Conference Material > Abstract
Ben-Farhat J
Epicentre Scientific Day 2022. 1 June 2022
INTRODUCTION
The COVID-19 pandemic and the measures taken to limit its spread have severely disrupted health systems and medical care. People living with HIV (PLHIV) suffer from high levels of comorbidities and stigma, and often faced challenges in access to care prior to the pandemic. The aim of this study was to explore the extent to which the pandemic and the public health measures have affected medical care for PLHIV. The study took place in two different contexts in terms of care and experience of the pandemic where MSF operates, in Arua (Uganda) and Chiradzulu (Malawi).
METHODS
We conducted a multicentric mixed-methods study . The quantitative component explored patients’ retention in care and viral suppression using programmatic data routinely collected from January 2018 to April 2021 . The qualitative study investigated patient perspectives and perceptions of the impact of Covid-19 and the public health and social measures on their lives and ability to manage their health, and on HIV care. The interviews with patients were conducted from January to June 2021.
RESULTS
From 2020 to 2021, we observed a 15% decrease in active cohort among adults on any regimen and a 17% decrease among children and adolescents in Arua. During the same period in Chiradzulu, the first- and second-line cohorts decreased in size (10% drop and 12% drop, respectively). In addition, we observed a reduction in ART initiations and in clinical consultations at the start of pandemic (50% and 68% in Arua and 34% and 60% in Chiradzulu, respectively) and a gradual decrease in viral load coverage. In Uganda, the lockdown affected patients’ and caregivers’ livelihoods, education, access to food and psychosocial wellbeing negatively, which at times affected their ability to manage HIV condition at home and to adhere. Adolescents lost support, experienced increasing HIV stigma, and started to provide for themselves. In Malawi, patients and caregivers emphasized the impact of the pandemic and public health measures on livelihoods and food security and noted the reduction or absence of MSF social support activities during this time. Also, the fear of COVID at health facilities and the confusion and lack of communication about regarding day-to-day changes in activities was disturbing to both patients and staff.
CONCLUSION
The COVID-19 epidemic and public health measures had an important negative impact on HIV care in the health facilities and in the community in Arua and Chiradzulu. To ensure a conducive environment for patients’ access to essential HIV care and treatment during potential future outbreaks requires continued collaboration with the national authorities and advocacy for more non-violent and less authoritarian ways of implementing restrictions. In addition, innovative public health information campaigns about COVID-19 and care services, to reduce fear of disease and to dispel rumours and misinformation are recommended.
KEY MESSAGE
COVID-19 has severely disrupted access to health systems and treatment. The measures put in place to limit the spread of the epidemic have altered people's bearings. How has the pandemic in Arua and Chiradzulu affected PLHIV, who already suffer from higher levels of mental health problems, comorbidities and stigma?
This abstract is not to be quoted for publication.
The COVID-19 pandemic and the measures taken to limit its spread have severely disrupted health systems and medical care. People living with HIV (PLHIV) suffer from high levels of comorbidities and stigma, and often faced challenges in access to care prior to the pandemic. The aim of this study was to explore the extent to which the pandemic and the public health measures have affected medical care for PLHIV. The study took place in two different contexts in terms of care and experience of the pandemic where MSF operates, in Arua (Uganda) and Chiradzulu (Malawi).
METHODS
We conducted a multicentric mixed-methods study . The quantitative component explored patients’ retention in care and viral suppression using programmatic data routinely collected from January 2018 to April 2021 . The qualitative study investigated patient perspectives and perceptions of the impact of Covid-19 and the public health and social measures on their lives and ability to manage their health, and on HIV care. The interviews with patients were conducted from January to June 2021.
RESULTS
From 2020 to 2021, we observed a 15% decrease in active cohort among adults on any regimen and a 17% decrease among children and adolescents in Arua. During the same period in Chiradzulu, the first- and second-line cohorts decreased in size (10% drop and 12% drop, respectively). In addition, we observed a reduction in ART initiations and in clinical consultations at the start of pandemic (50% and 68% in Arua and 34% and 60% in Chiradzulu, respectively) and a gradual decrease in viral load coverage. In Uganda, the lockdown affected patients’ and caregivers’ livelihoods, education, access to food and psychosocial wellbeing negatively, which at times affected their ability to manage HIV condition at home and to adhere. Adolescents lost support, experienced increasing HIV stigma, and started to provide for themselves. In Malawi, patients and caregivers emphasized the impact of the pandemic and public health measures on livelihoods and food security and noted the reduction or absence of MSF social support activities during this time. Also, the fear of COVID at health facilities and the confusion and lack of communication about regarding day-to-day changes in activities was disturbing to both patients and staff.
