Sarala Nicholas

Epicentre MSF

Background Many countries are now replacing non-nucleoside reverse transcriptase inhibitor (NNRTI)-based first-line antiretroviral therapy (ART) with a regimen containing tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD). Recognising laboratory limitations, Malawi opted to transition those on NNRTI-based first-line ART to TLD withou...

Objective We monitored a large‐scale implementation of the Simple Amplification‐Based Assay semi‐quantitative viral load test for HIV‐1 version I (SAMBA I Viral Load = SAMBA I VL) within Médecins Sans Frontières’ HIV programmes in Malawi and Uganda, to assess its performance and operational feasibility. Methods Descriptive analysis of routine prog...

In January 2019 the Ministry of Health of Malawi rolled-out tenofovir-lamivudine-dolutegravir (TLD) as national first-line antiretroviral therapy (ART). Transitioning of patients already on non-nucleoside-reverse-transcriptase-inhibitor-(NNRTI) first line was without prior HIV-1 viral load (VL) testing. VL monitoring and drug resistance testing (DR...

Please be advised that one of the author names is incorrectly spelled in the published article: 'Irene Kyomuhagi' should be 'Irene Kyomuhangi'.

Introduction: Routinely monitoring the HIV viral load (VL) of people living with HIV (PLHIV) on anti-retroviral therapy (ART) facilitates intensive adherence counselling and faster ART regimen switch when treatment failure is indicated. Yet standard VL-testing in centralized laboratories can be time-intensive and logistically difficult in low-reso...

Introduction Longer intervals between clinic consultations for clinically stable antiretroviral therapy (ART) patients may improve retention in care and reduce facility workload. We assessed long‐term retention among clinically stable ART patients attending six‐monthly clinical consultations (SMCC) with three‐monthly fast‐track drug refills, and es...

Objectives The number of patients on second‐line antiretroviral therapy is growing, but data on HIV drug resistance patterns at failure in resource‐constrained settings are scarce. We aimed to describe drug resistance and investigate the factors associated with extensive resistance to nucleoside/nucleotide reverse transcriptase inhibitors (NRTI), i...

Background: Insecticide-treated clothing (ITC) has long been used for military and outdoor recreational purposes and there is substantial evidence to show that it can protect against arthropod biting. As a complementary vector control measure, ITC could be used to address outdoor transmission of malaria, particularly among mobile and migrant popul...

The 2014 Ebola epidemic has shown the importance of accurate and rapid triage tools for patients with suspected Ebola virus disease (EVD). Our objective was to create a predictive score for EVD. We retrospectively reviewed all suspected cases admitted to the Ebola treatment center (ETC) in Nzérékoré, Guinea, between December 2, 2014, and February 2...

Background: Antibiotic resistance is an issue of growing global concern. One key strategy to minimise further development of resistance is the rational use of antibiotics, by providers and patients alike. Through integrated community case management (iCCM), children diagnosed with suspected pneumonia are treated with antibiotics; one component of...

Background: Pneumonia is the leading infectious cause of mortality in children under five worldwide. Community-level interventions, such as integrated community case management, have great potential to reduce the burden of pneumonia, as well as other diseases, especially in remote populations. However, there are still questions as to whether commu...

The 2010 cholera epidemic in Haiti was one of the largest cholera epidemics ever recorded. To estimate the magnitude of the death toll during the first wave of the epidemic, we retrospectively conducted surveys at 4 sites in the northern part of Haiti. Overall, 70,903 participants were included; at all sites, the crude mortality rates (19.1-35.4 de...

Technical Appendix. Estimated excess deaths in study population, calculated by using low, medium, and high variants, Haiti, 2010; observed and expected crude mortality rate estimates for Haiti, 1970–2020.

Introduction: Since 2010, WHO has recommended oral cholera vaccines as an additional strategy for cholera control. During a cholera episode, pregnant women are at high risk of complications, and the risk of fetal death has been reported to be 2-36%. Due to a lack of safety data, pregnant women have been excluded from most cholera vaccination campa...

Supplementary information. (DOC)

STROBE checklist. (DOC)

Scale-up of malaria interventions seems to have contributed to a decline in the disease but other factors may also have had some role. Understanding changes in transmission and determinant factors will help to adapt control strategies accordingly. Four sites in Ethiopia and Uganda were set up to monitor epidemiological changes and effectiveness of...

In 2010 and 2011, Haiti was heavily affected by a large cholera outbreak that spread throughout the country. Although national health structure-based cholera surveillance was rapidly initiated, a substantial number of community cases might have been missed, particularly in remote areas. We conducted a community-based survey in a large rural, mounta...

Background A large poliomyelitis outbreak occurred in 2010 in the Republic of Congo. This paper describes the demographic and clinical characteristics of poliomyelitis cases and their outcomes following physiotherapy. Findings Demographic and clinical data were collected on 126 individuals between November 23, 2010 and March 23, 2011. The male/fem...

Despite high reported coverage for routine and supplementary immunization, in 2010 in Malawi, a large measles outbreak occurred that comprised 134,000 cases and 304 deaths. Although the highest attack rates were for young children (2.3%, 7.6%, and 4.5% for children <6, 6-8, and 9-11 months, respectively), persons >15 years of age were highly affect...

Weekly incidence and timeliness of the outbreaks response immunizations conducted by the Ministry of Health and Médecins Sans Frontières, Malawi, 2010.

