ESWATINI: MSF showcases medical humanitarian field research at first-ever ‘Scientific Day’ in Eswatini

Monday, July 2, 2018 — For the first time ever, Doctors Without Borders (MSF) presents operational research by our field teams presented in Eswatini (formerly known as Swaziland) as part of the third Scientific Day Southern Africa this coming Friday, 6 July 2018. 

First launched in London in 2004, MSF Scientific Days present peer-reviewed research from MSF’s medical operations around the world to an audience of medical practitioners, researchers, academics, partners and government representatives.

Through the research, MSF aims to propose new and innovative strategies for providing quality medical care for the people affected by armed conflict, epidemics, healthcare exclusion and natural and man-made disasters.

Today, we would like to share with you some of the key research findings and new insights from the different projects in Eswatini, Mozambique, South Africa, Bangladesh and Syria.

1. Successful implementation of HIV self-testing in rural Shiselweni, Eswatini

The study looks at the effectiveness of HIV Self-Testing (HIVST) as an innovative testing strategy in a rural setting. The study concludes that implementation of HIVST is feasible within the public health sector in rural Eswatini. The pilot study informed national health policy and HIVST was subsequently adopted as an additional national testing strategy in Swaziland. The study comes in handy as current healthcare worker-led HIV testing approaches are failing to reach all people in need, especially men and young people who are hard to reach. WHO recommends HIV self-testing (HIVST), however this has not previously been applied to Eswatini.

2. Provision of oral pre-exposure prophylaxis for female sex workers and men who have sex with men in Beira, Mozambique

MSF together with the Ministry of Health, undertook a nine-month study to evaluate the feasibility and acceptability of oral pre-exposure prophylaxis (PrEP) amongst 252 female sex workers  and 58 men who have sex with men in Mozambique. The study observed a high uptake of PrEP, however despite the acceptability of PrEP, dropout rates were high and mostly related to changing residence and lack of awareness of infection risks. This study provides baseline data, which may inform future implementation of PrEP in MSF projects, as well as potentially influencing national policies.

3. What next after treatment failure for multidrug-resistant tuberculosis with the short course regimen?

In Eswatini, multidrug-resistant tuberculosis (MDR-TB) treatment guidelines recommend the short course regimen (SCR), following the World Health Organisation (WHO) 2016 recommendations. In Eswatini, a high MDR-TB/HIV prevalence country, MSF has examined outcomes with SCR at two treatment sites since 2014 in a study showing a 72.3% success rate. About 12 (8.6%) patients in that study had microbiological failure as a final outcome.

MSF, together with the Eswatini Ministry of Health, is currently supporting the roll-out of newer TB drugs (bedaquiline and delamanid) for management of MDR-TB.

The study presents a sub-analysis of those 12 patients with microbiological failure, their management and early culture conversion interim results. One of the key conclusions is that the short regiment, with conventional second-line drugs, and regimens with newer TB drugs, are complementary therapeutic strategies to fight MDR-TB. Although study limitations such as the retrospecrtive nature of the analysis and the small number of patients, the study indicates promising early treatment outcomes after microbiological failure on the short course regimen.

4. Pregnancy and Ebola: survival outcomes for pregnant women admitted to MSF Ebola treatment centres in the West Africa outbreak

A study from West Africa compares survival outcomes for Ebola Virus Disease (EVD)-confirmed pregnant women with those of EVD confirmed clinically and self-reported non-pregnant women of reproductive age (WRA) attending Ebola Treatment Centres (ETCs).

The study concluded that maternal survival appeared higher than previously documented, and was associated with lower viral load at admission and earlier trimesters of pregnancy. MSF did not see survival differences between EVD pregnant and non-pregnant women. The study also noted persistent EVD RNA positivity in amniotic fluid and products of conception in some women. MSF strongly recommends routine pregnancy testing at admission for suspected EVD in WRA.

Background on MSF Scientific Days

MSF Scientific Day Southern Africa was held for the first time in 2015 in Harare, Zimbabwe and since then events have been held in Johannesburg, South Africa and in Blantyre, Malawi. Last year MSF staff, researchers and Ministry of Health colleagues came together to share challenges faced in the fields of HIV, infectious disease and providing medical care in the context of the Syrian Crisis. This year, MSF Scientific Days have taken place in London, New Delhi and on Friday in Eswatini. The event continues to attract hundreds of MSF stakeholders. 

A health promoter is explaining the HIV oral self testing to the famers at the « Dip Tank », Shiselweni region.<br/>The « Dip tank » is a traditional farmers meeting to disinfect the cattle. MSF in Eswatini use the event in its strategy to gather and sensitize young people that are hard to reach. MSF health promoters provide counseling about HIV and TB and consultations. In 2018, MSF has started offering oral HIV self-tests to people at risk, such as young men. Many say they cannot go to a health centre for testing during work hours and the HIVST allows people to get tested in the comfort of their home. <br/><br/>MSF has been present in Eswatini (ex Swaziland) since 2007 to support the Ministry of Health in fighting the dual epidemics of HIV and TB in the small landlocked kingdom. Eswatini has one of the world's highest rate of HIV affecting roughly one in three adults.. It also has one of the highest rates of TB. MSF has used innovative approaches to curb the two diseases (PMTCT B+, Test and Treat, community based treatment, task-shifting, etc). Many of the approaches initiated by MSF are now part of the national health programme, and people in Eswatini have much greater access to treatment. Photographer: Fanny Hostettler
Close up of an oral HIV self-testing kit. After mandatory counseling, MSF distribute HIV oral self-testing kits to people living in remote areas. Many say they cannot go to a health centre for testing during work hours and the HIVST allows people to get tested in the comfort of their home. Photographer: Fanny Hostettler
Dr Benjamin Black. At the MSF Ebola Management Centre in Kailahun, Sierra Leone.London based obstetrics & gynaecology registrar, with an interest in humanitarian emergencies and their impact on the reproductive health of affected populations.<br/><br/>London-based obstetrics & gynaecology registrar,Benjamin Black has an interest in humanitarian emergencies and their impact on the reproductive health of affected populations.<br/><br/>He first travelled to Sierra Leone, the country with the worst recorded maternal mortality in the world, to join a team setting-up a project supporting maternal and child health in Tonkilili. <br/><br/>Together, alongside many healthcare workers who took Ebola head-on he worked to "meet the challenge of reaching women and their children so that they can have a safe birth, and training in the community to ensure a safer future".<br/><br/>In 2014, Benjamin Black worked in Sierra Leone with MSF in an obstetric referral centre. As the Ebola crisis unfurled his activities adapted alongside it. He returned to Sierra Leone in October 2014, working in Ebola Management Centres and providing support for pregnant and lactating women infected with Ebola both here and in Liberia, as well as providing hands on support and training when needed. Photographer: MSF
MSF Midwife Ruth Kauffman with Kumba at the Kailahun Ebola Treatment centre in Sierra Leone, October 2014. Kumba was fighting infection with the Ebola virus and at seven months pregnant it was feared she would not survive. Midwife Ruth Kauffman worked to provide care that supported Kumba through the critical period of delivery. The feotus was still born, having died due to the effects of the virus however Kumba made a full recovery. Photographer: Fabio Basone
MSF workers standing in front of the TB Ward, Nhlangano Health Centre. In the MSF-built TB ward at Nhlangano Health Centre, severely ill patients and patients who cannot receive treatment at home are treated. Photoghrapher: Fanny Hostettler