Conference Material > Abstract
Lissouba P, Huerga H, Rucker C
Epicentre Scientific Day 2021. 10 June 2021
BACKGROUND
The novel point-of-care urine-based FujiLAM test is promising for diagnosis of tuberculosis. We assessed the diagnostic yield of FujiLAM in HIV patients and the feasibility of using the test.
METHODS
We conducted a prospective diagnostic study and a mixed-methods feasibility and acceptability study in 4 countries: Uganda, Kenya,
Mozambique and South Africa. The diagnostic study included 2 groups of ambulatory HIV-positive adults: 1) with TB symptoms, 2) with advanced HIV disease and no TB symptoms. Patients received FujiLAM and AlereLAM, Xpert MTB/RIF, culture and chest X-ray. The feasibility study included test’ users, key informants and patients who participated through standard questionnaires, individual interviews and group discussions.
RESULTS
We included 1117 patients in the diagnostic study: 712 with TB symptoms (Group 1) and 405 with advanced HIV disease and no TB
symptoms (Group 2). TB was confirmed in 9.2% (63/685) and 4.1% (16/395) in Group 1 and 2, respectively. FujiLAM diagnostic yield among patients with confirmed TB was 63.2% and 43.8% in Group 1 and 2, respectively. FujiLAM diagnostic yield by CD4 count was: 75.0% in CD4<200, 77.8% in CD4 200-349, 31.3% in CD4≥350 (Group 1) and 46.7% in CD4<200 (Group 2). Most of the test users (including lay health workers) found FujiLAM easy to perform. The main concern was the multiple timed steps involved. Invalid results were obtained if test cartridges were dropped or performed on blood stained or cloudy urine. Most patients viewed urine sampling
positively and easier than sputum provision.
CONCLUSIONS
FujiLAM detects TB in a high proportion of the HIV patients with confirmed TB who have symptoms of TB and low CD4 counts, and in
a considerable proportion of those asymptomatic. The test is easy to perform at point-of-care. Urine sampling is well accepted by patients. These results encourage the future use of the FujiLAM assay.
KEY MESSAGES: The novel urine-based FujiLAM is a useful and easy to use point-of care test for TB diagnosis in HIV-positive patients. Urine sampling is well accepted.
This abstract is not to be quoted for publication.
The novel point-of-care urine-based FujiLAM test is promising for diagnosis of tuberculosis. We assessed the diagnostic yield of FujiLAM in HIV patients and the feasibility of using the test.
METHODS
We conducted a prospective diagnostic study and a mixed-methods feasibility and acceptability study in 4 countries: Uganda, Kenya,
Mozambique and South Africa. The diagnostic study included 2 groups of ambulatory HIV-positive adults: 1) with TB symptoms, 2) with advanced HIV disease and no TB symptoms. Patients received FujiLAM and AlereLAM, Xpert MTB/RIF, culture and chest X-ray. The feasibility study included test’ users, key informants and patients who participated through standard questionnaires, individual interviews and group discussions.
RESULTS
We included 1117 patients in the diagnostic study: 712 with TB symptoms (Group 1) and 405 with advanced HIV disease and no TB
symptoms (Group 2). TB was confirmed in 9.2% (63/685) and 4.1% (16/395) in Group 1 and 2, respectively. FujiLAM diagnostic yield among patients with confirmed TB was 63.2% and 43.8% in Group 1 and 2, respectively. FujiLAM diagnostic yield by CD4 count was: 75.0% in CD4<200, 77.8% in CD4 200-349, 31.3% in CD4≥350 (Group 1) and 46.7% in CD4<200 (Group 2). Most of the test users (including lay health workers) found FujiLAM easy to perform. The main concern was the multiple timed steps involved. Invalid results were obtained if test cartridges were dropped or performed on blood stained or cloudy urine. Most patients viewed urine sampling
positively and easier than sputum provision.
CONCLUSIONS
FujiLAM detects TB in a high proportion of the HIV patients with confirmed TB who have symptoms of TB and low CD4 counts, and in
a considerable proportion of those asymptomatic. The test is easy to perform at point-of-care. Urine sampling is well accepted by patients. These results encourage the future use of the FujiLAM assay.
KEY MESSAGES: The novel urine-based FujiLAM is a useful and easy to use point-of care test for TB diagnosis in HIV-positive patients. Urine sampling is well accepted.