CONCLUSION
The COVID-19 epidemic and public health measures had an important negative impact on HIV care in the health facilities and in the community in Arua and Chiradzulu. To ensure a conducive environment for patients’ access to essential HIV care and treatment during potential future outbreaks requires continued collaboration with the national authorities and advocacy for more non-violent and less authoritarian ways of implementing restrictions. In addition, innovative public health information campaigns about COVID-19 and care services, to reduce fear of disease and to dispel rumours and misinformation are recommended.
KEY MESSAGE
COVID-19 has severely disrupted access to health systems and treatment. The measures put in place to limit the spread of the epidemic have altered people's bearings. How has the pandemic in Arua and Chiradzulu affected PLHIV, who already suffer from higher levels of mental health problems, comorbidities and stigma?
This abstract is not to be quoted for publication.
Conference Material > Video
Namulwana ML
Epicentre Scientific Day 2022. 21 June 2022
Conference Material > Video
Coldiron ME
Epicentre Scientific Day 2022. 21 June 2022
Conference Material > Video
Langendorf C
Epicentre Scientific Day 2022. 21 June 2022
Conference Material > Abstract
Coldiron ME
Epicentre Scientific Day 2022. 1 June 2022
The early 2000s saw great advances in malaria control worldwide, in part due to scale-up of proven preventive strategies such as insecticide-treated bednets and a variety of chemoprevention measures. In 2015, that progress began to stall, and in 2020, according to WHO, there was a marked increase in the number of malaria cases and deaths, larger than any seen in the last two decades: over 241 million cases of malaria and 626 000 deaths, including 479 000 deaths among African children under 5 years old. In this troubling context, there have been many recent advances and changes regarding malaria prevention, which will be detailed in the introduction to this roundtable.
• The largest headline came in 2021, with a recommendation to use the RTS,S vaccine, the first malaria vaccine to be approved for broad use in African contexts. This modestly effective vaccine will be expensive but could have a major impact if access issues could be overcome and the vaccine used effectively at scale.
• New WHO guidelines for a variety of chemoprevention strategies are expected soon. Strategies like Seasonal Malaria Chemoprevention (SMC) may see their eligibility criteria broadened, and Mass Drug Administration may be given a more prominent place in the malaria toolbox. Older proven strategies, like Intermittent Preventive Treatment (IPT) among pregnant women and IPT among infants may be re-branded, and re-emphasized in an effort to improve uptake.
• Pyrethroid insecticides are standard in impregnated bednets. Mosquito resistance to pyrethroid insecticides is increasing, which might eventually warrant the roll-out of next-generation pyrethroid-PBO bednets, which are more expensive and less durable.
Malaria prevention is at a critical juncture. We will discuss these scientific, public health, and strategic considerations in-depth with an expert panel.
This abstract is not to be quoted for publication
• The largest headline came in 2021, with a recommendation to use the RTS,S vaccine, the first malaria vaccine to be approved for broad use in African contexts. This modestly effective vaccine will be expensive but could have a major impact if access issues could be overcome and the vaccine used effectively at scale.
• New WHO guidelines for a variety of chemoprevention strategies are expected soon. Strategies like Seasonal Malaria Chemoprevention (SMC) may see their eligibility criteria broadened, and Mass Drug Administration may be given a more prominent place in the malaria toolbox. Older proven strategies, like Intermittent Preventive Treatment (IPT) among pregnant women and IPT among infants may be re-branded, and re-emphasized in an effort to improve uptake.
• Pyrethroid insecticides are standard in impregnated bednets. Mosquito resistance to pyrethroid insecticides is increasing, which might eventually warrant the roll-out of next-generation pyrethroid-PBO bednets, which are more expensive and less durable.
Malaria prevention is at a critical juncture. We will discuss these scientific, public health, and strategic considerations in-depth with an expert panel.
