Treatment of multidrug-resistant tuberculosis in a remote, conflict-affected area of the Democratic Republic of Congo [Notes from the field]

Shanks, Leslie; Masumbuko, E W; Ngoy, N M; Maneno, Mary; Bartlett, Stacey; Thi, Sein Sein; Shah, Taif

doi:10.5588/ijtld.11.0240

Cited by 12 publications

(15 citation statements)

References 1 publication

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“…Another class in this group was teleconsultations that were established between physicians of developing countries and experts from developed countries. Requesting countries in one third of the articles in this class were from Africa varying in medical fields like pediatrics ( 27 , 28 ), orthopedics ( 4 ), surgery ( 29 ), and infectious disease ( 30 ). In addition, experiences of teleconsultation between Antarctic stations with their supporting countries ( 31 - 33 ) or geographically remote islands with other countries were reported ( 34 - 37 ).…”

Section: Resultsmentioning

confidence: 99%

Teleconsultation and Clinical Decision Making: a Systematic Review

2016

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Background:The goal of teleconsultation is to omit geographical and functional distance between two or more geographically separated health care providers. The purpose of present study is to review and analyze physician-physician teleconsultations. Method: The PubMed electronic database was searched. The primary search was done on January 2015 and was updated on December 2015. A fetch and tag plan was designed by the researchers using an online Zotero library. Results: 174 full-text articles of 1702 records met inclusion criteria. Teleconsultation for pediatric patients accounts for 14.36 percent of accepted articles. Surgery and general medicine were the most prevalent medical fields in the adults and pediatrics, respectively. Most teleconsultations were inland experiences (no=135), and the USA, Italy and Australia were the three top countries in this group. Non-specialists health care providers/centers were the dominant group who requested teleconsultation (no=130). Real time, store and forward, and hybrid technologies were used in 50, 31, and 16.7 percent of articles, respectively. The teleconsultation were reported to result in change in treatment plan, referral or evacuation rate, change in diagnosis, educational effects, and rapid decision making. Use of structured or semi-structured template had been noticed only in a very few articles. Conclusion: The present study focused on the recent ten years of published articles on physician-physician teleconsultations. Our findings showed that although there are positive impacts of teleconsultation as improving patient management, still have gaps that need to be repaired.

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Section: Resultsmentioning

confidence: 99%

Teleconsultation and Clinical Decision Making: a Systematic Review

2016

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“…Our treatment model shows it is possible to manage and follow-up DR-TB patients in a primary care setting with non-specialists, rather than requiring a vertical DR-TB programme, if there is a system in place for supportive guidance from DR-TB experts, as previously documented in other MSF programmes [ 13 ]. It may be possible to adopt this approach in similar remote or conflict affected areas.…”

Section: Discussion and Evaluationmentioning

confidence: 99%

“…Availability of these pre-requisites for DR-TB treatment and care in remote rural settings is uncertain. To date, little is known about DR-TB management in a primary health care setting in areas affected by conflict [ 13 ]. To address this knowledge gap, this report aims to describe MSF experiences of providing treatment to DR-TB patients in a mobile primary health care outpatient clinic, in a low-intensity conflict setting in India.…”

Section: Introductionmentioning

confidence: 99%

Treating drug-resistant tuberculosis in a low-intensity chronic conflict setting in India

Armstrong¹,

Das²,

Mansoor³

et al. 2014

Confl Health

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IntroductionThe eastern part of India has been affected by an ongoing low-intensity conflict between government forces and armed Maoist groups, known as Naxalites. Since 2006, Médecins Sans Frontières (MSF) has been providing primary health care services in the conflict-affected region along the Andhra Pradesh-Chhattisgarh border. In 2011, treatment for drug-resistant tuberculosis (DR-TB) was included in the services provided. This report aims to describe MSF experiences of providing treatment to DR-TB patients in a mobile primary health care outpatient clinic, in a low-intensity conflict setting in India.Case descriptionA total of thirteen patients were diagnosed with drug-resistant TB (DR-TB) between January 2011 and October 2013. An innovative treatment model was developed which delegated responsibility to non-TB clinicians, including primary-care nurses and nurse-aids who were remotely supported by a TB-specialist from the MSF DR-TB project in Mumbai. Individualised regimens were designed for each patient based on WHO guidelines. Of these 13 patients, 10 patients had an outcome, of whom seven (70%) patients were cured. One patient became lost to follow-up prior to treatment initiation, one patient died prior to starting treatment and one patient refused treatment. Three patients were on-treatment, were clinically improving and were culture-negative at the end of their intensive phase of treatment.Discussion and evaluationDrug-resistant tuberculosis diagnosis and treatment is a highly specialised and technical subject which requires continued patient follow-up. However, our study demonstrates that it is feasible to manage DR-TB patients in a conflict setting, using a primary-care model with remote expert support. Long-term commitment and sustainability are essential for continued care, even more so in similar conflict settings. Loss to follow-up in patients remains a programmatic challenge and community involvement may play a key role.ConclusionManaging DR-TB in a primary health care programme is feasible in a low-conflict setting with an appropriate treatment model. Ambulatory strategies and standardised treatment regimens should be considered to further simplify treatment delivery and allow for scale-up when needed.

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“…The one qualitative study (Kevany et al 2014) was assessed using the Critical Appraisals Skills Programme (CASP) checklist (CASP 2013), with a score of 1-4 considered low, 5-8 moderate, and 9-10 (out of 10) high. The case series study (-Shanks et al 2012) was assessed using the NIH Quality Assessment Tool for Case Series (NIH 2014), with a score of 1-3 considered low, 4-6 moderate, and 7-9 high (out of 9). Given the lack of a validated tool, the quality of descriptive case studies could not be formally assessed.…”

Section: Quality Assessmentmentioning

confidence: 99%

Humanitarian health programming and monitoring in inaccessible conflict settings: a literature review

Chaudhri

Cordes

Miller

2019

Int J Humanitarian Action

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Increasing global conflicts and risk to humanitarian aid workers have necessitated innovative approaches to deliver humanitarian assistance. Remotely managed operations aim to continue the provision of services where grave risk to expatriate staff and restrictions by authorities inhibit access. This review of peer-reviewed and gray literature identified these remote approaches and collated lessons learned and best practices for humanitarian health programming and monitoring in inaccessible conflict settings. Analysis identified key principles, including the importance of capacity building and frequent communication, comprehensively assessing and addressing the risks to national staff, increasing monitoring and evaluation efforts despite difficult conditions, and planning for the possibility of a transition to remote programming and having an exit strategy to prevent falling into the remote operations trap. Evidence on how to effectively carry out remote operations is limited; rigorous documentation and evaluation of remotely managed humanitarian operations are required to further build the evidence base.

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Treatment of multidrug-resistant tuberculosis in a remote, conflict-affected area of the Democratic Republic of Congo [Notes from the field]

Cited by 12 publications

References 1 publication

Teleconsultation and Clinical Decision Making: a Systematic Review

Teleconsultation and Clinical Decision Making: a Systematic Review

Treating drug-resistant tuberculosis in a low-intensity chronic conflict setting in India

Humanitarian health programming and monitoring in inaccessible conflict settings: a literature review

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