This abstract is not to be quoted for publication.
Conference Material > Video
Ntone R
Epicentre Scientific Day 2021. 10 June 2021
Conference Material > Video
Broban A
Epicentre Scientific Day 2021. 4 August 2021
Conference Material > Abstract
Haider A, Finger F
Epicentre Scientific Day 2021. 10 June 2021
In this presentation, we provide an overview of the evolution of the COVID-19 pandemic in Yemen and Afghanistan and describe the characteristics of patients seen selected MSF health facilities.
YEMEN
The true burden of the COVID-19 pandemic in Yemen is largely underestimated. The official surveillance data is limited to the southern governorates only. The country has experienced two waves so far and until May 31 2021, the total number of confirmed cases reported was 6 746 with 1 322 associated deaths. With limited testing capacity, PCR tests are spared for suspect cases presenting with severe symptoms only. MSF has been operating several COVID-19 projects in the southern and northern parts since the beginning of the pandemic. To date, MSF France has treated 2 138 COVID-19 patients. The in-hospital mortality was 30%. This presentation provides an overview of the evolution of the pandemic in Yemen and a description of patients seen at MSF health facilities.
AFGHANISTAN
Afghanistan is currently experiencing a third wave of COVID-19. To date (31 May 2021) a total of nearly 73 000 confirmed cases and 3 000 deaths have been reported. The PCR testing capacity remains limited, particularly outside the national capital, and the characteristics of suspected patients are poorly described. MSF has bee supporting the pandemic response in Herat, the regional capital of Western Afghanistan, by running a COVID-19 triage at the Herat Regional Hospital and through case management. To date, over 31 000 patients have been received at the triage, and, if required, oriented towards appropriate care. In addition, patient data collected at the triage facility are a valuable surveillance tool since they allow to follow epidemic trends and to describe patient characteristics. Here we give an update about the current situation in Afghanistan and Herat and describe the characteristics of patients through the three epidemic waves.
YEMEN
The true burden of the COVID-19 pandemic in Yemen is largely underestimated. The official surveillance data is limited to the southern governorates only. The country has experienced two waves so far and until May 31 2021, the total number of confirmed cases reported was 6 746 with 1 322 associated deaths. With limited testing capacity, PCR tests are spared for suspect cases presenting with severe symptoms only. MSF has been operating several COVID-19 projects in the southern and northern parts since the beginning of the pandemic. To date, MSF France has treated 2 138 COVID-19 patients. The in-hospital mortality was 30%. This presentation provides an overview of the evolution of the pandemic in Yemen and a description of patients seen at MSF health facilities.
AFGHANISTAN
Afghanistan is currently experiencing a third wave of COVID-19. To date (31 May 2021) a total of nearly 73 000 confirmed cases and 3 000 deaths have been reported. The PCR testing capacity remains limited, particularly outside the national capital, and the characteristics of suspected patients are poorly described. MSF has bee supporting the pandemic response in Herat, the regional capital of Western Afghanistan, by running a COVID-19 triage at the Herat Regional Hospital and through case management. To date, over 31 000 patients have been received at the triage, and, if required, oriented towards appropriate care. In addition, patient data collected at the triage facility are a valuable surveillance tool since they allow to follow epidemic trends and to describe patient characteristics. Here we give an update about the current situation in Afghanistan and Herat and describe the characteristics of patients through the three epidemic waves.
Conference Material > Video
Camacho A
Epicentre Scientific Day 2021. 10 June 2021
Conference Material > Abstract
Rieux C, Koudika MH
Epicentre Scientific Day 2021. 10 June 2021
The emergence of chronic communicable diseases is a new health issue facing resource-limited countries and the medical organizations working in them. Cancer in particular has the greatest inequalities in survival and epidemiological predictions are worrying. It is estimated that by 2040, the number of new cancer cases and deaths in the poorest countries will double and more than 1.2 million new cases are expected. In 2018, MSF OCP has decided to get involved in the fight against cancer by developing operational projects and investing in access to prevention, diagnosis and treatment.
