• Effectiveness of melarsoprol and eflornithine as first-line regimens for gambiense sleeping sickness in nine Médecins Sans Frontières programmes.

      Balasegaram, M; Young, H; Chappuis, F; Priotto, G; Raguenaud, M E; Checchi, F; Médecins Sans Frontières-United Kingdom, 67-74 Saffron Hill, London EC1N 8QX, UK. (2008-10-21)
      This paper describes the effectiveness of first-line regimens for stage 2 human African trypanosomiasis (HAT) due to Trypanosoma brucei gambiense infection in nine Médecins Sans Frontières HAT treatment programmes in Angola, Republic of Congo, Sudan and Uganda. Regimens included eflornithine and standard- and short-course melarsoprol. Outcomes for 10461 naïve stage 2 patients fitting a standardised case definition and allocated to one of the above regimens were analysed by intention-to-treat analysis. Effectiveness was quantified by the case fatality rate (CFR) during treatment, the proportion probably and definitely cured and the Kaplan-Meier probability of relapse-free survival at 12 months and 24 months post admission. The CFR was similar for the standard- and short-course melarsoprol regimens (4.9% and 4.2%, respectively). The CFR for eflornithine was 1.2%. Kaplan-Meier survival probabilities varied from 71.4-91.8% at 1 year and 56.5-87.9% at 2 years for standard-course melarsoprol, to 73.0-91.1% at 1 year for short-course melarsoprol, and 79.9-97.4% at 1 year and 68.6-93.7% at 2 years for eflornithine. With the exception of one programme, survival at 12 months was >90% for eflornithine, whilst for melarsoprol it was <90% except in two sites. Eflornithine is recommended where feasible, especially in areas with low melarsoprol effectiveness.
    • Eflornithine is a cost-effective alternative to melarsoprol for the treatment of second-stage human West African trypanosomiasis in Caxito, Angola.

      Robays, J; Raguenaud, M E; Josenando, T; Boelaert, M; Institute of Tropical Medicine, Antwerp, Belgium. Medecins Sans Frontieres Belgium. National Sleeping Sickness control program of Angola (2008-02)
      OBJECTIVE: To compare the cost-effectiveness of eflornithine and melarsoprol in the treatment of human African trypanosomiasis. METHOD: We used data from a Médecins Sans Frontières treatment project in Caxito, Angola to do a formal cost-effectiveness analysis, comparing the efficiency of an eflornithine-based approach with melarsoprol. Endpoints calculated were: cost per death avoided; incremental cost per additional life saved; cost per years of life lost (YLL) averted; incremental cost per YLL averted. Sensitivity analysis was done for all parameters for which uncertainty existed over the plausible range. We did an analysis with and without cost of trypanocidal drugs included. RESULTS: Effectiveness was 95.6% for melarsoprol and 98.7% for eflornithine. Cost/patient was 504.6 for melarsoprol and 552.3 for eflornithine, cost per life saved was 527.5 USD for melarsoprol and 559.8 USD for eflornithine without cost of trypanocidal drugs but it increases to 600.4 USD and 844.6 USD per patient saved and 627.6 USD and 856.1 USD per life saved when cost of trypanocidal drugs are included. Incremental cost-effectiveness ratio is 1596 USD per additional life saved and 58 USD per additional life year saved in the baseline scenario without cost of trypanocidal drugs but it increases to 8169 USD per additional life saved and 299 USD per additional life year saved if costs of trypanocidal drugs are included. CONCLUSION: Eflornithine saves more lives than melarsoprol, but melarsoprol is slightly more cost-effective. Switching from melarsoprol to eflornithine can be considered as a cost-effective option according to the WHO choice criteria.
    • Epidemiology and Clinical Features of Patients with Visceral Leishmaniasis Treated by an MSF Clinic in Bakool Region, Somalia, 2004-2006.

