http://fieldresearch.msf.org/msf Le syst&egrave;me de dépôt institutionnel MSF obtient, conserve, indexe et distribue les documents électroniques. Chercher dans ce canal chercher http://fieldresearch.msf.org/msf/simple-search http://hdl.handle.net/10144/37312 Titre: Evaluation of a systematic substitution of zidovudine for stavudine-based HAART in a program setting in rural Cambodia<br/><br/>Auteur(s): Isaakidis, Petros; Raguenaud, Marie-Eve; Phe, Thong; Khim, Sam A; Kuoch, Sokhan; Khem, Sopheap; Reid, Tony; Arnould, Line<br/><br/>Résumé: OBJECTIVE:: To evaluate a treatment strategy of substituting zidovudine (ZDV) for stavudine (d4T)-based highly active antiretroviral therapy (HAART), aimed at preventing d4T-associated toxicity, in a programmatic setting in rural Cambodia. METHODS:: Survival probability, CD4 gain, anemia incidence, and factors associated with severe anemia were analyzed in a cohort of adult patients switched from d4T- to ZDV-containing regimens from March 2006 to March 2007. RESULTS:: Among 527 patients systematically switched to ZDV after d4T-based HAART for a median of 18 months, 4 (0.8%) patients died, 2 (0.4%) were lost to follow-up, 18 (3.4%) were transferred out, and 503 (95.4%) remained on HAART. Median CD4 gain was +263.5 cells/muL (interquartile range: 89.25-369.5) at 24 months. Within 1 year after the switch, 21.9% and 7.1% of patients developed anemia (grades 1-4) and severe anemia (grades 3-4), respectively. Low body mass index (</=18) and low CD4 count (<200 cells/muL) at the time of switch were factors associated with severe anemia. Additional follow-up visits for laboratory monitoring and adherence counseling, increased absenteeism from work, and transportation costs for the patients were noted. CONCLUSIONS:: The switch strategy of substituting ZDV for d4T-based HAART led to satisfactory overall clinical outcomes. However, it resulted in a relatively high incidence of mild to severe anemia and increased burden for the program and the patients. http://hdl.handle.net/10144/37332 Titre: Assessing antimalarial efficacy in a time of change to artemisinin-based combination therapies: The role of Médecins Sans Frontières<br/><br/>Auteur(s): Guthmann, Jean-Paul; Checchi, Francesco; van den Broek, Ingrid; Balkan, Suna; van Herp, Michel; Comte, Eric; Bernal, Oscar; Kindermans, Jean-Marie; Venis, Sarah; Legros, Dominique; Guerin, Philippe J. http://hdl.handle.net/10144/33194 Titre: Second-line antiretroviral therapy in resource-limited settings: the experience of Médecins Sans Frontières<br/><br/>Auteur(s): Pujades-Rodríguez, Mar; O'Brien, Daniel P; Humblet, Pierre; Calmy, Alexandra<br/><br/>Résumé: OBJECTIVES: To describe the use of second-line protease-inhibitor regimens in Médecins Sans Frontières HIV programmes, and determine switch rates, clinical outcomes, and factors associated with survival. DESIGN/METHODS: We used patient data from 62 Médecins Sans Frontières programmes and included all antiretroviral therapy-naive adults (> 15 years) at the start of antiretroviral therapy and switched to a protease inhibitor-containing regimen with at least one nucleoside reverse transcriptase inhibitor change after more than 6 months of nonnucleoside reverse transcriptase inhibitor first-line use. Cumulative switch rates and survival curves were estimated using Kaplan-Meier methods, and mortality predictors were investigated using Poisson regression. RESULTS: Of 48,338 adults followed on antiretroviral therapy, 370 switched to a second-line regimen after a median of 20 months (switch rate 4.8/1000 person-years). Median CD4 cell count at switch was 99 cells/microl (interquartile ratio 39-200; n = 244). A lopinavir/ritonavir-based regimen was given to 51% of patients and nelfinavir-based regimen to 43%; 29% changed one nucleoside reverse transcriptase inhibitor and 71% changed two nucleoside reverse transcriptase inhibitors. Median follow-up on second-line antiretroviral therapy was 8 months, and probability of remaining in care at 12 months was 0.86. Median CD4 gains were 90 at 6 months and 135 at 12 months. Death rates were higher in patients in World Health Organization stage 4 at antiretroviral therapy initiation and in those with CD4 nadir count less than 50 cells/microl. CONCLUSION: The rate of switch to second-line treatment in antiretroviral therapy-naive adults on non-nucleoside reverse transcriptase inhibitor-based first-line antiretroviral therapy was relatively low, with good early outcomes observed in protease inhibitor-based second-line regimens. Severe immunosuppression was associated with increased mortality on second-line treatment. http://hdl.handle.net/10144/31336 Titre: [Frequency of sexually transmitted infections and related factors in Pweto, Democratic Republic of Congo, 2004]<br/><br/>Auteur(s): Luque Fernández, Miguel Angel; Bauernfeind, Ariane; Palma Urrutia, Pedro Pablo; Ruiz Pérez, Isabel<br/><br/>Résumé: OBJECTIVES: To estimate the prevalence of genital ulcer and urethral discharge in Pweto, Democratic Republic of Congo, and to analyze the association between the estimated prevalence and age, marital status, profession, and number of sexual partners. METHODS: We performed a descriptive cross-sectional study through a survey