In Mali, the oncology project, dedicated to cervical and breast cancers (representing 30% of cancers of both sexes), built in partnership with Malian colleagues and Ministry of Health, started at the end of 2018 with palliative care, then support for screening, histopathology laboratory and specific treatments (surgery, chemotherapy, radiotherapy). In 2020, MSF provided specific care for 542 patients (366 breast cancers and 176 cervical cancers) and performed 2828 palliative consultations and 3260 tumor wounds care.
This experience confirmed the lack of financial and geographical access to screening and care facilities leading to diagnoses at very advanced stages and the complexity of management and multidisciplinary care pathways. This type of project implies new ways of working for MSF: the development of a holistic and patient-centered approach, long-term projection and working in partnership with national actors and international experts. Research, an essential element, needs to be developed around several axes: epidemiological, therapeutic trials and the introduction and evaluation of technological tools to improve diagnosis and management such as telemedicine and artificial intelligence. Finally, the issues of access not only to treatment but also to diagnosis and prevention are one of the major added values that MSF could bring to the fight against cancer.
KEY MESSAGE: Cancer is one of the new challenges that MSF has decided to tackle and for which new ways of working and research are needed.
This abstract is not to be quoted for publication.
In Mali, the oncology project, dedicated to cervical and breast cancers (representing 30% of cancers of both sexes), built in partnership with Malian colleagues and Ministry of Health, started at the end of 2018 with palliative care, then support for screening, histopathology laboratory and specific treatments (surgery, chemotherapy, radiotherapy). In 2020, MSF provided specific care for 542 patients (366 breast cancers and 176 cervical cancers) and performed 2828 palliative consultations and 3260 tumor wounds care.
This experience confirmed the lack of financial and geographical access to screening and care facilities leading to diagnoses at very advanced stages and the complexity of management and multidisciplinary care pathways. This type of project implies new ways of working for MSF: the development of a holistic and patient-centered approach, long-term projection and working in partnership with national actors and international experts. Research, an essential element, needs to be developed around several axes: epidemiological, therapeutic trials and the introduction and evaluation of technological tools to improve diagnosis and management such as telemedicine and artificial intelligence. Finally, the issues of access not only to treatment but also to diagnosis and prevention are one of the major added values that MSF could bring to the fight against cancer.
KEY MESSAGE: Cancer is one of the new challenges that MSF has decided to tackle and for which new ways of working and research are needed.
This abstract is not to be quoted for publication.
Conference Material > Abstract
Karl F
Epicentre Scientific Day 2021. 10 June 2021
BACKGROUND
While 2.5 million envenomings and 130,000 deaths occur globally due to snakebites, with 1 million envenomings and 30,000 deaths in sub-Saharan Africa, the accessibility of antivenom for treatment of snakebites remain limited. The Inoserp® Pan-Africa antivenom is being used in many African countries including Cameroon but there is few data on its efficacy or tolerance in those settings. We therefore aim to evaluate the tolerance and efficacy of the Inoserp® Pan-Africa antivenom (AVS) in Cameroon.
METHODS
We performed a Phase IV clinical trial and included participants 5 years and above with snakebites in 14 healthcare centers across 6 of the 10 regions of Cameroon. Participants with envenomation were treated with Inoserp AVS and followed-up for 3 days in the hospital and 15 more days at home. The main study endpoints were complete follow-up to day 15, occurrence of adverse events, including disability or death.
RESULTS
Between October 15, 2019 and April 30, 2021, we included 427 participants with snakebites. Echis ocellatus (43.3%) was the most incriminated. Most frequent signs at admission were pain and edema with 90.9% (388/427) and 75.2% (321/427) respectively. We administered AVS to 81.3% (347/427) of patients with an average dose of 2 doses of AVS. Coagulation disorders was present in 50.4% (215/427) of the participants. We reported 12 deaths (2.7%); none were imputed to the administration of AVS. According to preliminary analysis necessitating confirmation, we observed at least one mild or moderate adverse event in 75 of 347 patients (21.6%), including tachypnea, tachycardia and bradycardia.
CONCLUSIONS
Snakebites are still an important neglected problem. Treatment with the Inoserp® Pan-Africa AVS appeared to be well tolerated in the Cameroonian patients and ongoing analysis will help to better assess its effectiveness.
KEY MESSAGES: Snakebites are neglected and their management is most at times inappropriate. We found the Inoserp® Pan-Africa antivenom to be well tolerated in the Cameroonian population.
