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.