      Raguenaud, M E; Jansson, A; Vanlerberghe, V; Van der Auwera, G; Deborggraeve, S; Dujardin, J C C; Orfanos, G; Reid, T; Boelaert, M; Médecins Sans Frontières, Medical Department, Brussels, Belgium. (Public Library of Science, 2007)
      BACKGROUND: There are few reports describing the epidemiology of visceral leishmaniasis (VL) in Somalia. Over the years 2002 to 2005, a yearly average of 140 patients were reported from the Huddur centre in Bakool region, whereas in 2006, this number rose to 1002 patients. Given the limited amount of information on VL and the opportunity to compare features with the studies done in 2000 in this part of Somalia, we describe the epidemiologic and clinical features of patients who presented to the Huddur treatment centre of Bakool region, Somalia, using data routinely collected over a five-year observation period (2002-2006). METHODOLOGY: Methods used included the analysis of routine data on VL cases treated in the Huddur treatment centre, a retrospective study of records of patients admitted between 2004 and 2006, community leaders interviews, and analysis of blood specimens taken for parasite species identification in Antwerp Institute of Tropical Medicine. PRINCIPAL FINDINGS: A total of 1671 VL patients were admitted to the Huddur centre from January 2002 until December 2006. Nearly all patients presented spontaneously to the health centre. Since 2002, the average patient load was stable, with an average of 140 admissions per year. By the end of 2005, the number of admissions dramatically increased to reach a 7-fold increase in 2006. The genotype of L. donovani identified in 2006 was similar to the one reported in 2002. 82% of total patients treated for VL originated from two districts of Bakool region, Huddur and Tijelow districts. Clinical recovery rate was 93.2% and case fatality rate 3.9%. CONCLUSIONS: After four years of low but constant VL case findings, a major increase in VL was observed over a 16-month period in the Huddur VL centre. The profile of the patients was pediatric and mortality relatively low. Decentralized treatment centers, targeted active screening, and community sensitization will help decrease morbidity and mortality from VL in this endemic area. The true magnitude of VL in Somalia remains unknown. Further documentation to better understand transmission dynamics and thus define appropriate control measures will depend on the stability of the context and safe access to the Somali population.
    • Evaluation of a systematic substitution of zidovudine for stavudine-based HAART in a program setting in rural Cambodia

      Isaakidis, P; Raguenaud, M E; Phe, T; Khim, S; Kuoch, S; Khem, S; Reid, T; Arnould, L; Médecins Sans Frontières OCB, Phnom Penh, Cambodia; Chronic Diseases Clinic, Donkeo Provincial Referral Hospital, Ministry of Health, Takeo, Cambodia; Médecins Sans Frontières OCB, Brussels, Belgium (2008-09-01)
    • High adherence to anti-tuberculosis treatment among patients attending a hospital and slum health centre in Nairobi, Kenya

      Raguenaud, M E; Zachariah, R; Massaquoi, M; Ombeka, V; Ritter, H; Chakaya, J; Medecins Sans Fronteres (Taylor & Francis, 2008-10-22)
      We conducted a study among patients with tuberculosis (TB) attending two health facilities - a hospital and a slum health centre - in Nairobi, in order to: (a) assess adherence to anti-TB treatment; and (b) identify reasons for non-adherence. Urine Isoniazid (INH), used as a proxy for overall adherence, was detected in 142 (97%) (95% CI 92-99) of the 147 patients involved in the study. Five patients had no INH detected in urine and had run out of pills within the previous three days. The reasons included: not having enough pills to last until the next appointment date (1); and losing some pills (1). Anti-TB treatment adherence is high, and is reassuring information as Kenya plans to change to a superior first-line regimen based on rifampicin throughout the course of anti-TB treatment. Providing patients with a three-day "excess stock" of pills would provide a "safety net" for continued treatment.
    • Idiopathic CD4+ T-lymphocytopenia with cryptococcal meningitis: first case report from Cambodia.

      Augusto, E; Raguenaud, M E; Kim, C; Mony, M; Isaakidis, P; Médecins Sans Frontières Belgium, Phnom Penh, Cambodia MSFB-Phnom-Penh-Med@brussels.msf.org. (2009-07)
      We report on a patient with cryptococcal meningitis with CD4+ T-lymphocytopenia and no evidence of HIV infection.