http://fieldresearch.msf.org/msf MSF captures, stores, indexes, preserves, and distributes digital research material. Search the Channel search http://fieldresearch.msf.org/msf/simple-search http://hdl.handle.net/10144/90941 Title: Rethinking surgical care in conflict.<br/><br/>Authors: Chu, Kathryn; Trelles, Miguel; Ford, Nathan http://hdl.handle.net/10144/91160 Title: Assessment of two malaria rapid diagnostic tests in children under five years of age, with follow-up of false-positive pLDH test results, in a hyperendemic falciparum malaria area, Sierra Leone.<br/><br/>Authors: Gerstl, Sibylle; Dunkley, Sophie; Mukhtar, Ahmed; De Smet, Martin; Baker, Samuel; Maikere, Jacob<br/><br/>Abstract: ABSTRACT: BACKGROUND: Most malaria rapid diagnostic tests (RDTs) use HRP2 detection, including Paracheck-Pf(R), but their utility is limited by persistent false positivity after treatment. PLDH-based tests become negative more quickly, but sensitivity has been reported below the recommended standard of 90%. A new pLDH test, CareStartTM three-line P.f/PAN-pLDH, claims better sensitivity with continued rapid conversion to negative. The study aims were to 1) compare sensitivity and specificity of CareStartTM to Paracheck-Pf(R) to diagnose falciparum malaria in children under five years of age, 2) assess how quickly false-positive CareStartTM tests become negative and 3) evaluate ease of use and inter-reader agreement of both tests. METHODS: Participants were included if they were aged between two and 59 months, presenting to a Medecins Sans Frontieres community health centre in eastern Sierra Leone with suspected malaria defined as fever (axillary temperature > 37.5degreesC) and/or history of fever in the previous 72 hours and no signs of severe disease. The same capillary blood was used for the RDTs and the blood slide, the latter used as the gold standard reference. All positive participants were treated with supervised artesunate and amodiaquine treatment for three days. Participants with a persistent false-positive CareStartTM, but a negative blood slide on Day 2, were followed with repeated CareStartTM and blood slide tests every seven days until CareStartTM became negative or a maximum of 28 days. RESULTS: Sensitivity of CareStartTM was 99.4% (CI 96.8-100.0, 168/169) and of Paracheck-Pf(R), 98.8% (95% CI 95.8-99.8, 167/169). Specificity of CareStartTM was 96.0% (CI 91.9-98.4, 167/174) and of Paracheck-Pf(R), 74.7% (CI 67.6-81.0, 130/174) (p<0.001). Neither test showed any change in sensitivity with decreasing parasitaemia. Of the 155 eligible follow-up CareStartTM participants, 63.9% (99/155) had a false-positive test on day 2, 21.3% (33/155) on day 7, 5.8% (9/155) on day 14, 1.9% (3/155) on day 21 and 0.6% (1/155) on day 28. The median time for test negativity was seven days. CareStartTM was as easy to use and interpret as Paracheck-Pf(R) with excellent inter-reader agreement. CONCLUSIONS: Both RDTs were highly sensitive, met WHO standards for the detection of falciparum malaria monoinfections where parasitaemia was >100 parasites/mul and were easy to use. CareStartTM persistent false positivity decreased quickly after successful anti-malarial treatment, making it a good choice for a RDT for a hyperendemic falciparum malaria area. http://hdl.handle.net/10144/90194 Title: MSF ERB Members' CVs Jan 2010 http://hdl.handle.net/10144/90161 Title: Infection control during filoviral hemorrhagic fever outbreaks<br/><br/>Authors: Raabe V, Mutyaba I, Roddy P, et al.<br/><br/>Abstract: Interviews were conducted with health workers and community members in Masindi,Uganda on improving the acceptability of infection control measures used during an Ebolaoutbreak. Measures that promote cultural sensitivity and transparency of control activitieswere preferred and should be employed in future control efforts. We suggest assessingthe practicality of body bags with viewing windows, and face shields with or without chinprotectors, in future outbreaks. http://hdl.handle.net/10144/91158 Title: Outcomes after chemotherapy with WHO category II regimen in a population with high prevalence of drug resistant tuberculosis.<br/><br/>Authors: Matthys, Francine; Rigouts, Leen; Sizaire, Vinciane; Vezhnina, Natalia; Lecoq, Maryvonne; Golubeva, Vera; Portaels, Françoise; Van der Stuyft, Patrick; Kimerling, Michael<br/><br/>Abstract: 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. http://hdl.handle.net/10144/88062 Title: Directly observed antiretroviral therapy: a systematic review and meta-analysis of randomised clinical trials.<br/><br/>Authors: Ford, Nathan; Nachega, Jean B; Engel, Mark E; Mills, Edward J<br/><br/>Abstract: BACKGROUND: Directly observed therapy has been recommended to improve adherence for patients with HIV infection who are on highly active antiretroviral therapy, but the benefit and cost-effectiveness of this approach has not been established conclusively. We did a systematic review and meta-analysis of randomised trials of directly observed versus self-administered antiretroviral treatment. METHODS: We did duplicate searches of databases (from inception to July 27, 2009), searchable websites of major HIV conferences (up to July, 2009), and lay publications and websites (March-July, 2009) to identify randomised trials assessing directly observed therapy to promote adherence to antiretroviral therapy in adults. Our primary outcome was virological suppression at study completion. We calculated relative risks (95% CIs), and pooled estimates using a random-effects method. FINDINGS: 12 studies met our inclusion criteria; four of these were done in groups that were judged to be at high risk of poor adherence (drug users and homeless people). Ten studies reported on the primary outcome (n=1862 participants); we calculated a pooled relative risk of 1.04 (95% CI 0.91-1.20, p=0.55), and noted moderate heterogeneity between the studies (I(2)= 53.8%, 95% CI 0-75.7, p=0.0247) for directly observed versus self-administered treatment. INTERPRETATION: Directly observed antiretroviral therapy seems to offer no benefit over self-administered treatment, which calls into question the use of such an approach to support adherence in the general patient population. FUNDING: None. http://hdl.handle.net/10144/88074 Title: "Paradoxical" immune-mediated reactions to Mycobacterium ulcerans during antibiotic treatment: a result of treatment success, not failure.