• Access to healthcare for the most vulnerable migrants: a humanitarian crisis

      Pottie, Kevin; Martin, Jorge Pedro; Cornish, Stephen; Biorklund, Linn Maria; Gayton, Ivan; Doerner, Frank; Schneider, Fabien (BioMed Central (Springer Science), 2015-05-07)
      A series of Médecins Sans Frontières projects for irregular migrants over the past decade have consistently documented high rates of 14 physical and sexual trauma, extortion and mental illness amidst severe healthcare, food, and housing limitations. Complex interventions were needed to begin to address illness and barriers to healthcare and to help restore dignity to the most vulnerable women, children and men. Promising interventions included mobile clinics, use of cultural mediators, coordination with migrant-friendly entities and NGOs and integrating advocacy programs and mental health care with medical services. Ongoing interventions, research and coordination are needed to address this neglected humanitarian crisis.
    • Evaluation of HIV testing algorithms in Ethiopia: the role of the tie-breaker algorithm and weakly reacting test lines in contributing to a high rate of false positive HIV diagnoses

      Shanks, Leslie; Siddiqui, M; Kliescikova, Jarmila; Pearce, Neil; Ariti, Cono; Muluneh, Libsework; Pirou, Erwan; Ritmeijer, Koert; Masiga, Johnson; Abebe, Almaz (BioMed Central (Springer Science), 2015-02-03)
      BackgroundIn Ethiopia a tiebreaker algorithm using 3 rapid diagnostic tests (RDTs) in series is used to diagnose HIV. Discordant results between the first 2 RDTs are resolved by a third `tiebreaker¿ RDT. Médecins Sans Frontières uses an alternate serial algorithm of 2 RDTs followed by a confirmation test for all double positive RDT results. The primary objective was to compare the performance of the tiebreaker algorithm with a serial algorithm, and to evaluate the addition of a confirmation test to both algorithms. A secondary objective looked at the positive predictive value (PPV) of weakly reactive test lines.MethodsThe study was conducted in two HIV testing sites in Ethiopia. Study participants were recruited sequentially until 200 positive samples were reached. Each sample was re-tested in the laboratory on the 3 RDTs and on a simple to use confirmation test, the Orgenics Immunocomb Combfirm® (OIC). The gold standard test was the Western Blot, with indeterminate results resolved by PCR testing.Results2620 subjects were included with a HIV prevalence of 7.7%. Each of the 3 RDTs had an individual specificity of at least 99%. The serial algorithm with 2 RDTs had a single false positive result (1 out of 204) to give a PPV of 99.5% (95% CI 97.3%-100%). The tiebreaker algorithm resulted in 16 false positive results (PPV 92.7%, 95% CI: 88.4%-95.8%). Adding the OIC confirmation test to either algorithm eliminated the false positives. All the false positives had at least one weakly reactive test line in the algorithm. The PPV of weakly reacting RDTs was significantly lower than those with strongly positive test lines.ConclusionThe risk of false positive HIV diagnosis in a tiebreaker algorithm is significant. We recommend abandoning the tie-breaker algorithm in favour of WHO recommended serial or parallel algorithms, interpreting weakly reactive test lines as indeterminate results requiring further testing except in the setting of blood transfusion, and most importantly, adding a confirmation test to the RDT algorithm. It is now time to focus research efforts on how best to translate this knowledge into practice at the field level.Trial registrationClinical Trial registration #: NCT01716299.
    • Health in the service of state-building in fragile and conflict affected contexts: an additional challenge in the medical-humanitarian environment

      Philips, Mit; Derderian, Katharine (BioMed Central (Springer Science), 2015-03-29)
      Global health policy and development aid trends also affect humanitarian health work. Reconstruction, rehabilitation and development initiatives start increasingly earlier after crisis, unleashing tensions between development and humanitarian paradigms. Recently, development aid shows specific interest in contexts affected by conflict and fragility, with increasing expectations for health interventions to demonstrate transformative potential, including towards more resilient health systems as a contribution to state-building agendas.
    • Hepatitis B virus in the Lao People's Democratic Republic: A Cross Sectional Serosurvey in Different Cohorts.

