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Treatment Beyond Borders

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ChinAfrica 2012年第8期4卷 44-45页

作者： Cui Xiaoqin Stories of Chinese doctors working with medecins sans frontieres

DR. An Na has just returned to Beijing from a medical assistance program in Pakistan, and her warm smile and passion are infec- tious at first sight. An, a Chinese gynecologist, began working with her program, which is affiliated with medecins sans frontieres （mSF - also called Doctors Without Borders） in Sierra Leone in 2011. But she is not the only Chinese physician working with the international medical and humanitarian non-governmental or- ganization （NGO）. In recent years, an increasing number of Chi- nese doctors have partnered with mSF to provide medical aid to the world＇s most in need.

关键词： mSF Treatment Beyond Borders

China’s 1-3-7 surveillance and response strategy for malaria elimination: Is case reporting, investigation and foci response happening according to plan?

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Infectious Diseases of Poverty 2015年第1期4卷 465-473页

作者： Shui-Sen Zhou Shao-Sen Zhang Li Zhang Aafje ECRietveld Andrew RRamsay Rony Zachariah Karen Bissell Rafael Van den Bergh Zhi-Gui Xia Xiao-Nong Zhou Richard ECibulskis National Institute of Parasitic Diseases Chinese Center for Disease Control and PreventionKey Laboratory of Parasite and Vector BiologyMOHWHO Collaborating Centre for Tropic DiseasesNational Center for International Research on Tropical Diseases207 Rui Jin Er RoadShanghai200025People’s Republic of China Global malaria Programme World Health Organization20 Avenue AppiaCH-1211Geneva 27Switzerland Special Programme for Research and Training in Tropical Diseases(TDR) 20 Avenue AppiaCH-1211Geneva 27Switzerland Médecins Sans Frontieres Brussels Operational CentreLuxembourgLuxembourg International Union Against Tuberculosis and Lung Disease ParisFrance

Background:The China’s 1-3-7 strategy was initiated and extensively adopted in different types of counties(geographic regions)for reporting of malaria cases within 1 day,their confirmation and investigation within 3 days,and the appropriate public health response to prevent further transmission within 7 days.Assessing the level of compliance to the 1-3-7 strategy at the county level is a first step towards determining whether the surveillance and response strategy is happening according to plan.This study assessed if the time-bound targets of the 1-3-7 strategy were being sustained over time.Such information would be useful to improve implementation of the 1-3-7 strategy in China.methods:This cross-sectional study involved country-wide programmatic data for the period January 1st 2013 to June 30th 2014.Data variables were extracted from the national malaria information system and included socio-demographic information,type of county,date of diagnosis,date of reporting,date of case investigation,case classification(indigenous,or imported,or unknown),focus investigation,date of reactive case detection(RACD),and date of indoor residual spraying(IRS).Summary statistics and proportions were used and comparisons between groups were assessed using the chi-square test.Level of significance was set at a P-value≤0.05.Results:Of a total of 5,688 malaria cases from 731 counties,there were 55(1%)indigenous cases(only in Type 1 and Type 2 counties)and 5,633(99%)imported cases from all types of counties.There was no delay in reporting malaria cases by type of county.In terms of case investigation,97.5%cases were investigated within 3 days with the proportion of delays(1.5%)in type 2 counties,being significantly lower than type 1 counties(4.1%).Regarding active foci,96.4%were treated by RACD and/or IRS.Conclusions:The performance of 1-3-7 strategy was encouraging but identified some challenges that if addressed can further improve implementation.

