Multidrug-resistant tuberculosis (MDR-TB) is a major threat to global TB control. MDR-TB treatment regimens typically have a high pill burden, last 20 months or more and often lead to unsatisfactory outcomes. A 9–11 month regimen with seven antibiotics has shown high success rates among selected MDR-TB patients in different settings and is conditionally recommended by the World Health Organization. This study constructs a transmission-dynamic model of TB to estimate the likely impact of a shorter MDR-TB regimen when applied in a low HIV prevalence region of Uzbekistan (Karakalpakstan) with high rates of drug resistance, good access to diagnostics and a well-established community-based MDR-TB treatment programme providing treatment to around 400 patients. Based on empirical outcomes among MDR-TB patients and assuming no improvement in treatment success rates, it was concluded that shorter MDR-TB treatment regimens also have the potential to reduce transmission of resistant strains.
Artemisinin-resistant Plasmodium falciparum malaria parasites are now present across much of mainland Southeast Asia, where ongoing surveys are measuring and mapping their spatial distribution. These efforts require substantial resources. Here we propose a generic ‘smart surveillance’ methodology to identify optimal candidate sites for future sampling and thus map the distribution of artemisinin resistance most efficiently. The study uses ‘uncertainty’ map generated iteratively by a geostatistical model to determine optimal locations for subsequent sampling. It was concluded that this methodology, which has broader application to geostatistical mapping in general, could improve the quality and efficiency of drug resistance mapping and thereby guide practical operations to eliminate malaria in affected areas.
During a cholera outbreak in May 2015, in Juba, South Sudan, the Ministry of Health, Doctors Without Borders/Médecins Sans Frontières (MSF) and partners engaged in the first field deployment of a single dose of oral cholera vaccine to enhance the outbreak response. This is a case-cohort study, combining information on the vaccination status and disease outcomes from a random cohort recruited from throughout the city of Juba with that from all the cases detected. It was concluded that one dose of Shanchol was effective in preventing medically attended cholera in this study. These results support the use of a single-dose strategy in outbreaks in similar epidemiological settings.
Antibiotic stewardship program (ASP) implementation in humanitarian settings is a new endeavour - Doctors Without Borders/Médecins Sans Frontières (MSF) introduced an ASP within a hospital in Amman, Jordan, where patients from Iraq, Syria, and Yemen with chronic, often multidrug-resistant, infections related to war are managed. Antibiotics were reviewed, and real-time recommendations were made to optimise choice, dose, duration, and route by a small team. Over the first year of implementation, acceptance of the ASP’s recommendations improved. When compared with the year prior to implementation, antibiotic cost in 2014 declined considerably from approximately $252,077 (average, $21,006/month) to <$159,948 ($13,329/month) and a reduction in the use of broad-spectrum agents was observed. An ASP in a humanitarian surgical hospital proved acceptable and effective, reducing antibiotic expenditures and use of broad-spectrum agents.
In Afghanistan, Doctors Without Borders/Médecins Sans Frontières (MSF) provided specialised trauma care in Kunduz Trauma Centre (KTC), including physiotherapy. In this study, we describe the development of an adapted functional score for patient outcome monitoring and document the rehabilitation care provided and patient outcomes in relation to this functional score. The study concludes that the provision of physiotherapy was feasible in this humanitarian setting, and the tailored functional score appeared to be relevant.