      Black, Antony P; Nouanthong, Phonethipsavanh; Nanthavong, Naphavan; Souvannaso, Chanthasone; Vilivong, Keooudomphone; Jutavijittum, Prapan; Samountry, Bounthome; Lütteke, Nina; Hübschen, Judith M; Goossens, Sylvie; et al. (BioMed Central (Springer Science), 2014-08-23)
      Despite hepatitis B vaccination at birth and at 6, 10 and 14 weeks of age, hepatitis B virus (HBV) infection continues to be endemic in the Lao People's Democratic Republic (PDR). We carried out a cross-sectional serological study in infants, pre-school children, school pupils and pregnant women to determine their burden of disease, risk of infection and vaccination status.
    • Impact of variability in adherence to HIV antiretroviral therapy on the immunovirological response and mortality

      Boussari, Olayidé; Subtil, Fabien; Genolini, Christophe; Bastard, Mathieu; Iwaz, Jean; Fonton, Noël; Etard, Jean-François; Ecochard, René (BioMed Central (Springer Science), 2015-02-05)
      Several previous studies have shown relationships between adherence to HIV antiretroviral therapy (ART) and the viral load, the CD4 cell count, or mortality. However, the impact of variability in adherence to ART on the immunovirological response does not seem to have been investigated yet.
    • In Vivo Efficacy of Artesunate-Amodiaquine and Artemether-Lumefantrine for the Treatment of Uncomplicated Falciparum Malaria: an Open-Randomized, Non-Inferiority Clinical Trial in South Kivu, Democratic Republic of Congo

      de Wit, M; Funk, AL; Moussally, K; Nkuba, DA; Siddiqui, R; Bil, K; Piriou, E; Bart, A; Bahizi Bizoza, P; Bousema, T (BioMed Central (Springer Science), 2016)
      Between 2009 and 2012, malaria cases diagnosed in a Médecins sans Frontières programme have increased fivefold in Baraka, South Kivu, Democratic Republic of the Congo (DRC). The cause of this increase is not known. An in vivo drug efficacy trial was conducted to determine whether increased treatment failure rates may have contributed to the apparent increase in malaria diagnoses.
    • Measles in Democratic Republic of Congo: an outbreak description from Katanga, 2010--2011

      Grout, L; Minetti, A; Hurtado, N; François, G; Fermon, F; Chatelain, A; Harczi, G; Ngoie, J; N Goran, A; Luquero, F J; et al. (BioMed Central (Springer Science), 2013-05-22)
      BACKGROUND: The Democratic Republic of Congo experiences regular measles outbreaks. From September 2010, the number of suspected measles cases increased, especially in Katanga province, where Medecins sans Frontieres supported the Ministry of Health in responding to the outbreak by providing free treatment, reinforcing surveillance and implementing non-selective mass vaccination campaigns. Here, we describe the measles outbreak in Katanga province in 2010--2011 and the results of vaccine coverage surveys conducted after the mass campaigns. METHODS: The surveillance system was strengthened in 28 of the 67 health zones of the province and we conducted seven vaccination coverage surveys in 2011. RESULTS: The overall cumulative attack rate was 0.71% and the case fatality ratio was 1.40%.The attack rate was higher in children under 4 and decreased with age. This pattern was consistent across districts and time. The number of cases aged 10 years and older barely increased during the outbreak. CONCLUSIONS: Early investigation of the age distribution of cases is a key to understanding the epidemic, and should guide the vaccination of priority age groups.
    • Patch-Testing for the Management of Hypersensitivity Reactions to Second-Line Anti-Tuberculosis Drugs: A Case Report

      Khan, S; Andries, A; Pherwani, A; Saranchuk, P; Isaakidis, P (BioMed Central (Springer Science), 2014-08-15)
      The second-line anti-tuberculosis drugs used in the treatment of multidrug-resistant tuberculosis often cause adverse events, especially in patients co-infected with the human immunodeficiency virus. Severe hypersensitivity reactions due to these drugs are rare and there is little published experience to guide their management.
    • ReRouting Biomedical Innovation: Observations from a Mapping of the Alternative Research and Development (R&D) Landscape