关键词： 1-3-7 strategy malaria elimination Surveillance and response

如何提高传染性肺结核病人的发现率?——埃塞俄比亚索马里地区的成功经验

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国际结核病与肺部疾病杂志 2003年第2期 78-80页

作者： m-L.Lambert H.Sugulle D.Seyoum S.Abdurahman A.Abdinasir m.Frieden F.matthys P.Van der Stuyft 马玙 Department of Public Health Institute For Tropical MedicineAntwerpBelgium medecins sans frontieres Belgium in Ethiopia Jijiga Somali National Regional State Health Bureau JijigaEthiopia medecins sans frontieres Belgium in Ethiopia Jijiga medecins sans frontieres Belgium Brussels Belgium Department of Public Health Institute For Tropical Medicine AntwerpBelgium

1999年初,埃塞俄比亚索马里地区发现的肺结核(PTB)病例中48％者为痰涂片阳性。于是提出实验室水平上的质量强化措施,并对痰涂片阴性的肺结核诊断进行复核。临床医生虽然了解国家结核病规划关于肺结核诊断的基本原则,但并没有完全遵循这... 详细信息

1999年初,埃塞俄比亚索马里地区发现的肺结核(PTB)病例中48％者为痰涂片阳性。于是提出实验室水平上的质量强化措施,并对痰涂片阴性的肺结核诊断进行复核。临床医生虽然了解国家结核病规划关于肺结核诊断的基本原则,但并没有完全遵循这些原则,部分是因为考虑到病人的费用问题。通过上述非威胁性方式对临床医生提出挑战,发挥其临床实践当中的积极主动性获得了巨大成功,涂阳肺结核比例增至65％。需要开展研究以评估这些广泛推行的涂阴肺结核诊断指南的可行性。

关键词：结核病诊断控制实用指南

全球市场上抗结核药物固定剂量复合剂的质量控制:体外研究结果报告

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结核与肺部疾病杂志 2005年第1期8卷 1-7页

作者： Y. Ashokraj S. Agrawal m. V. S. Varma I. Singh K. Gunjan K. J. Kaur S. R. Shade C. L. Kaul J. m. Caudron J. Pinel R. Panchagnula 马玙 Department of Pharmaceutics National Institute of Pharmaceutical Education and Research (NIPER) Mohali Punjab India medecins sans frontieres International Office Brussels Belgium

目的:评价在国家结核病控制规划中大范围供应使用抗结核药物固定剂量复合剂(FDC)的质量,尤其是FDC中利福平的溶解特性。方法:对4家药厂供应的4种制剂采用不同的溶媒(0.1NHCL及0.01NHCL、磷酸缓冲液(PB)及含20%植物油的PB)、不同振荡强度... 详细信息

目的:评价在国家结核病控制规划中大范围供应使用抗结核药物固定剂量复合剂(FDC)的质量,尤其是FDC中利福平的溶解特性。方法:对4家药厂供应的4种制剂采用不同的溶媒(0.1NHCL及0.01NHCL、磷酸缓冲液(PB)及含20%植物油的PB)、不同振荡强度(USPⅡ型仪)进行溶解度研究。并对FDC进行了4周的催化稳定性研究(40℃/75%相对湿度[RH]),评价其物理、化学和溶解稳定性。结果:根据药典中的质控试验(CQC)对待评价制剂进行检测。利福平的溶解程度不受溶媒影响;有两种产品的利福平溶解速度有轻微降低。75%以上的药物成分在除30rpm外的各种振荡强度下,代表饱食状态的含20%植物油溶媒中45分钟内溶解。在制药厂建议的包装条件下,各制剂至少在4周内性能稳定。结论:所检测的制剂均通过了质量控制试验并证明其性能稳定。虽然有的制剂溶解速度有所降低,但其溶解程度未发生改变,但这就需要胃及肠道不同PH条件下的多点溶解,以保证制剂体内生物利用度的稳定性。

关键词：固定剂量复合剂抗结核药物质量控制结果报告体外研究结核病控制规划市场全球溶解速度稳定性研究生物利用度利福平相对湿度药物成分包装条件 FDC 植物油制剂大范围溶媒缓冲液溶解度制药厂供应强度

薄层琼脂方法检测结核分枝杆菌分离物对利福平、氧氟沙星和卡那霉素的耐药性

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国际结核病与肺部疾病杂志 2010年第1期5卷 1-4页

