• Mixed methods evaluation of MSF primary care based NCD service in Irbid, Jordon: February 2017 - February 2018

      Ansbro, Eimhin; Homan, Tobias; Jobanputra, Kiran; Rehr, Manuela; Ellithy, S; Quasim, Jamil; Tanni, Hashem; Garrett, Peter; Shoaib, Muhammad; Bil, Karla; Roberts, Bayard; Perel, Pablo; Garry, Sylvia; Prieto, David; Sadique, Zia; Altarawneh, Mohammad; Assad, Majed; Fardous, T; Zindah, Myassar; MSF; LSHTM; MoH Jordon (2018-09)
      Non-communicable diseases (NCD) are the leading causes of mortality and morbidity among Syrian refugees in Jordan. Following the onset of the Syrian crisis in 2011, the Jordanian health system was overwhelmed by the chronic disease burden among this group. In response, in late 2014, Médecins sans Frontières Operational Centre Amsterdam (MSF-OCA) opened an NCD service at two primary care centres targeting non-camp based Syrian refugees and vulnerable Jordanians in Irbid, north Jordan, using a multi-disciplinary primary care model. The programme focused on the NCDs causing most deaths in pre-war Syria: cardiovascular disease (CVD), including hypertension, diabetes (DM), and chronic respiratory disease. The model evolved in response to patient needs, programmatic lessons learned and contextual changes. A programme evaluation was done, aiming to refine the model, generate evidence on its feasibility, acceptability and effectiveness and learn lessons to inform translation of a similar model of NCD care to comparable humanitarian settings.
    • Evaluation of NCD service integrated into a general OPD and HIV service in Matsapha, Eswatini, 2017

      Ansbro, Eimhin; Meyer, Inga; Okello, Velephi; Verdecchia, Maria; Keus, Kees; Piening, Turid; Sadique, Zia; Roberts, Bayard; Perel, Pablo; Jobanputra, Kiran; MSF OCA; LSHTM; MSF Eswatini; MoH Eswatini (2018-09)
      Background: Swaziland faces a growing noncommunicable disease (NCD) burden alongside HIV and TB epidemics. MSF provided primary care services, HIV and TB programmes at Matsapha MOH comprehensive clinic from 2011 to 2018. With MOH collaboration, MSF integrated NCD care into general outpatient (OPD), HIV and TB services in April 2016. A retrospective analysis of routine clinical and programmatic data was undertaken to examine programme processes, effectiveness and costs in order to strengthen the service, facilitate handover and inform MSF and MOH policy and scale-up. The specific objectives were to: 1) describe the care model; 2) examine its effectiveness; 3) examine predictors of NCD treatment outcomes, including HIV status; and 4) determine incremental total and unit service costs. Methods: We undertook a retrospective evaluation of routine data from Matsapha Comprehensive Care Clinic, located outside Manzini, Eswatini’s largest city. This comprised: care model description; routine cohort data analysis to investigate effectiveness of care and predictors of reaching clinical targets; and incremental costing analysis. Enrolment criteria included: a diagnosis of established cardiovascular disease (CVD), hypertension, diabetes mellitus (DM) types 1 or 2, chronic respiratory disease; and committing to regular attendance. Routine clinical data of adults aged 18 or over, enrolled from July 2016 to July 2017, were analysed using descriptive statistics and logistic regression modelling. A costing analysis from the providers’ perspective utilised routine accounting, service and consumption data. Results: Model of care description: We implemented: staff training; locally adapted protocols; chronic care files; a revised appointment system and patient flow; and a new database. Doctors reviewed patients at first visit, and saw complex or unstable patients monthly, resulting in significant workload. Nurses reviewed stable patients three-monthly; patients requiring treatment initiation/adjustment, ad hoc blood testing or external referral were referred back to doctors. Thus, task sharing to nurses did not occur as intended. Specific health literacy, adherence support groups or lay counsellor involvement were lacking. Integrating NCD care resulted in longer consultation times. Repeated medication stock outs occurred despite MSF’s efforts to support the MOH supply chain. Routine cohort data analysis: Of 895 enrolled patients, mean age was 55 years (IQR 5.3 to 10.6); 66% were women, of whom 54.6% were obese. Mean follow-up was 8 months; 16.3% defaulted during the study period. The most common diagnoses at enrolment were: hypertension (85.7%) and DM type 2 (37.4%), asthma (3.8%) and DM type 1 (1.2%). 3 patients had known CVD; none had known chronic obstructive pulmonary disease. At last visit, 60.4% (n=608) of hypertensive patients and 63.3% (n=289) of diabetics were at target. Obesity and HIV positivity were weakly associated with an increased risk of uncontrolled hypertension. Descriptive costing analysis: Total 2016 incremental financial costs were: INT$437,228. The principle costs drivers were human resources (61% of total) and drugs (18%; insulin accounting for a quarter). Per patient per year (PPPY) incremental costs (INT$ 448.52) were similar to those reported for chronic HIV programmes. Conclusions and Lessons Learned: NCD care can be integrated into a HIV department and OPD setting in an MSFsupported primary care centre by utilising pre-existing structures, and can achieve acceptable intermediate clinical outcomes and retention rates at a cost that is similar to HIV programmes. The current model of NCD care is complex and time consuming, resulting in significant doctor workload. Streamlined, algorithm-driven protocols and work with the local government to extend prescribing rights for NCD medications to nurses may facilitate task sharing and decentralisation of care. Drug supply chain strengthening is required and advocacy around drug prices could reduce programme costs. Inclusion of specific treatment support and adherence counselling, learning lessons from HIV and TB care, is also essential to integrating NCD care into pre-existing services.
    • Diabetes service evaluation (2014-2017) – main findings from Mweso, North Kivu, the Democratic Republic of Congo

