Journal Article > CommentaryFull Text
Lancet. 2003 March 8; Volume 361 (Issue 9360); 875.; DOI:10.1016/S0140-6736(03)12717-1
Ford NP, Cantau N, Jeanmart H
Lancet. 2003 March 8; Volume 361 (Issue 9360); 875.; DOI:10.1016/S0140-6736(03)12717-1
Journal Article > ResearchFull Text
BMC Medical Ethics. 2015 June 2; Volume 16 (Issue 1); DOI:10.1186/s12910-015-0032-x
Shanks L, Moroni C, Rivera IC, Price DJ, Clementine SB, et al.
BMC Medical Ethics. 2015 June 2; Volume 16 (Issue 1); DOI:10.1186/s12910-015-0032-x
Community consultation is increasingly recommended, and in some cases, required by ethical review boards for research that involves higher levels of ethical risk such as international research and research with vulnerable populations. In designing a randomised control trial of a mental health intervention using a wait list control, we consulted the community where the research would be undertaken prior to finalising the study protocol. The study sites were two conflict-affected locations: Grozny in the Chechen Republic and Kitchanga in eastern Democratic Republic of Congo.
Journal Article > Meta-AnalysisFull Text
PLOS Med. 2012 August 28; Volume 9 (Issue 8); DOI:10.1371/journal.pmed.1001300
Ahuja SD, Ashkin D, Avendano M, Banerjee R, Bayona J, et al.
PLOS Med. 2012 August 28; Volume 9 (Issue 8); DOI:10.1371/journal.pmed.1001300
Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB.
Journal Article > CommentaryFull Text
BMJ. 1998 January 10; Volume 316; 138.; DOI:10.1136/bmj.316.7125.138
Veeken H
BMJ. 1998 January 10; Volume 316; 138.; DOI:10.1136/bmj.316.7125.138
SUMMARY POINTS
-- Russia is finding it increasingly difficult to look after all its citizens. Alcohol misusers and homeless and elderly people fight to survive.
-- A recent problem is the rapid rise in the number of injecting drug misusers. In Moscow an estimated 100 000 users form an important core group for HIV transmission.
-- With the health system in a state of collapse and sexually transmitted diseases on the rise, all the ingredients for a HIV epidemic are present. By the turn of the century the Ministry of Health forecasts there will be 800 000 people who are HIV positive.
-- Médecins Sans Frontières has started an HIV prevention campaign in cooperation with the government.
-- Russia is finding it increasingly difficult to look after all its citizens. Alcohol misusers and homeless and elderly people fight to survive.
-- A recent problem is the rapid rise in the number of injecting drug misusers. In Moscow an estimated 100 000 users form an important core group for HIV transmission.
-- With the health system in a state of collapse and sexually transmitted diseases on the rise, all the ingredients for a HIV epidemic are present. By the turn of the century the Ministry of Health forecasts there will be 800 000 people who are HIV positive.
-- Médecins Sans Frontières has started an HIV prevention campaign in cooperation with the government.
Journal Article > ResearchFull Text
PLOS One. 2009 November 23; Volume 4 (Issue 11); DOI:10.1371/journal.pone.0007954
Matthys F, Rigouts L, Sizaire V, Vezhnina N, Lecoq M, et al.
PLOS One. 2009 November 23; Volume 4 (Issue 11); DOI:10.1371/journal.pone.0007954
Standard short course chemotherapy is recommended by the World Health Organization to control tuberculosis worldwide. However, in settings with high drug resistance, first line standard regimens are linked with high treatment failure. We evaluated treatment outcomes after standardized chemotherapy with the WHO recommended category II retreatment regimen in a prison with a high prevalence of drug resistant tuberculosis (TB). A cohort of 233 culture positive TB patients was followed through smear microscopy, culture, drug susceptibility testing and DNA fingerprinting at baseline, after 3 months and at the end of treatment. Overall 172 patients (74%) became culture negative, while 43 (18%) remained positive at the end of treatment. Among those 43 cases, 58% of failures were determined to be due to treatment with an inadequate drug regimen and 42% to either an initial mixed infection or re-infection while under treatment. Overall, drug resistance amplification during treatment occurred in 3.4% of the patient cohort. This study demonstrates that treatment failure is linked to initial drug resistance, that amplification of drug resistance occurs, and that mixed infection and re-infection during standard treatment contribute to treatment failure in confined settings with high prevalence of drug resistance.
Journal Article > CommentaryFull Text
Bull World Health Organ. 2014 September 22; Volume 92 (Issue 12); 903-908.; DOI:10.2471/BLT.14.142372
Heiden D, Tun NL, Maningding E, Heiden M, Rose-Nussbaumer J, et al.
Bull World Health Organ. 2014 September 22; Volume 92 (Issue 12); 903-908.; DOI:10.2471/BLT.14.142372
PROBLEM
Acquired immunodeficiency syndrome (AIDS)-related cytomegalovirus (CMV) retinitis continues to be a neglected source of blindness in resource-poor settings. The main issue is lack of capacity to diagnose CMV retinitis in the clinical setting where patients receive care and all other opportunistic infections are diagnosed.
APPROACH
We developed and implemented a four-day workshop to train clinicians working in human immunodeficiency virus (HIV) clinics how to perform binocular indirect ophthalmoscopy and diagnose CMV retinitis. Workshops comprised both classroom didactic instruction and direct clinical eye examinations in patients with advanced AIDS. Between 2007 and 2013, 14 workshops were conducted in China, Myanmar and the Russian Federation.