作者： A.martin F.Paasch A.Von Groll K.Fissette P.Almeida F.Varaine F.Portaels J-C.Palomino 夏辉刘宇红 Institute of Tropical medicine Mycobacteriology UnitAntwerpBelgium Laboratory of mycobacteriology Universidade Federal do Rio GrandeRio Grande do SulBrazil medecins sans frontieres ParisFrance

背景:在低收入国家迫切需要经济的方法检测结核分枝杆菌对抗结核药物的敏感性。目的:评估薄层琼脂方法(thin-layer agar,TLA)快速检测结核分枝杆菌临床分离物对利福平(RmP)、氧氟沙星(Ofx)、卡那霉素(Km)的耐药性;与金标准比较,评估该... 详细信息

背景:在低收入国家迫切需要经济的方法检测结核分枝杆菌对抗结核药物的敏感性。目的:评估薄层琼脂方法(thin-layer agar,TLA)快速检测结核分枝杆菌临床分离物对利福平(RmP)、氧氟沙星(Ofx)、卡那霉素(Km)的耐药性;与金标准比较,评估该方法的敏感度、特异度以及阳性结果的报告时间。方法:共纳入147份结核结核分枝杆菌临床分离物。进行TLA方法时,采用含有RmP,Ofx及Km的7H11琼脂培养基的四象限平皿。TLA方法RmP耐药性结果与Bactec mGIT960结果进行比较,TLA方法检测Ofx和Km耐药性结果与比例法的耐药性结果进行比较。结果:RmP和Ofx的敏感度和特异度均为100%,Km的敏感度和特异度分别为100%和98.7%。使用TLA四象限平皿方法可以快速(中位数为10 d)检测3种抗结核药物(RmP、Ofx、Km)的耐药性。结论:对于检测所研究的3种药物的耐药性,LTA是1种准确的方法。这种快速的方法操作简便,为资源有限、不能应用复杂技术的国家提供了一种替代的方法。

关键词：结核耐药薄层琼脂

Engagement of public and private medical facilities in tuberculosis care in myanmar:contributions and trends over an eight-year period

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Infectious Diseases of Poverty 2017年第1期6卷 1083-1089页

作者： Thin Thin Nwe Saw Saw Le Le Win myo myo mon Johan van Griensven Shuisen Zhou Palanivel Chinnakali Safieh Shah Saw Thein Si Thu Aung Procurement Unit Department of Public HealthNaypyitawMyanmar Department of medical Research YangonMyanmar Institute of Tropical medicine AntwerpBelgium Institute of Parasitic Diseases Chinese Center for Disease Control and PreventionShanghaiChina Jawaharlal Institute of Postgraduate medical Education and Research(JIPmER) PuducherryIndia Operational Research Unit(LuxOR) MEdecins Sans FrontiEres-Operational Centre BrusselsLuxembourgLuxembourg National TB Program Department of Public HealthNaypyitawMyanmar Procurement and Supply Division Department of Public HealthMinistry of HealthNaypyitawMyanmar

Background:As part of the WHO End TB strategy,national tuberculosis(TB)programs increasingly aim to engage all private and public TB care providers.Engagement of communities,civil society organizations and public and private care provider is the second pillar of the End TB strategy.In myanmar,this entails the public-public and public-private mix(PPm)approach.The public-public mix refers to public hospital TB services,with reporting to the national TB program(NTP).The public-private mix refers to private general practitioners providing TB services including TB diagnosis,treatment and reporting to NTP.The aim of this study was to assess whether PPm activities can be scaled-up nationally and can be sustained over time.methods:Using 2007-2014 aggregated program data,we collected information from NTP and non-NTP actors on 1)the number of TB cases detected and their relative contribution to the national case load;2)the type of TB cases detected;3)their treatment outcomes.Results:The total number of TB cases detected per year nationally increased from 133,547 in 2007 to 142,587 in 2014.The contribution of private practitioners increased from 11%in 2007 to 18%in 2014,and from 1.8%to 4.6%for public hospitals.The NTP contribution decreased from 87%in 2007 to 77%in 2014.A similar pattern was seen in the number of new smear(+)TB cases(31%of all TB cases)and retreatment cases,which represented 7.8%of all TB cases.For new smear(+)TB cases,adverse outcomes were more common in public hospitals,with more patients dying,lost to follow up or not having their treatment outcome evaluated.Patients treated by private practitioners were more frequently lost to follow up(8%).Adverse treatment outcomes in retreatment cases were particularly common(59%)in public hospitals for various reasons,predominantly due to patients dying(26%)or not being evaluated(10%).In private clinics,treatment failure tended to be more common(8%).Conclusions:The contribution of non-NTP actors to TB detection at the national level increased over time,with the larg

