• Task shifting for antiretroviral treatment delivery in sub-Saharan Africa: not a panacea.

      Philips, M; Zachariah, R; Venis, S; Analysis and Advocacy Unit, Médecins Sans Frontières, Brussels Operational Centre, Belgium. (Elsevier, 2008-02-23)
    • Teleradiology usage and user satisfaction with the telemedicine system operated by Médecins Sans Frontières

      Halton, Jarred; Kosack, Cara; Spijker, Saskia; Joekes, Elizabeth; Andronikou, Savvas; Chetcuti, Karen; Brant, William E; Bonnardot, Laurent; Wootton, Richard (Frontiers Media, 2014-10-28)
      Médecins Sans Frontières (MSF) began a pilot trial of store-and-forward telemedicine in 2010, initially operating separate networks in English, French, and Spanish; these were merged into a single, multilingual platform in 2013. We reviewed the pattern of teleradiology usage on the MSF telemedicine platform in the 4-year period from April 2010. In total, 564 teleradiology cases were submitted from 22 different countries. A total of 1114 files were uploaded with the 564 cases, the majority being of type JPEG (n = 1081, 97%). The median file size was 938 kb (interquartile range, IQR 163-1659). A panel of 14 radiologists was available to report cases, but most (90%) were reported by only 4 radiologists. The median radiologist response time was 6.1 h (IQR 3.0-20). A user satisfaction survey was sent to 29 users in the last 6 months of the study. There was a 28% response rate. Most respondents found the radiologist's advice helpful and all of them stated that the advice assisted in clarification of a diagnosis. Although some MSF sites made substantial use of the system for teleradiology, there is considerable potential for expansion. More promotion of telemedicine may be needed at different levels of the organization to increase engagement of staff.
    • Ten Tips to Improve the Visibility and Dissemination of Research for Policy Makers and Practitioners

      Tripathy, J; Bhatnagar, A; Shewade, H; Kumar, A; Zachariah, R; Harries, A (International Union Against Tuberculosis and Lung Disease, 2017-03-21)
      Effective dissemination of evidence is important in bridging the gap between research and policy. In this paper, we list 10 approaches for improving the visibility of research findings, which in turn will hopefully contribute towards changes in policy. Current approaches include using social media (Facebook, Twitter, LinkedIn); sharing podcasts and other research outputs such as conference papers, posters, presentations, reports, protocols, preprint copy and research data (figshare, Zenodo, Slideshare, Scribd); and using personal blogs and unique author identifiers (ORCID, ResearcherID). Researchers and funders could consider drawing up a systematic plan for dissemination of research during the stage of protocol development.
    • Time to embrace access programmes for medicines: Lessons from the South African flucytosine access programme

      Shroufi, A; Govender, NP; Meintjes, G; Black, J; Nel, J; Moosa, MY; Menezes, C; Dawood, H; Wilson, D; Trivino Duran, L; et al. (Elsevier, 2020-02-29)
      BACKGROUND: Cryptococcal Meningitis (CM) is estimated to cause 181,000 deaths annually; with the majority occurring in Sub Saharan Africa. Flucytosine is recommended by the World Health Organization as part of the treatment for CM. Widespread use of flucytosine could reduce mortality in hospital by as much as 40% compared to the standard of care, yet due to market failure quality assured flucytosine remains unregistered and largely inaccessible throughout Africa. METHODS: The recently established South African flucytosine clinical access programme is an attempt to address market failure which led to a lack of public-sector access to flucytosine for cryptococcal meningitis, by making the medicine freely available to tertiary hospitals in South Africa. RESULTS: Between November 2018 and September 2019, 327 CM patients received flucytosine through this programme, with efforts to support sustainable national scale up presently ongoing. We describe why this programme was needed, its catalytic potential, what is still required to ensure widespread access to flucytosine, and observation from this experience that may have wider relevance. CONCLUSIONS: The South African Flucytosine Access Programme illustrates how access programmes may be one part of the solution to addressing the vicious cycle of perceived low demand, limiting manufacturer interest in specific product markets.
    • Tough choices: tenofovir, tenders and treatment

      Ford, N; Gray, A; Venter, F (South African Medical Association, 2008-06-04)
      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.
    • Trade concerns must not be allowed to set the public health agenda.

      Ford, N; 't Hoen, E; McKee, M (Elsevier, 2003-01-04)
    • Trade systems in less-developed countries.

      Kamal, M; 't Hoen, E (Elsevier, 2001-05-19)
    • Treating HIV in the developing world: getting ahead of the drug development curve.

      Ford, N; Calmy, A; von Schoen-Angerer, T (Elsevier, 2007-01)
    • TRIPs revisited.

      Ford, N (2001-11)
    • TRIPS, pharmaceutical patents, and access to essential medicines: a long way from Seattle to Doha.