This abstract is not to be quoted for publication.
While 2.5 million envenomings and 130,000 deaths occur globally due to snakebites, with 1 million envenomings and 30,000 deaths in sub-Saharan Africa, the accessibility of antivenom for treatment of snakebites remain limited. The Inoserp® Pan-Africa antivenom is being used in many African countries including Cameroon but there is few data on its efficacy or tolerance in those settings. We therefore aim to evaluate the tolerance and efficacy of the Inoserp® Pan-Africa antivenom (AVS) in Cameroon.
METHODS
We performed a Phase IV clinical trial and included participants 5 years and above with snakebites in 14 healthcare centers across 6 of the 10 regions of Cameroon. Participants with envenomation were treated with Inoserp AVS and followed-up for 3 days in the hospital and 15 more days at home. The main study endpoints were complete follow-up to day 15, occurrence of adverse events, including disability or death.
RESULTS
Between October 15, 2019 and April 30, 2021, we included 427 participants with snakebites. Echis ocellatus (43.3%) was the most incriminated. Most frequent signs at admission were pain and edema with 90.9% (388/427) and 75.2% (321/427) respectively. We administered AVS to 81.3% (347/427) of patients with an average dose of 2 doses of AVS. Coagulation disorders was present in 50.4% (215/427) of the participants. We reported 12 deaths (2.7%); none were imputed to the administration of AVS. According to preliminary analysis necessitating confirmation, we observed at least one mild or moderate adverse event in 75 of 347 patients (21.6%), including tachypnea, tachycardia and bradycardia.
CONCLUSIONS
Snakebites are still an important neglected problem. Treatment with the Inoserp® Pan-Africa AVS appeared to be well tolerated in the Cameroonian patients and ongoing analysis will help to better assess its effectiveness.
KEY MESSAGES: Snakebites are neglected and their management is most at times inappropriate. We found the Inoserp® Pan-Africa antivenom to be well tolerated in the Cameroonian population.
This abstract is not to be quoted for publication.
Conference Material > Abstract
Juan A
Epicentre Scientific Day 2021. 10 June 2021
This presentation provides and overview of fractional dosing and discusses opportunities and barriers for other vaccines.
Fractional dosing of vaccines is considered a dose sparing solution for situations of vaccine shortages. Lower doses of vaccines, typically as 1/5th of the standard dose, are at present used for vaccines such as rabies, inactivated polio and yellow fever vaccines. However, the immunogenicity and safety of fractional doses compared to full dose need to be established before this strategy can be used. Since 2016, Epicentre has been working on assessing fractional doses of yellow fever vaccines. The aim of these studies is to provide the needed evidence to recommend fractional dosing of YF vaccines for outbreak response, when there are insufficient standard doses to protect the population at risk.
A non-inferiority trial assessing the non-inferiority of fractional doses of the four WHO-prequalified yellow fever vaccines in a general adult population, children and HIV+ adults has been recently completed in Uganda and Kenya. To complement these, a study looking at the non-inferiority of lower doses of the yellow fever vaccine manufactured by Institut Pasteur Dakar is currently ongoing. Several factors have been considered in the design of these studies to ensure that the results are sufficient for policy and practice change. These include the fraction to be studied, the study design and goal, evaluation of vaccine protection and practical aspects related to the administration of the vaccine.
This abstract is not to be quoted for publication.
Fractional dosing of vaccines is considered a dose sparing solution for situations of vaccine shortages. Lower doses of vaccines, typically as 1/5th of the standard dose, are at present used for vaccines such as rabies, inactivated polio and yellow fever vaccines. However, the immunogenicity and safety of fractional doses compared to full dose need to be established before this strategy can be used. Since 2016, Epicentre has been working on assessing fractional doses of yellow fever vaccines. The aim of these studies is to provide the needed evidence to recommend fractional dosing of YF vaccines for outbreak response, when there are insufficient standard doses to protect the population at risk.
A non-inferiority trial assessing the non-inferiority of fractional doses of the four WHO-prequalified yellow fever vaccines in a general adult population, children and HIV+ adults has been recently completed in Uganda and Kenya. To complement these, a study looking at the non-inferiority of lower doses of the yellow fever vaccine manufactured by Institut Pasteur Dakar is currently ongoing. Several factors have been considered in the design of these studies to ensure that the results are sufficient for policy and practice change. These include the fraction to be studied, the study design and goal, evaluation of vaccine protection and practical aspects related to the administration of the vaccine.