Objectives: To identify factors influencing mortality in an HIV programme providing care to large numbers of injecting drug users (IDUs) and patients co-infected with hepatitis C (HCV). Methods: A longitudinal analysis of monitoring data from HIV-infected adults who started antiretroviral therapy (ART) between 2003 and 2009 was performed. Mortal...

We investigated the association between immune response and mortality in four HIV African programs supported by Médecins Sans Frontières. Multicentric retrospective cohort study. All antiretroviral therapy (ART) naive adults (>15 years) who initiated therapy between March 2001 and November 2010 and receiving therapy for 9 months or more were includ...

There is little evidence to describe the feasibility and outcomes of services for the care of street children and youth in low-income countries. To describe the outcomes of a multidisciplinary case management approach delivered in a drop-in centre for street children and youth. A longitudinal study of street children and youth followed in an urban...

Eight HIV programs in sub-Saharan Africa. To describe the incidence of pulmonary and extrapulmonary tuberculosis before and after the start of combined antiretroviral therapy (ART) and investigate associated risk factors. Multicohort study. Adults enrolled between January 2006 and September 2008. A total of 30,134 patients contributed 25,916 person...

Among people living with HIV/AIDS, nutritional support is increasingly recognized as a critical part of the essential package of care, especially for patients in sub-Saharan Africa. The objectives of the study were to evaluate the outcomes of HIV-positive malnourished adults treated with ready-to-use therapeutic food and to identify factors associa...

Jaarlijks melden zich zeventien à achttien duizend vrouwen bij de vrouwenopvang om het geweld van hun partner te ontvluchten. Welke vrouwen zijn dit? Wat is hun achtergrond? Wat zijn hun problemen en zorgbehoeften? Welke hulp krijgen ze bij de vrouwenopvang en sluit die hulp aan bij hun situatie? Om antwoord op deze vragen te geven, deed het Trimbo...

The relative contributions of reactivation of latent infection and clusters of new infections to the overall incidence of tuberculosis in the U.K. is unknown. A study was carried out in North-West London to determine the feasibility of IS6110 RFLP strain typing as a tool to investigate the relative contributions of these two sources. All available...

A survey of 104 mental health units found that half did not have policies on treatment of detained patients from black and ethnic minority groups. Almost three-quarters had no policy for dealing with racial harassment of black and ethnic-minority patients. 11 percent of patients whose notes were examined had reported racial harassment.

Sexually transmitted diseases (STDs) are an important cause of pelvic inflammatory disease (PID) but have often not been detected in microbiological studies of Indian women admitted to hospital gynaecology wards or private clinics. In this cross sectional study, women living in the inner city of Mumbai (Bombay) were investigated for socioeconomic,...

Iron-deficiency anaemia is highly prevalent among women of reproductive age in South-East Asia. In this study, the haemoglobin levels of 2813 women living in inner-city Mumbai, India, were measured as part of a reproductive health study. Women were recruited over a two-year period at three health facilities providing pregnancy and post-partum servi...

Reported are the prevalence of reproductive tract infections and their contribution to pelvic inflammatory disease (PID), as well as the seroprevalence of human immunodeficiency virus (HIV), among women living in three inner city wards of Mumbai, India. Women aged < or = 35 years were recruited and screened as cases if they had been admitted to hos...

A national survey of tuberculosis notifications in England and Wales was carried out in 1993 to determine the notification rate of tuberculosis and the trends in the occurrence of disease by ethnic group in comparison with the findings of similar surveys in 1978/79, 1983, and 1988. The prevalence of HIV infection in adults notified with tuberculosi...

The effectiveness of influenza vaccination in preventing serious illness and death was determined in an elderly population during the influenza epidemic of was determined in an elderly population during the influenza epidemic of was determined in an elderly population during the influenza epidemic of 1989-90. A retrospective cohort study was carrie...

The aetiology of sporadic campylobacter infection was investigated by means of a multicentre case-control study. During the course of the study 598 cases and their controls were interviewed. Conditional logistic regressional analysis of the data collected showed that occupational exposure to raw meat (odds ratio [OR] 9·37; 95 % confidence intervals...

A case control study of sporadic hepatitis A was carried out in 201 districts in England from July 1990 to June 1991. The aims were to determine the risk factors associated with the infection and to identify individuals or groups who might benefit from prophylactic measures, such as human normal immunoglobulin or hepatitis A vaccine. Factors associ...

We report on the first four years (1990-93) of a survey within the national HIV prevalence monitoring programme. The survey's objective is to monitor the prevalence of infection with the human immunodeficiency virus (HIV) in pregnant women in London and elsewhere in England. The survey--based in forty centres that offer antenatal care in London, Gr...

In 1990 a programme based on the unlinked anonymous test method began in England and Wales to monitor the prevalence of HIV infection. It included a survey of blood specimens collected from pregnant women for rubella screening in London and other parts of England.1 Forty antenatal centres took part: 15 in London, 19 in three other cities (Mancheste...

In the U.K., blood donations have been routinely screened for anti-HCV since September 1991. In order to get the most epidemiological benefit from these extensive screening data, the histories obtained at counselling from donors confirmed to be anti-HCV positive, 'indeterminate' and falsely positive have been analysed in detail. In addition, the as...

An outbreak of cryptosporidiosis occurred in the Isle of Thanet during December 1990 and January 1991. A total of 47 cases ranging in age from 2 months to 85 years were identified in residents from the Margate, Broadstairs and Ramsgate areas, with dates of onset of illness from 3 December to 14 January. A case-control study demonstrated a strong st...