<br/><br/>Authors: O'Brien, Daniel P; Robson, Michael E; Callan, Peter P; McDonald, Anthony H<br/><br/>Abstract: We present the first clinical descriptions of immune-mediated paradoxical reactions to effective antibiotic treatment for Mycobacterium ulcerans infection, which result in clinical deterioration after initial improvement. Recognition of this phenomenon could prevent unnecessary changes to antibiotic regimens, and might obviate the need for, or reduce the extent of, further surgery. (MJA 2009; 191: 564-566). http://hdl.handle.net/10144/88073 Title: Scaling up antiretroviral therapy in Malawi-implications for managing other chronic diseases in resource-limited countries.<br/><br/>Authors: Harries, Anthony D; Zachariah, Rony; Jahn, Andreas; Schouten, Erik J; Kamoto, Kelita<br/><br/>Abstract: The national scale-up of antiretroviral therapy (ART) in Malawi is based on the public health approach, with principles and practices borrowed from the successful DOTS (directly observed treatment, short course) tuberculosis control framework. The key principles include political commitment, free care, and standardized systems for case finding, treatment, recording and reporting, and drug procurement. Scale-up of ART started in June 2004, and by December 2008, 223,437 patients were registered for treatment within a health system that is severely underresourced. The Malawi model for delivering lifelong ART can be adapted and used for managing patients with chronic noncommunicable diseases, the burden of which is already high and continues to grow in low-income and middle-income countries. This article discusses how the principles behind the successful Malawi model of ART delivery can be applied to the management of other chronic diseases in resource-limited settings and how this paradigm can be used for health systems strengthening. http://hdl.handle.net/10144/87054 Title: Human African Trypanosomiasis: Real Obstacles to Elimination<br/><br/>Authors: Serge Kazadi, Michel Quere, Jacqueline Tong, Claude Mahoudeau, François Chappuis<br/><br/>Abstract: Significant progress has been made in controlling human African trypanosomiasis (HAT) caused by T.b. gambiense as evidenced by the clear decline in the number of reported cases in recent years. Now the prevailing discourse is about the possible elimination of HAT and the need to integrate treatment for it into existing health structures. However, “Hot spots” still exist and one of which is the northeastern region of Orientale Province in the Democratic Republic of Congo (DRC). In this region there is neither a monitoring system nor working health centres capable of diagnosing and treating patients.An assessment carried out by the DRC’s national program to fight HAT and Doctors Without Borders/Médecins Sans Frontières (MSF) in 2004 discovered an alarming prevalence (2.1%) in the region. Between June 2007 and March 2009 MSF launched a HAT monitoring program in the Doruma, Ango, and Bili health zones. The overall prevalence was found to be 3.4%. Of the 46,601 people tested (18,559 through passive screening and 28,042 through active screening), 1,570 people were infected with T.b. gambiense. Of that group, 947 (60%) were in the first phase of HAT, indicating intense transmission of the disease. Due to the acute insecurity in this region of the DRC, MSF had to suspend its projects in March 2009, even though the limits of the disease foci had not yet been reached. Moreover, the disease could spread further by the displacement of entire populations who are fleeing the insecurity and heading for areas that had been previously “cleaned” of HAT.The intervention, which took place during a crisis situation, leads us to question the feasibility of eliminating HAT and integrating treatment in crisis areas where health services are at a minimum.<br/><br/>Description: Abstract presented at: 5ème Congrès International de Pathologie Infectieuse et Parasitaire - en présence du Ministre de la Santé, Kinshasa, DRC, November 2009 http://hdl.handle.net/10144/88061 Title: Operational research in low-income countries: what, why, and how?<br/><br/>Authors: Zachariah, Rony; Harries, Anthony D; Ishikawa, Nobukatsu; Rieder, Hans L; Bissell, Karen; Laserson, Kayla; Massaquoi, Moses; Van Herp, Micheal; Reid, Tony<br/><br/>Abstract: Operational research is increasingly being discussed at institutional meetings, donor forums, and scientific conferences, but limited published information exists on its role from a disease-control and programme perspective. We suggest a definition of operational research, clarify its relevance to infectious-disease control programmes, and describe some of the enabling factors and challenges for its integration into programme settings. Particularly in areas where the disease burden is high and resources and time are limited, investment in operational research and promotion of a culture of inquiry are needed so that health care can become more efficient. Thus, research capacity needs to be developed, specific resources allocated, and different stakeholders (academic institutions, national programme managers, and non-governmental organisations) brought together in promoting operational research.