Issue 2); e011431.; DOI:10.1136/bmjgh-2022-011431
The call to strengthen global health governance against future outbreaks through a binding treaty on pandemics has attracted global attention and opinion. Yet, few of these perspectives have reflected the voices from early career global health professionals in Africa. We share our perspectives on the Pandemic Treaty, and specifically our scepticism on the limitations of the current top-down approach of the treaty, and the need for the treaty to centre equity, transparency and fairness to ensure equitable and effective cooperation in response to global health emergencies. We also highlight the challenges intergovernmental organisations for health faced in coordinating nation states during the COVID-19 crisis and how a Pandemic Treaty would address these challenges. We argue that lessons from the COVID-19 pandemic provide a critical opportunity to strengthen regional institutions in Africa—particularly in a multipolar world with huge disparities in power and resources. However, addressing these challenges and achieving this transformation may not be easy. Fiscal space in many countries remains constrained now more than ever. New tools such as the Pandemic Fund should be designed in ways that consider the specific needs and capacities of countries. Therefore, strengthening countries’ capacities overall requires an increase in domestic investment. This paper calls for wider structural reforms such as debt restructuring among other tools to strengthen countries’ capacities.
Journal Article > ResearchFull Text
PLOS One. 2023 May 18; Volume 18 (Issue 5); e0278251.; DOI:10.1371/journal.pone.0278251
Otshudiema JO, Folefack GLT, Nsio JM, Kakema CH, Minikulu L, et al.
PLOS One. 2023 May 18; Volume 18 (Issue 5); e0278251.; DOI:10.1371/journal.pone.0278251
A community-based coronavirus disease (COVID-19) active case-finding strategy using an antigen-detecting rapid diagnostic test (Ag-RDT) was implemented in the Democratic Republic of Congo (DRC) to enhance COVID-19 case detection. With this pilot community-based active case finding and response program that was designed as a clinical, prospective testing performance, and implementation study, we aimed to identify insights to improve community diagnosis and rapid response to COVID-19. This pilot study was modeled on the DRC’s National COVID-19 Response Plan and the COVID-19 Ag-RDT screening algorithm defined by the World Health Organization (WHO), with case findings implemented in 259 health areas, 39 health zones, and 9 provinces. In each health area, a 7-member interdisciplinary field team tested the close contacts (ring strategy) and applied preventive and control measures to each confirmed case. The COVID-19 testing capacity increased from 0.3 tests per 10,000 inhabitants per week in the first wave to 0.4, 1.6, and 2.2 in the second, third, and fourth waves, respectively. From January to November 2021, this capacity increase contributed to an average of 10.5% of COVID-19 tests in the DRC, with 7,110 positive Ag-RDT results for 40,226 suspected cases and close contacts who were tested (53.6% female, median age: 37 years [interquartile range: 26.0–50.0)]. Overall, 79.7% (n = 32,071) of the participants were symptomatic and 7.6% (n = 3,073) had comorbidities. The Ag-RDT sensitivity and specificity were 55.5% and 99.0%, respectively, based on reverse transcription polymerase chain reaction analysis, and there was substantial agreement between the tests (k = 0.63). Despite its limited sensitivity, the Ag-RDT has improved COVID-19 testing capacity, enabling earlier detection, isolation, and treatment of COVID-19 cases. Our findings support the community testing of suspected cases and asymptomatic close contacts of confirmed cases to reduce disease spread and virus transmission.
Journal Article > CommentaryFull Text
BMJ Glob Health. 2021 October 25; Volume 6 (Issue 10); e006913.; DOI:10.1136/bmjgh-2021-006913
Martins D, Ribeiro I, Potet J
BMJ Glob Health. 2021 October 25; Volume 6 (Issue 10); e006913.; DOI:10.1136/bmjgh-2021-006913
SUMMARY POINTS
• Despite inherent differences, Snakebite Envenoming and COVID-19 have much in common in terms of research and development (R&D) challenges and opportunities.
• Both crises require a diversified portfolio of R&D solutions, ranging from diagnostics to treatments, that can effectively work and be accessible in different resource settings.
• Collaborative clinical research and streamlined regulatory pathways are critical to accelerate these candidates in the R&D pipeline.
• Transformative progress is possible with a concerted approach that aligns strong political will, coordinated financing and the needs of the most marginalised communities.
• Despite inherent differences, Snakebite Envenoming and COVID-19 have much in common in terms of research and development (R&D) challenges and opportunities.
• Both crises require a diversified portfolio of R&D solutions, ranging from diagnostics to treatments, that can effectively work and be accessible in different resource settings.
• Collaborative clinical research and streamlined regulatory pathways are critical to accelerate these candidates in the R&D pipeline.
• Transformative progress is possible with a concerted approach that aligns strong political will, coordinated financing and the needs of the most marginalised communities.