This abstract is not to be quoted for publication.
Conference Material > Video
Gignoux EM
Epicentre Scientific Day 2021. 10 June 2021
Conference Material > Abstract
Gignoux EM
Epicentre Scientific Day 2021. 10 June 2021
BACKGROUND
More than a year after the emergence of the SARS-COV-2 virus, the proportion of infected people has been little studied in low-income countries. In addition, the excess mortality caused by the pandemic remains very uncertain. Through serology surveys we wanted to assess the real proportion of infected people in the population and in particular for health workers, including MSF teams, who are particularly exposed to infections. In some cases, we have combined these with mortality surveys.
METHOD
We conducted three types of surveys: to monitor trends and detect alerts we tested the relevance of testing blood donors in Aden, Yemen and Koutiala, Mali. To estimate the proportion of infection and morbidity of health workers we conducted a survey in Maradi, Niger and Aden, Yemen. To estimate the seroprevalence in the population and mortality we have conducted a survey in Dagahaley camp in Kenya, in Lubumbashi in DRC, and we are starting a survey in Abidjan in Ivory coast and another one covering the whole Cameroon.
RESULTS
The blood donors survey in Aden showed very low seroprevalence (2%), while high seroprevalence was found by rapid tests in Koutiala (24%) and very high prevalence based on laboratory tests (65%), these repeated surveys did not detect any alerts. In Yemen 8% of health staff tested positive by rapid tests and 59% by laboratory tests, in Maradi 42% of staff were positive by rapid tests and
84% by laboratory tests. The survey of the Dagahaley camp population revealed a seroprevalence of 6% by rapid tests. In Lubumbashi the seroprevalence was 16%. Mortality was higher during the pandemic period than before.
DISCUSSION
The seroprevalence detected was higher than what was expected looking at the number of cases reported. Uncertainties remain regarding the use of rapid laboratory tests depending on the context and timing. Preliminary results suggest an impact on mortality and further analysis is underway.
KEY MESSAGE: Studies led by Epicentre in low-income countries show higher SARS-COV-2 seroprevalence than what was expected. Preliminary results suggest an impact on mortality.
This abstract is not to be quoted for publication.
More than a year after the emergence of the SARS-COV-2 virus, the proportion of infected people has been little studied in low-income countries. In addition, the excess mortality caused by the pandemic remains very uncertain. Through serology surveys we wanted to assess the real proportion of infected people in the population and in particular for health workers, including MSF teams, who are particularly exposed to infections. In some cases, we have combined these with mortality surveys.
METHOD
We conducted three types of surveys: to monitor trends and detect alerts we tested the relevance of testing blood donors in Aden, Yemen and Koutiala, Mali. To estimate the proportion of infection and morbidity of health workers we conducted a survey in Maradi, Niger and Aden, Yemen. To estimate the seroprevalence in the population and mortality we have conducted a survey in Dagahaley camp in Kenya, in Lubumbashi in DRC, and we are starting a survey in Abidjan in Ivory coast and another one covering the whole Cameroon.
RESULTS
The blood donors survey in Aden showed very low seroprevalence (2%), while high seroprevalence was found by rapid tests in Koutiala (24%) and very high prevalence based on laboratory tests (65%), these repeated surveys did not detect any alerts. In Yemen 8% of health staff tested positive by rapid tests and 59% by laboratory tests, in Maradi 42% of staff were positive by rapid tests and
84% by laboratory tests. The survey of the Dagahaley camp population revealed a seroprevalence of 6% by rapid tests. In Lubumbashi the seroprevalence was 16%. Mortality was higher during the pandemic period than before.
DISCUSSION
The seroprevalence detected was higher than what was expected looking at the number of cases reported. Uncertainties remain regarding the use of rapid laboratory tests depending on the context and timing. Preliminary results suggest an impact on mortality and further analysis is underway.
KEY MESSAGE: Studies led by Epicentre in low-income countries show higher SARS-COV-2 seroprevalence than what was expected. Preliminary results suggest an impact on mortality.
This abstract is not to be quoted for publication.