This abstract is not to be quoted for publication
Conference Material > Video
Issa-Soumana A-M
Epicentre Scientific Day 2022. 21 June 2022
Conference Material > Abstract
Aqel R
Epicentre Scientific Day 2022. 1 June 2022
BACKGROUND
Post-traumatic osteomyelitis (PTO) is a serious consequence of orthopaedic trauma often complicated with multi-drug resistant (MDR) infections, a major health issue globally and particularly in conflict settings like Gaza, Palestine. In this study we aimed to provide a description of the clinical characteristics and outcomes of PTO patients treated by MSF in our reconstructive surgery centres in Gaza, Palestine.
METHODS
This is a retrospective cohort study using routinely collected clinical data on patients with PTO admitted to the reconstructive surgery centres supported by MSF in Gaza, between 01-December-2018 and 15-September-2021 and followed up till 31-January-2022.
RESULTS
202 patients with 275 PTO episodes, primarily to gunshot wounds resulting from the conflict in Gaza were included. Among all episodes, 43% (118/275) were polymicrobial, with 437 organisms isolated in total. The most common isolated pathogens were Staphylococcus aureus (157/437, 36%), Staphylococcus epidermidis (71/437, 16%) and Pseudomonas aeruginosa (45/437, 10%). 33% (146/437) of the isolates were MDR; the most prevalent being Methicillin-resistant Staphylococcus aureus [MRSA, (97/146, 66%)] and extended spectrum beta-lactamase [ESBL, (24/146, 16%]. 77 (38%) of PTO patients had >=1 recurrent infection during their follow-up. The odds of developing an MDR infection with a polymicrobial episode were almost twice higher than with a monomicrobial episode [OR 2.39 (95% CI 1.36 - 4.24), p-value=0.03]. Patients admitted within 1 year from their injury were almost 80% less likely to develop an MDR infection versus those admitted >=4 years from their injury [OR 0.17 (95% CI (0.03 - 0.73), p-value=0.031].
CONCLUSION
The study results highlighted the level of complexity of PTO cases seen in Gaza with a high risk of recurrent infections. This provides an evidence-based data to guide the existing MSF treatment guidelines.
KEY MESSAGE
Treating post-traumatic osteomyelitis cases in Gaza is complex and is presented with high MDR infections and risk of recurrent infections.
This abstract is not to be quoted for publication.
Post-traumatic osteomyelitis (PTO) is a serious consequence of orthopaedic trauma often complicated with multi-drug resistant (MDR) infections, a major health issue globally and particularly in conflict settings like Gaza, Palestine. In this study we aimed to provide a description of the clinical characteristics and outcomes of PTO patients treated by MSF in our reconstructive surgery centres in Gaza, Palestine.
METHODS
This is a retrospective cohort study using routinely collected clinical data on patients with PTO admitted to the reconstructive surgery centres supported by MSF in Gaza, between 01-December-2018 and 15-September-2021 and followed up till 31-January-2022.
RESULTS
202 patients with 275 PTO episodes, primarily to gunshot wounds resulting from the conflict in Gaza were included. Among all episodes, 43% (118/275) were polymicrobial, with 437 organisms isolated in total. The most common isolated pathogens were Staphylococcus aureus (157/437, 36%), Staphylococcus epidermidis (71/437, 16%) and Pseudomonas aeruginosa (45/437, 10%). 33% (146/437) of the isolates were MDR; the most prevalent being Methicillin-resistant Staphylococcus aureus [MRSA, (97/146, 66%)] and extended spectrum beta-lactamase [ESBL, (24/146, 16%]. 77 (38%) of PTO patients had >=1 recurrent infection during their follow-up. The odds of developing an MDR infection with a polymicrobial episode were almost twice higher than with a monomicrobial episode [OR 2.39 (95% CI 1.36 - 4.24), p-value=0.03]. Patients admitted within 1 year from their injury were almost 80% less likely to develop an MDR infection versus those admitted >=4 years from their injury [OR 0.17 (95% CI (0.03 - 0.73), p-value=0.031].
CONCLUSION
The study results highlighted the level of complexity of PTO cases seen in Gaza with a high risk of recurrent infections. This provides an evidence-based data to guide the existing MSF treatment guidelines.