关键词： Public and private Tuberculosis myanmar Operational research

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The contribution of a non-governmental organisation’s Community Based Tuberculosis Care Programme to case finding in myanmar:trend over time

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Infectious Diseases of Poverty 2017年第1期6卷 449-454页

作者： Htet myet Win maung Saw Saw Petros Isaakidis mohammed Khogali Anthony Reid Nguyen Binh Hoa Ko Ko Zaw Saw Thein Si Thu Aung National Tuberculosis Programme Ministry of Health and SportsZabuthiri townshipPostcode 15011 Nay Pyi TawMyanmar Department of medical Research Ministry of Health and SportsYangonMyanmar medecins sans frontieres Operational Research UnitMSF-LuxembourgLuxembourgLuxembourg National Tuberculosis Programme HanoiVietnam Centre for Operational Research International Union Against Tuberculosis and Lung DiseaseParisFrance

Background:It is estimated that the standard,passive case finding(PCF)strategy for detecting cases of tuberculosis(TB)in myanmar has not been successful:26%of cases are missing.Therefore,alternative strategies,such as active case finding(ACF)by community volunteers,have been initiated since 2011.This study aimed to assess the contribution of a Community Based TB Care Programme(CBTC)by local non-government organizations(NGOs)to TB case finding in myanmar over 4 years.methods:This was a descriptive study using routine,monitoring data.Original data from the NGOs were sent to a central registry within the National TB Programme and data for this study were extracted from that database.Data from all 84 project townships in five regions and three states in myanmar were used.The project was launched in 2011.Results:Over time,the number of presumptive TB cases that were referred decreased,except in the Yangon Region,although in some areas,the numbers fluctuated.At the same time,there was a trend for the proportion of cases treated,compared to those referred,that decreased over time(P=0.051).Overall,among 84 townships,the contribution of CBTC to total case detection deceased from 6%to 4%over time(Pm previous studies in other countries,a concerning reduction in TB case finding by local NGO volunteer networks in several areas in myanmar was recorded over 4 years.This suggests that measures to support the volunteer network and improve its performance are needed.They may include discussion with local NGOs human resources personnel,incentives for the volunteers,closer supervision of volunteers and improved monitoring and evaluation tools.

关键词： Operational research Community based tuberculosis care Contribution SORT IT

Different challenges,different approaches and related expenditures of communitybased tuberculosis activities by international non-governmental organizations in myanmar

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Infectious Diseases of Poverty 2017年第1期6卷 506-513页

作者： Wai Wai Han Saw Saw Petros Isaakidis mohammed Khogali Anthony Reid Nguyen Hoa Ko Ko Zaw Si Thu Aung Department of medical Research Ministry of Health and SportsNo 5Ziwaka RoadDagon Township11191 YangonMyanmar mddecins sans frontieres Operational Research UnitLuxembourg cityLuxembourg Centre for Operational Research International Union Against Tuberculosis and Lung DiseaseParisFrance National Tuberculosis Programme Ministry of Health and SportsNay Pyi TawMyanmar National Tuberculosis Programme HanoiVietnam