      Jobanputra, Kiran; Ansbro, Eimhin; MSF OCA (2018-09)
      Médecins sans Frontières (MSF) has been implementing an Integrated Diabetic Clinic within the Outpatient Department of Mweso District General Hospital since 2014 in the insecure conflict-affected area of Mweso in North Kivu in the Democratic Republic of Congo (DRC). The aim of this evaluation was to examine the effectiveness of this diabetes programme, the challenges and facilitators relating to adoption and acceptance by staff and patients, and the lessons learnt from implementation that can be generalised to comparable settings. Specifically, we aimed to identify the essential elements of a simple model of care for diabetes that can be applied in humanitarian contexts.
    • Non-Communicable Diseases - programmatic and clinical guidelines

      Jobanputra, Kiran, Editor; MSF OCA (MSF OCA, 2018-03)
    • Evidence-Based FRC Targets

      Ali, SI; Ali, SS; Fesselet, JF (2016-11-29)
    • Dagahaley Refugee Camp, Dadaab, Kenya

      Cyr, J; Watson-Stryker, E (Medecins Sans Frontieres, Switzerland, 2016-10)
    • Dadaab to Somalia: Pushed Back Into Peril

      Medecins Sans Frontieres (2016-10)
    • Untangling the Web of Antiretroviral Price Reductions 18th Edition

      MSF Access Campaign (MSF Access Campaign, 2016-07)
    • Simplifying Cardiovascular Risk Assessment - mixed methods audit of MSF's NCD mission in Irbid, Jordan

      Collins, Dylan (2016-06-17)
      We undertook a mixed methods clinical audit with the aim of simplifying guidance for cardiovascular risk assessment in humanitarian settings
    • Management of Obstertic Fistula in Burundi

      Morren, Geert; van den Boogaard, Wilma; Dominguez, Eva; MSF OCB (MSF, 2016-05)
    • Challenges in Diagnosing Human African Trypanosomiasis: Evaluation of the MSF OCG project in Dingila, DRC

      Van Nieuwenhove, Simon (2015-11-04)
      Between late 2010 and the end of 2014 and under extremely difficult conditions, Médecins sans Frontières (MSF) carried out a project to combat Human African Trypanosomiasis (HAT), also known as sleeping sickness, in the Dingila, Ango and Zobia regions of Orientale Province in the Democratic Republic of Congo (DRC). HAT in DRC is caused by Trypanosoma brucei gambiense and is transmitted by the tsetse fly (Glossina genus) of the Palpalis group. Without effective treatment, virtually all first-stage HAT patients and one hundred per cent of second-stage patients will die.
    • Défis en matière de diagnostic de la Trypanosomiase Humaine Africaine

      Van Nieuwenhove, Simon (2015-11-04)
      Entre fin 2010 et fin 2014, Médecins sans Frontières a, dans des conditions extrêmement difficiles, mené un projet de lutte contre la trypanosomiase humaine africaine (THA) ou maladie du sommeil dans la région de Dingila, Ango et Zobia, dans la Province Orientale de la République Démocratique du Congo (RDC). La THA en RDC est causée par Trypanosoma brucei gambiense et y est transmise par des glossines (mouches tsé-tsé) du groupe palpalis. Sans traitement efficace, quasiment tous les malades du premier stade et cent pourcent des malades au deuxième stade de la THA décèdent.