KEY MESSAGE
Treating post-traumatic osteomyelitis cases in Gaza is complex and is presented with high MDR infections and risk of recurrent infections.
This abstract is not to be quoted for publication.
Conference Material > Abstract
Malaeb R, Nagwan Y
Epicentre Scientific Day 2022. 1 June 2022
BACKGROUND
Antimicrobial resistance (AMR) is a global health problem and growing at an alarming rate, resulting in a rapid deterioration of the effectiveness of antibiotics. The middle and low-income countries are currently carrying the highest burden resulting in an increased risk of death, prolonged treatment duration and unaffordable costs of antibiotic therapy. In countries like Yemen, this problem appears to be more complex due to the current war, high number of trauma patients and limited access to healthcare. In this study we aimed to describe the clinical characteristics and antimicrobial resistance patterns among patients treated at the MSF Aden Acute Trauma hospital.
METHODS
We conducted a retrospective descriptive analyses using routinely collected programme data for all patients who were admitted between 2018 and June 2021 and received antibiotic therapy for a diagnosed infection based on MSF guidelines.
RESULTS
The study cohort consisted of 481 trauma patients treated with antibiotics for more than 500 infections. The most common infections were soft and skin tissue infection (25%), intra-abdominal infection (20%), and osteomyelitis (20%). Secondary blood stream infections were also present in 20% of all the diagnosed infections. 65 % of these patients were infected with at least one multi-drug resistant (MDR) organism. A wide variety of 993 isolated organisms were detected mainly consisting of Escherichia coli (20%), Enterococcus faecalis (14%), Staphylococcus aureus (9.7%), Pseudomonas aeruginosa (8.6%), and Klebsiella pneumoniae (8.2%). The antibiotic resistance patterns for the most common antibiotics showed a high level of resistance.
CONCLUSION
The findings of this study showed a very high number of MDR infections among trauma patients in Aden with worrisome drug resistance rate to the most antibiotics. This would assist MSF in reviewing its current empiric treatment and in strengthening its antibiotic stewardship programme.
KEY MESSAGE
A high level of antibiotic resistance patterns were observed at the MSF Aden trauma centre highlighting the need to strengthen the antibiotic stewardship programme and evaluate the current empiric treatment provided.
This abstract is not to be quoted for publication
Antimicrobial resistance (AMR) is a global health problem and growing at an alarming rate, resulting in a rapid deterioration of the effectiveness of antibiotics. The middle and low-income countries are currently carrying the highest burden resulting in an increased risk of death, prolonged treatment duration and unaffordable costs of antibiotic therapy. In countries like Yemen, this problem appears to be more complex due to the current war, high number of trauma patients and limited access to healthcare. In this study we aimed to describe the clinical characteristics and antimicrobial resistance patterns among patients treated at the MSF Aden Acute Trauma hospital.
METHODS
We conducted a retrospective descriptive analyses using routinely collected programme data for all patients who were admitted between 2018 and June 2021 and received antibiotic therapy for a diagnosed infection based on MSF guidelines.
RESULTS
The study cohort consisted of 481 trauma patients treated with antibiotics for more than 500 infections. The most common infections were soft and skin tissue infection (25%), intra-abdominal infection (20%), and osteomyelitis (20%). Secondary blood stream infections were also present in 20% of all the diagnosed infections. 65 % of these patients were infected with at least one multi-drug resistant (MDR) organism. A wide variety of 993 isolated organisms were detected mainly consisting of Escherichia coli (20%), Enterococcus faecalis (14%), Staphylococcus aureus (9.7%), Pseudomonas aeruginosa (8.6%), and Klebsiella pneumoniae (8.2%). The antibiotic resistance patterns for the most common antibiotics showed a high level of resistance.
CONCLUSION
The findings of this study showed a very high number of MDR infections among trauma patients in Aden with worrisome drug resistance rate to the most antibiotics. This would assist MSF in reviewing its current empiric treatment and in strengthening its antibiotic stewardship programme.
KEY MESSAGE
A high level of antibiotic resistance patterns were observed at the MSF Aden trauma centre highlighting the need to strengthen the antibiotic stewardship programme and evaluate the current empiric treatment provided.