LOCAL SETTING
Workshops were held with local clinicians at HIV clinics supported by nongovernmental organizations, public-sector municipal hospitals and provincial infectious disease referral hospitals. Each setting had limited or no access to locally- trained ophthalmologists, and an HIV-infected population with advanced disease.
RELEVANT CHANGES
Clinicians learnt how to do binocular indirect ophthalmoscopy and to diagnose CMV retinitis. One year after the workshop, 32/38 trainees in Myanmar did systematic eye examination for early diagnosis of CMV retinitis as standard care for at-risk patients. In China and the Russian Federation, the success rates were lower, with 10/15 and 3/5 trainees, respectively, providing follow-up data.
LESSONS LEARNT
Skills necessary for screening and diagnosis of CMV retinitis can be taught in a four-day task-oriented training workshop. Successful implementation depends on institutional support, ongoing training and technical support. The next challenge is to scale up this approach in other countries.
Acquired immunodeficiency syndrome (AIDS)-related cytomegalovirus (CMV) retinitis continues to be a neglected source of blindness in resource-poor settings. The main issue is lack of capacity to diagnose CMV retinitis in the clinical setting where patients receive care and all other opportunistic infections are diagnosed.
APPROACH
We developed and implemented a four-day workshop to train clinicians working in human immunodeficiency virus (HIV) clinics how to perform binocular indirect ophthalmoscopy and diagnose CMV retinitis. Workshops comprised both classroom didactic instruction and direct clinical eye examinations in patients with advanced AIDS. Between 2007 and 2013, 14 workshops were conducted in China, Myanmar and the Russian Federation.
LOCAL SETTING
Workshops were held with local clinicians at HIV clinics supported by nongovernmental organizations, public-sector municipal hospitals and provincial infectious disease referral hospitals. Each setting had limited or no access to locally- trained ophthalmologists, and an HIV-infected population with advanced disease.
RELEVANT CHANGES
Clinicians learnt how to do binocular indirect ophthalmoscopy and to diagnose CMV retinitis. One year after the workshop, 32/38 trainees in Myanmar did systematic eye examination for early diagnosis of CMV retinitis as standard care for at-risk patients. In China and the Russian Federation, the success rates were lower, with 10/15 and 3/5 trainees, respectively, providing follow-up data.
LESSONS LEARNT
Skills necessary for screening and diagnosis of CMV retinitis can be taught in a four-day task-oriented training workshop. Successful implementation depends on institutional support, ongoing training and technical support. The next challenge is to scale up this approach in other countries.
Journal Article > CommentaryFull Text
Lancet. 2004 September 11; Volume 364 (Issue 9438); 1008.; DOI:10.1016/S0140-6736(04)17029-3
de Jong K, van der Kam S, Ford NP, Hargreaves S, van Oosten R, et al.
Lancet. 2004 September 11; Volume 364 (Issue 9438); 1008.; DOI:10.1016/S0140-6736(04)17029-3
Conference Material > Poster
Abramenko K, Shchenina K, Stringer B, Koerner L, Tan C, et al.
MSF Scientific Days International 2021: Research. 2021 May 18
Journal Article > ResearchFull Text
Public Health Action. 2019 September 21
England K, Masini T, Fajardo E
Public Health Action. 2019 September 21
The World Health Organization (WHO) currently recommends Xpert® MTB/RIF as the initial test for all people with presumptive tuberculosis (TB). A number of challenges have been reported, however, in using this technology, particularly in low-resource settings. Here we examine these challenges, and provide our perspective of the barriers to Xpert scale-up as assessed through a survey in 16 TB burden countries in which the Médecins Sans Frontières is present. We observed that the key barriers to scale-up include a lack of policy adoption and implementation of WHO recommendations for the use of Xpert, resulting from high costs, poor sensitisation of clinical staff and a high turnover of trained laboratory
staff; insufficient service and maintenance provision provided by the manufacturer; and inadequate resources for sustainability and expansion. Funding is a critical issue as countries begin to transition out of support from the Global Fund. While it is clear that there is still an urgent need for research into and development of a rapid, affordable point-of-care test for TB that is truly adapted for use in low-resource settings, countries in the meantime need to develop functional and sustainable Xpert networks in order to close the existing diagnostic gap.
staff; insufficient service and maintenance provision provided by the manufacturer; and inadequate resources for sustainability and expansion. Funding is a critical issue as countries begin to transition out of support from the Global Fund. While it is clear that there is still an urgent need for research into and development of a rapid, affordable point-of-care test for TB that is truly adapted for use in low-resource settings, countries in the meantime need to develop functional and sustainable Xpert networks in order to close the existing diagnostic gap.
Journal Article > ResearchFull Text
Confl Health. 2013 September 16; Volume 7 (Issue 1); DOI:10.1186/1752-1505-7-19
de Jong K, Shanks L, Ariti C, Denault M, Siddiqui R, et al.
Confl Health. 2013 September 16; Volume 7 (Issue 1); DOI:10.1186/1752-1505-7-19
Medecins Sans Frontieres (MSF) provides individual counselling interventions in medical humanitarian programmes in contexts affected by conflict and violence. Although mental health and psychosocial interventions are a common part of the humanitarian response, little is known about how the profile and outcomes for individuals seeking care differs across contexts. We did a retrospective analysis of routine programme data to determine who accessed MSF counselling services and why, and the individual and programmatic risk factors for poor outcomes.