2564 research outputs found
Sort by
Sustainable HIV Treatment in Africa Through Viral-Load-Informed Differentiated Care
No full textThere are inefficiencies in current approaches to monitoring patients on antiretroviral therapy in sub-Saharan Africa. Patients typically attend clinics every 1 to 3 months for clinical assessment. The clinic costs are comparable with the costs of the drugs themselves and CD4 counts are measured every 6 months, but patients are rarely switched to second-line therapies. To ensure sustainability of treatment programmes, a transition to more cost-effective delivery of antiretroviral therapy is needed. In contrast to the CD4 count, measurement of the level of HIV RNA in plasma (the viral load) provides a direct measure of the current treatment effect. Viral-load-informed differentiated care is a means of tailoring care so that those with suppressed viral load visit the clinic less frequently and attention is focussed on those with unsuppressed viral load to promote adherence and timely switching to a second-line regimen. The most feasible approach to measuring viral load in many countries is to collect dried blood spot samples for testing in regional laboratories; however, there have been concerns over the sensitivity and specificity of this approach to define treatment failure and the delay in returning results to the clinic. We use modelling to synthesize evidence and evaluate the cost-effectiveness of viral-load-informed differentiated care, accounting for limitations of dried blood sample testing. We find that viral-load-informed differentiated care using dried blood sample testing is cost-effective and is a recommended strategy for patient monitoring, although further empirical evidence as the approach is rolled out would be of value. We also explore the potential benefits of point-of-care viral load tests that may become available in the future
Factors Associated with Virological Failure and Suppression after Enhanced Adherence Counselling, in Children, Adolescents and Adults on Antiretroviral Therapy for HIV in Swaziland
Get PDFThis study explores factors associated with virological detectability, and viral re-suppression after enhanced adherence counselling, in adults and children on antiretroviral therapy (ART) in Swaziland
Emergency response to Typhoon Haiyan
Get PDFThe Intersectional Philippines MSF Typhoon Haiyan Emergency Response review was requested by the Executive Committee of MSF. It was designed to examine the operational choices of each Operational Centre, the perceived cost disparity, the role of the MSF regional offices in the emergency and the external perception regarding MSF’s added value in the response. The review took place during August and November 2014. Overall the response by MSF to Typhoon Haiyan was well perceived by all involved. The response was timely compared to other actors, but the first MSF consultations were only done six days after the emergency and MSF’s surgical services commenced only after two weeks. The very low surgical activities done by OCB and OCBA raised the question of pertinence of the decision to send and setup an OT, especially as they were not functioning until two weeks after the typhoon. The presence of five OCs allowed for a good geographical coverage which was appreciated by the authorities and it allowed for a good contextual understanding and provision of a wide range of assistance. There was a cost disparity regarding the different operational choices and strategies which resulted in a wide difference between budgets. The MSF response was perceived as having had an added value and played an important role in the overall response, especially regarding the input provided by MSF as part of the foreign medical teams. The main obstacle remains the difficulty of access in natural disasters. From an MSF perspective the issue of supply remains a constraint, even though this doesn’t seem to be the case for OCB. How many resources are allocated towards managing supply in an emergency is still an issue for some OCs
“Now there is trouble with cows.....”
Get PDFA medical anthropological inquiry on the perceptions of health and illness and health seeking behaviour amongst the Dinka in the Abyei Administrative Area
Doing no harm? Adverse events in a nation-wide cohort of patients with multidrug-resistant tuberculosis in Nigeria
Get PDFAdverse events (AEs) of second line anti-tuberculosis drugs (SLDs) are relatively well documented. However, the actual burden has rarely been described in detail in programmatic settings. We investigated the occurrence of these events in the national cohort of multidrug-resistant tuberculosis (MDR-TB) patients in Nigeria
Personal Protective Equipment for Filovirus Epidemics: A Call for Better Evidence
Get PDFPersonal protective equipment (PPE) is an important part of worker protection during filovirus outbreaks. The need to protect against a highly virulent fluid-borne pathogen in the tropical environment imposes a heat stress on the wearer that is itself a safety risk. No evidence supports the choice of PPE employed in recent outbreaks, and standard testing procedures employed by the protective garment industry do not well simulate filovirus exposure. Further research is needed to determine the appropriate PPE for filoviruses and the heat stress that it imposes
Surgery in low-income countries during crisis: experience at Médecins Sans Frontières facilities in 20 countries between 2008 and 2014
Get PDFThe global burden of trauma and surgical conditions fall disproportionately on low- and middle-income countries (LMICs).(1, 2) Inopportunely, developing countries are least equipped to provide essential surgical care.(3) Consequently, LMICs have a significant burden of unmet surgical needs.(4) When these fragile health systems are disrupted by conflict, a natural disaster or an epidemic the volume and quality of surgical care decreases even further. This article is protected by copyright. All rights reserved
An Analysis of Cesarean Section and Emergency Hernia Ratios as Markers of Surgical Capacity in Low-Income Countries Affected by Humanitarian Emergencies from 2008 - 2014 at Médecins sans Frontières Operations Centre Brussels Projects
Get PDFSurgical capacity assessments in low-income countries have demonstrated critical deficiencies. Though vital for planning capacity improvements, these assessments are resource intensive and impractical during the planning phase of a humanitarian crisis. This study aimed to determine cesarean sections to total operations performed (CSR) and emergency herniorrhaphies to all herniorrhaphies performed (EHR) ratios from Médecins Sans Frontières Operations Centre Brussels (MSF-OCB) projects and examine if these established metrics are useful proxies for surgical capacity in low-income countries affected by crisis
Research Protocol - Cholera and pregnancy in Haiti: description of pregnant patients presenting to MSF OCA cholera treatment centers, September 2011-December 2013.
No full textResearch ProtocolPrincipal objective\ud
To understand the demographic, clinical and outcome profiles of pregnant patients that presented with cholera infection to Figaro CTC and CRUO CTU between September 2011 and December 2013.\ud
Specific objectives\ud
1. To determine the clinical presentation, treatment regimens and outcomes of pregnant patients with cholera seen at Figaro CTC and CRUO CTU between September 2011 and December 2014;\ud
\ud
2. To identify factors related to age, clinical presentation or treatment that favour positive outcomes in pregnant patients with cholera presenting to Figaro CTC and CRUO CTU between September 2011 and December 2014;\ud
\ud
3. To describe the evolution of patient profiles of pregnant cholera cases at Figaro CTC and CRUO CTU between September 2011 and December 2014 over time;\ud
\ud
4. To describe the evolution of patient profiles of pregnant cholera cases at Figaro CTC and CRUO CTU between September 2011 and December 2014 in terms of spatial characteristics.\ud
\ud
5. To identify differences in outcomes of patients presenting to a CTC (Figaro CTC) compared to a specialized maternal CTU (CRUO CTU).\ud
\ud
6. To identify differences in outcomes after the implementation of new, more aggressive, maternal rehydration guidelines in June 2013