This abstract is not to be quoted for publication
Conference Material > Abstract
Langendorf C
Epicentre Scientific Day 2022. 1 June 2022
BACKGROUND
The Mini-Lab is a simplified and modular bacteriology laboratory being developed by MSF to improve access to microbiology diagnostics and antibiotic resistance surveillance in resource-limited settings. After a first pilot study in Haiti in 2020, this second evaluation aimed to assess the performance and ease-of use of the Mini-Lab integrated in the clinical routine of an MSF-supported hospital which has had no prior access to microbiology.
METHODS
The study was conducted after the implementation of the Mini-Lab in an MSFsupported hospital in Carnot, CAR, along with an antibiotic stewardship program. We included hospitalized patients with successful blood culture sampling on admission or during hospitalization, and who consented to study participation. The bacteria identified from blood culture in the Mini-Lab were shipped to a reference laboratory in Bicêtre hospital, France for identification (ID) and antibiotic susceptibility testing (AST) using reference methods. Laboratory technicians evaluated the usability of the Mini-Lab through repeated ease-of use questionnaires and competency assessment.
RESULTS
Between September 2021 and February 2022, we included 835 patients who had a total of 960 blood cultures. Positivity rate with pathogens was 12.5%. Over 121 pathogens identified in the Mini-Lab, 74 have been tested with reference methods so far and 68 (92.0%) gave ID results concordant with the Mini-Lab with 97.4% agreement to genus. No particular organism-antibiotic combination caused systematic errors on AST. Upon completion of the initial training, the laboratory technicians reported most of the aspects of the Mini-Lab easy to use, except for preparation and reading of ID and AST methods, which were reported to be simple after 3 months of experience. Assessment of the laboratory technicians' competencies after the initial training yielded very high scores (>90%) and 100% after 3 months.
CONCLUSION
The comparison of the Mini-Lab results with the reference methods for ID and AST showed overall very good results. We did not highlight any major malfunction preventing its deployment in other resource-limited countries.
KEY MESSAGE
The performances of the simplified and modular bacteriology laboratory, the Mini-Lab, are overall very good. We did not highlight any major malfunctions preventing its deployment in other fields.
This abstract is not to be quoted for publication
The Mini-Lab is a simplified and modular bacteriology laboratory being developed by MSF to improve access to microbiology diagnostics and antibiotic resistance surveillance in resource-limited settings. After a first pilot study in Haiti in 2020, this second evaluation aimed to assess the performance and ease-of use of the Mini-Lab integrated in the clinical routine of an MSF-supported hospital which has had no prior access to microbiology.
METHODS
The study was conducted after the implementation of the Mini-Lab in an MSFsupported hospital in Carnot, CAR, along with an antibiotic stewardship program. We included hospitalized patients with successful blood culture sampling on admission or during hospitalization, and who consented to study participation. The bacteria identified from blood culture in the Mini-Lab were shipped to a reference laboratory in Bicêtre hospital, France for identification (ID) and antibiotic susceptibility testing (AST) using reference methods. Laboratory technicians evaluated the usability of the Mini-Lab through repeated ease-of use questionnaires and competency assessment.
RESULTS
Between September 2021 and February 2022, we included 835 patients who had a total of 960 blood cultures. Positivity rate with pathogens was 12.5%. Over 121 pathogens identified in the Mini-Lab, 74 have been tested with reference methods so far and 68 (92.0%) gave ID results concordant with the Mini-Lab with 97.4% agreement to genus. No particular organism-antibiotic combination caused systematic errors on AST. Upon completion of the initial training, the laboratory technicians reported most of the aspects of the Mini-Lab easy to use, except for preparation and reading of ID and AST methods, which were reported to be simple after 3 months of experience. Assessment of the laboratory technicians' competencies after the initial training yielded very high scores (>90%) and 100% after 3 months.
CONCLUSION
The comparison of the Mini-Lab results with the reference methods for ID and AST showed overall very good results. We did not highlight any major malfunction preventing its deployment in other resource-limited countries.
KEY MESSAGE
The performances of the simplified and modular bacteriology laboratory, the Mini-Lab, are overall very good. We did not highlight any major malfunctions preventing its deployment in other fields.
This abstract is not to be quoted for publication
Conference Material > Video
Malaeb R, Nagwan Y
Epicentre Scientific Day 2022. 21 June 2022