Background:International non-governmental organizations(INGOs)have been implementing community-based tuberculosis(TB)care(CBTBC)in myanmar since 2011.Although the National TB Programme(NTP)ultimately plans to take over CBTBC,there have been no evaluations of the models of care or of the costs of providing CBTBC in myanmar by INGOs.methods:This was a descriptive study using routinely-collected programmatic and financial data from four INGOs during 2013 and 2014,adjusted for inflation.Data analysis was performed from the provider perspective.Costs for sputum examination were not included as it was provided free of charge by NTP.We calculated the average cost per year of each programme and cost per patient completing treatment.Results:Four INGOs assisted the NTP by providing CBTBC in areas where access to TB services was challenging.Each INGO faced different issues in their contexts and responded with a diversity of strategies.The total costs ranged from US$140754 to US$550221 during the study period.The cost per patient completing treatment ranged from US$215 to US$1076 for new cases and US$354 to US$1215 for retreatment cases,depending on the targeted area and the package of services offered.One INGO appeared less costly,more sustainable and patient oriented than others.Conclusions:This study revealed a wide variety of models of care and associated costs for implementing CBTBC in diverse and challenging populations and contexts in myanmar.Consequently,we recommend a more comprehensive evaluation,including development of a cost model,to estimate the costs of scaling up CBTBC country-wide,and cost-effectiveness studies,to best inform the NTP as it prepares to takeover CBTBC activities from INGOs.While awaiting evidence from these studies,model of CBTBC that have higher sustainability potential and allocate more resources to patient-centered care should be given priority support.

关键词： Operational research Cost Sustainability Budget allocation

Active case-finding for tuberculosis by mobile teams in myanmar:yield and treatment outcomes

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Infectious Diseases of Poverty 2017年第1期6卷 683-690页

作者： Ohnmar myint Saw Saw Petros Isaakidis mohammed Khogali Anthony Reid Nguyen Binh Hoa Thi Thi Kyaw Ko Ko Zaw Tin mi mi Khaing Si Thu Aung National Tuberculosis Programme Corner of Mingyi Road and Minglar StreetPathein townshipAyeyarwaddy RegionMyanmar Department of medical Research YangonMyanmar medecins sans frontieres Operational Research UnitLuxembourgLuxembourg National Tuberculosis Programme HanoiVietnam Centre for Operational Research International Union Against Tuberculosis and Lung DiseaseParisFrance TB Unit WHO Country Office for MyanmarYangonMyanmar

Background:Since 2005,the myanmar National Tuberculosis Programme(NTP)has been implementing active case finding(ACF)activities involving mobile teams in hard-to-reach areas.This study revealed the contribution of mobile team activities to total tuberculosis(TB)case detection,characteristics of TB patients detected by mobile teams and their treatment outcomes.methods:This was a descriptive study using routine programme data between October 2014 and December 2014.mobile team activities were a one-stop service and included portable digital chest radiography(CXR)and microscopy of two sputum samples.The algorithm of the case detection included screening patients by symptoms,then by CXR followed by sputum microscopy for confirmation.Diagnosed patients were started on treatment and followed until a final outcome was ascertained.Results:A total of 9349 people with symptoms suggestive of TB were screened by CXR,with an uptake of 96.6%.Of those who were meant to undergo sputum smear microscopy,51.4%had sputum examinations.Finally,504 TB patients were identified by the mobile teams and the overall contribution to total TB case detection in the respective townships was 25.3%.Among total cases examined by microscopy,6.4%were sputum smear positive TB.Treatment success rate was high as 91.8%in study townships compared to national rate 85%(2014 cohort).Conclusions:This study confirmed the feasibility and acceptability of ACF by mobile teams in hard-to-reach contexts,especially when equipped with portable,digital CXR machines that provided immediate results.However,the follow-up process of sputum examination created a significant barrier to confirmation of the diagnosis.In order to optimize the ACF through mobile team activity,future ACF activities were needed to be strengthened one stop service including molecular diagnostics or provision of sputum cups to all presumptive TB cases prior to CXR and testing if CXR suggestive of TB.

关键词： mobile team Active case finding Chest X-ray Treatment outcomes