      't Hoen, E; Globalisation Project of Medecins sans Frontieres ("MSF") Access to Essential Medicines Campaign. (Chicago Journal of International Law, 2002)
    • Understanding health care in the south Caucasus: examples from Armenia.

      von Schoen-Angerer, T; Médecins Sans Frontières, Manushyan St 48, 375012 Yerevan, Armenia. tavschoen@yahoo.com (2004-09-04)
    • Universal health coverage in a regional Nepali hospital: who is exempted from payment? [Short communication]

      Basnet, R.; Shrestha, B. R.; Nagaraja, S. B.; Basnet, B.; Satyanarayana, S.; Zachariah, R.; Nepal Health Sector Support Programme, Mid-Western Regional Health Directorate, Surkhet, Nepal (International Union Against Tuberculosis and Lung Disease, 2013-03-21)
      This study assessed the characteristics of beneficiaries of a government-led policy of exemption for payment being provided in a regional hospital in Nepal. In January and February 2012, 9547 patients sought services at the out-patient clinic, the majority (83%) of whom were from the same district although this was a referral hospital for 15 districts. Only 10.8% received exemption from payment; 66% of the individuals aged >60 years and eligible for exemption were missed. These shortcomings highlight intrinsic weaknesses in the current implementing mechanisms for payment exemption, which may not be providing financial protection. This hampers efforts towards achieving universal health coverage.
    • User Fees or Equity Funds in Low-Income Countries.

      Brikci, N; Philips, M; Programmes' Unit, Médecins Sans Frontières, London EC1N 8QX, UK. nouria.brikci@london.msf.org (Published by: Elsevier, 2007-01-06)
    • Violence Against Civilians and Access to Health Care in North Kivu, Democratic Republic of Congo: Three Cross-Sectional Surveys

      Alberti, Kathryn P; Grellety, Emmanuel; Lin, Ya-Ching; Polonsky, Jonathan; Coppens, Katrien; Encinas, Luis; Rodrigue, Marie-Noëlle; Pedalino, Biagio; Mondonge, Vital; Epicentre, France; Médecins Sans Frontières, Amsterdam; Médecins Sans Frontières, Belgium; Médecins Sans Frontières, France; Ministry of Health, Democratic Republic of Congo (2010-11-08)
    • Vital Registration in Rural Africa: Is There a Way Forward to Report on Health Targets of the Millennium Development Goals?

      Zachariah, R; Mwagomba, B; Misinde, D; Mandere, B C; Bemeyani, A; Ginindza, T; Cortier, H; Bissel, K; Jahn, A; Harries, A D; et al. (2011-04-19)
      Vital registration - the systematic recording of births and deaths - has both legal and health significance. In particular, accurate recording and reporting of vital statistics are public goods to enable the monitoring of progress towards achieving health related targets of the 2015 United Nations Millennium Development Goals (MDG). The reality in Africa is that most births and deaths cannot be traced in legal records or official statistics and as such, there is currently no way of assessing progress towards achieving MDG targets and this applies particularly to rural settings in Africa. From the context of a rural district in Malawi, we describe an informal traditional system for the reporting of deaths at village level, and discuss the potential opportunities, challenges and ways forward in the wider implementation and interpretation of vital data generated by such a system. Such a system might provide an interim solution for accelerating the production and use of district level vital statistics for legal, administrative, statistical purposes and to report on the MDG in rural Africa while waiting for more comprehensive national systems to become a reality.
    • The vital signs of chronic disease management.

      Harries, A D; Zachariah, R; Kapur, A; Jahn, A; Enarson, D A; International Union against Tuberculosis and Lung Disease, Paris, France. adharries@theunion.org (2009-06)
      The vital signs of pulse rate, blood pressure, temperature and respiratory rate are the 'nub' of individual patient management. At the programmatic level, vital signs could also be used to monitor the burden and treatment outcome of chronic disease. Case detection and treatment outcome constitute the vital signs of tuberculosis control within the WHO's 'DOTS' framework, and similar vital signs could be adapted and used for management of chronic diseases. The numbers of new patients started on therapy in each month or quarter (new incident cases) are sensitive indicators for programme performance and access to services. Using similar reporting cycles, treatment outcomes for all patients can be assessed, the vital signs being: alive and retained on therapy at the respective facility; died; stopped therapy; lost to follow-up; and transferred out to another facility. Retention on treatment constitutes the prevalent number of cases, the burden of disease, and this provides important strategic information for rational drug forecasting and logistic planning. If case numbers and outcomes of chronic diseases were measured reliably and consistently as part of an integrated programmatic approach, this would strengthen the ability of resource-poor countries to monitor and assess their response to these growing epidemics.