      Greenberg, A; Kiddell-Monroe, R (BioMed Central (Springer Science), 2016-09-14)
      In recent years, the world has witnessed the tragic outcomes of multiple global health crises. From Ebola to high prices to antibiotic resistance, these events highlight the fundamental constraints of the current biomedical research and development (R&D) system in responding to patient needs globally.To mitigate this lack of responsiveness, over 100 self-identified "alternative" R&D initiatives, have emerged in the past 15 years. To begin to make sense of this panoply of initiatives working to overcome the constraints of the current system, UAEM began an extensive, though not comprehensive, mapping of the alternative biomedical R&D landscape. We developed a two phase approach: (1) an investigation, via the RE:Route Mapping, of both existing and proposed initiatives that claim to offer an alternative approach to R&D, and (2) evaluation of those initiatives to determine which are in fact achieving increased access to and innovation in medicines. Through phase 1, the RE:Route Mapping, we examined 81 initiatives that claim to redress the inequity perpetuated by the current system via one of five commonly recognized mechanisms necessary for truly alternative R&D.Preliminary analysis of phase 1 provides the following conclusions: 1. No initiative presents a completely alternative model of biomedical R&D. 2. The majority of initiatives focus on developing incentives for drug discovery. 3. The majority of initiatives focus on rare diseases or diseases of the poor and marginalized. 4. There is an increasing emphasis on the use of push, pull, pool, collaboration and open mechanisms alongside the concept of delinkage in alternative R&D. 5. There is a trend towards public funding and launching of initiatives by the Global South. Given the RE:Route Mapping's inevitable limitations and the assumptions made in its methodology, it is not intended to be the final word on a constantly evolving and complex field; however, its findings are significant. The Mapping's value lies in its timely and unique insight into the importance of ongoing efforts to develop a new global framework for biomedical R&D. As we progress to phase 2, an evaluation tool for initiatives focused on identifying which approaches have truly achieved increased innovation and access for patients, we aim to demonstrate that there are a handful of initiatives which represent some, but not all, of the building blocks for a new approach to R&D.Through this mapping and our forthcoming evaluation, UAEM aims to initiate an evidence-based conversation around a truly alternative biomedical R&D model that serves people rather than profits.
    • Selection of Plasmodium Falciparum pfcrt and pfmdr1 Polymorphisms After Treatment with Artesunate-Amodiaquine Fixed Dose Combination or Artemether-Lumefantrine in Liberia

      Otienoburu, SD; Maïga-Ascofaré, O; Schramm, B; Jullien, V; Jones, JJ; Zolia, YM; Houzé, P; Ashley, EA; Kiechel, JR; Guérin, PJ; et al. (BioMed Central (Springer Science), 2016-09-05)
      Plasmodium falciparum uncomplicated malaria can successfully be treated with an artemisinin-based combination therapy (ACT). However resistance is spreading to the different ACT compounds; the artemisinin derivative and the partner drug. Studies of P. falciparum polymorphisms associated with drug resistance can provide a useful tool to track resistance and guide treatment policy as well as an in-depth understanding of the development and spread of resistance.
    • Significant sequelae after bacterial meningitis in Niger: a cohort study

      Jusot, J-F; Tohon, Z; Yazi, A A; Collard, J-M; Epidemiology/Health-Environment-Climate Unit, Centre de Recherche Médicale et Sanitaire, PO Box 10887, Niamey, Niger (BioMed Central (Springer Science), 2013-05-21)
      Beside high mortality, acute bacterial meningitis may lead to a high frequency of neuropsychological sequelae. The Sahelian countries belonging to the meningitis belt experience approximately 50% of the meningitis cases occurring in the world. Studies in Africa have shown that N. meningitidis could cause hearing loss in up to 30% of the cases, exceeding sometimes measles. The situation is similar in Niger which experiences yearly meningitis epidemics and where rehabilitation wards are rare and hearing aids remain unaffordable. The aim of this study was to estimate the frequency of neuropsychological sequelae after acute bacterial meningitis in four of the eight regions of Niger.
    • Treating drug-resistant tuberculosis in a low-intensity chronic conflict setting in India

      Armstrong, E; Das, M; Mansoor, H; Babu, R B; Isaakidis, P (BioMed Central (Springer Science), 2014-12-01)