conducted in May 2004 in a representative sample of 106 men in Pweto aged between 15 and 65 years old, with a precision of 9.5%. Questionnaire items about current or previous ulceration and urethral discharge where self-reported and referred to the previous year as of the date of the survey. To study the associations, crude and adjusted odds ratios (OR) were calculated using multivariate logistic regression. RESULTS: The prevalence was 39.6% (95% confidence interval [CI], 30-49) for urethral discharge and 33% (95%CI, 24-42) for genital ulcer. Soldiers were identified as a risk group independently of age, the number of sexual partners during the previous year, and marital status. The multivariate analysis showed an adjusted OR of 3.25 (95%CI, 1.10-9.95) (p < 0.05) for the frequency of urethral discharge in soldiers compared with other professions. CONCLUSIONS: The high prevalence of sexually transmitted infections in Pweto and the associated factors identified prompted the initiation of a controlled condom donation program for soldiers. In conflict situations with a high prevalence of sexually transmitted infections and lack of health services, humanitarian aid organizations should implement prevention activities focused on risk groups. http://hdl.handle.net/10144/37334 Titre: Substandard medicines in resource-poor settings: A problem that can no longer be ignored<br/><br/>Auteur(s): Caudron, J-M; Ford, N; Henkens, M; Macé, C; Kiddle-Monroe, R; Pinel, J<br/><br/>Résumé: The circulation of substandard medicines in the developing world is a serious clinical and public health concern. Problems include under or over concentration of ingredients, contamination, poor quality ingredients, poor stability and inadequate packaging. There are multiple causes. Drugs manufactured for export are not regulated to the same standard as those for domestic use, while regulatory agencies in the less-developed world are poorly equipped to assess and address the problem. A number of recent initiatives have been established to address the problem, most notably the WHO pre-qualification programme. However, much more action is required. Donors should encourage their partners to include more explicit quality requirements in their tender mechanisms, while purchasers should insist that producers and distributors supply drugs that comply with international quality standards. Governments in rich countries should not tolerate the export of substandard pharmaceutical products to poor countries, while developing country governments should improve their ability to detect substandard medicines. http://hdl.handle.net/10144/37354 Titre: How developing world concerns need to be part of drug development plans: A case study of four emerging antiretrovirals<br/><br/>Auteur(s): van Roey, Jens; von Schoen-Angerer, Tido; Ford, Nathan; Calmy, Alexandra<br/><br/>Résumé: Clinical trials are usually designed to meet registration requirements in developed countries, and do not always address key concerns for use in developing countries. Four late-stage investigational new drugs - rilpivirine, etravirine, raltegravir and maraviroc - show potential to improve antiretroviral therapy. However, a number of issues could limit their use in developing countries, including dose selection, treatment strategy, combination with other drugs, use in specific populations and reliance on expensive tests. Key research questions relevant for developing countries need to be answered early in the drug development process to ensure maximum benefit for the majority. http://hdl.handle.net/10144/37333 Titre: Adapting the DOTS framework for tuberculosis control to the management of non-communicable diseases in sub-Saharan Africa<br/><br/>Auteur(s): Harries, Anthony D; Jahn, Andreas; Zachariah, Rony; Enarson, Donald http://hdl.handle.net/10144/29474 Titre: Tough choices: tenofovir, tenders and treatment<br/><br/>Auteur(s): Ford, Nathan; Gray, Andy; Venter, Francois<br/><br/>Résumé: Scaling up antiretroviral therapy (ART) in developing countries would not have been possible without market competition, which has driven down the price of standard first-line ARV drugs from more than US$12,000 per person per year in 2000 to US$99 today. However, access to new, second-line ARVs remains largely restricted to originator (patented) drugs. This causes significant challenges in countries where access to newer drugs is becoming inceasingly important as programmes mature and face challenges related to drug toxicity and resistance. Toxicity, in particular, has emerged as a major reason for individual drug switches and regimen changes, and is strongly implicated in decreasing adherence. http://hdl.handle.net/10144/29477 Titre: Concordant HIV Infection and Visceral Leishmaniasis in Ethiopia: The Influence of Antiretroviral Treatment and Other Factors on Outcome<br/><br/>Auteur(s): ter Horst, Rachel; Collin, Simon; Ritmeijer, Koert; Bogale, Adey; Davidson, R N http://hdl.handle.net/10144/29332 Titre: Should active recruitment of health workers from sub-Saharan Africa be viewed as a crime?<br/><br/>Auteur(s): Mills, Edward J; Schabas, William A; Volmink, Jimmy; Walker, Roderick; Ford, Nathan; Katabira, Elly; Anema, Aranka; Joffres, Michel; Cahn, Pedro; Montaner, Julio