Posts tagged treatment

During my two-year-long treatment I faced many difficulties, I had mental and physical problems. Many times I wanted to give up but I knew it was my last chance, so I tried my very best to finish the course.

I still cough and have some complains but I know that little by little I’ll get through them. In general I feel very great and that ‘I crossed the bridge of the death’. I know that someday I’m going to die but not now.

Athong writes about finishing his two-year tuberculosis treatment  for multidrug-resistant tuberculosis. Please leave your comments for Athong in the comments box below his blog post.
Current treatment for dr-tb is complex and inadequate. For the first time in half a century drugs that could cure DR-TB are being tested, but the global health community needs to act fast.
Drug-resistant tuberculosis: we can stop this epidemic in its tracksThis article was originally published on The Guardian
DR-TB is a public health crisis that is spiralling out of control – the latest statistics from the World Health Organisation suggest more than 300,000 new cases every year among notified TB cases, a figure that Medecins Sans Frontieres/Doctors Without Borders (MSF) considers conservative based on the growing number of DR-TB patients in our projects. Once the preserve of people who had received incomplete or incorrect TB treatment, a growing number of people with DR-TB are presenting who have never had TB treatment before, which shows that DR-TB is becoming an epidemic in its own right.

Yet, the tools to tackle the disease remain woefully inadequate. People with DR-TB are forced to take up to 20 pills a day with excruciating side effects that range from deafness to nausea and psychosis. For healthcare professionals, the treatment is complex: individualised for each patient based on drug resistance patterns, and expensive, with drugs alone costing up to $ 6,000 (£3,962) per person for a treatment course. And even then, patients only have a 50% chance of cure.

However, after half a century of neglect there is a historic opportunity for change. The drug pipeline for TB is the best it has ever been, with 10 drugs in clinical testing. At the very end of 2012, the US Food and Drug Administration approved bedaquiline or Sirturo, the first dedicated new TB drug since 1963, while another drug, delamanid is currently undergoing review by the European Medicines Agency. Both drugs arecompletely new classes of antibiotics with no reported resistance, and represent an unprecedented opportunity to improve treatment for DR-TB.

So what do these developments mean for global health professionals – particularly those on the front-line treating TB in communities?

These new drugs could be game-changers and the TB community must urgently work out how best to use them. They offer the potential to make DR-TB treatment shorter, more effective and more tolerable, with fewer side effects. The first step is to make these new drugs available for research and ensure they are quickly registered in high-burden countries. The manufacturers must also make sure the drugs are affordable in low- and middle-income countries, eg through generic production.
The response of drug manufacturers to generic HIV drugs is perhaps the best incentive to do things differently with DR-TB: before the introduction of generic competition in 2001, antiretrovirals to treat HIV cost over US$10,000 per person per year and very few people in developing countries could afford that. As a result, millions of people died and the peak of AIDS related-deaths didn’t occur until 2005. Since 2001, the price has come down nearly 99% and people now have access to affordable medicines. With eight million people now on treatment, the curve of AIDS related-deaths has started to fall, but we still need to expand access to a total of 15 million people by 2015. New infections are also falling.

Current treatment for dr-tb is complex and inadequate. For the first time in half a century drugs that could cure DR-TB are being tested, but the global health community needs to act fast.

Drug-resistant tuberculosis: we can stop this epidemic in its tracks
This article was originally published on The Guardian

DR-TB is a public health crisis that is spiralling out of control – the latest statistics from the World Health Organisation suggest more than 300,000 new cases every year among notified TB cases, a figure that Medecins Sans Frontieres/Doctors Without Borders (MSF) considers conservative based on the growing number of DR-TB patients in our projects. Once the preserve of people who had received incomplete or incorrect TB treatment, a growing number of people with DR-TB are presenting who have never had TB treatment before, which shows that DR-TB is becoming an epidemic in its own right.

Yet, the tools to tackle the disease remain woefully inadequate. People with DR-TB are forced to take up to 20 pills a day with excruciating side effects that range from deafness to nausea and psychosis. For healthcare professionals, the treatment is complex: individualised for each patient based on drug resistance patterns, and expensive, with drugs alone costing up to $ 6,000 (£3,962) per person for a treatment course. And even then, patients only have a 50% chance of cure.

However, after half a century of neglect there is a historic opportunity for change. The drug pipeline for TB is the best it has ever been, with 10 drugs in clinical testing. At the very end of 2012, the US Food and Drug Administration approved bedaquiline or Sirturo, the first dedicated new TB drug since 1963, while another drug, delamanid is currently undergoing review by the European Medicines Agency. Both drugs arecompletely new classes of antibiotics with no reported resistance, and represent an unprecedented opportunity to improve treatment for DR-TB.

So what do these developments mean for global health professionals – particularly those on the front-line treating TB in communities?

These new drugs could be game-changers and the TB community must urgently work out how best to use them. They offer the potential to make DR-TB treatment shorter, more effective and more tolerable, with fewer side effects. The first step is to make these new drugs available for research and ensure they are quickly registered in high-burden countries. The manufacturers must also make sure the drugs are affordable in low- and middle-income countries, eg through generic production.

The response of drug manufacturers to generic HIV drugs is perhaps the best incentive to do things differently with DR-TB: before the introduction of generic competition in 2001, antiretrovirals to treat HIV cost over US$10,000 per person per year and very few people in developing countries could afford that. As a result, millions of people died and the peak of AIDS related-deaths didn’t occur until 2005. Since 2001, the price has come down nearly 99% and people now have access to affordable medicines. With eight million people now on treatment, the curve of AIDS related-deaths has started to fall, but we still need to expand access to a total of 15 million people by 2015. New infections are also falling.

Supposed to be on my 4 th year at University right now, most of my friends are going to be graduates this year and I’m not even close to that. Guess everything happens for a reason, but for this I don’t see any reason why it have to be so damn hard. But again I guess it’s those lessons that ‘life is not easy’ but really does it have to be this hard?? Mmhhh. Maybe it will be a happy new year, the day they say I’m actually cured from XDR (be it in June/July) for me that would be a HAPPY NEW YEAR.
22-year-old Phumeza is in her forth year of treatment for tuberculosis and is finding it tough. Please leave your questions, comments and messages of support for Phumeza in the comments box below her blog post. 
Rape is a crime that affects many aspects of human life; it is a medical emergency, it is a psychological trauma and it has deep consequences on both family and societal level. It is of utmost importance that survivors of rape have access to immediate medical and psychological care, and also for the sake of preventing sexual violence altogether in a long-term perspective it is important that women’s rights in general are improved.
MSF Mental Health Officer, Minja, reflects on the horrors of gang rape. Her main role is providing mental health care and psychological support for victims of family and sexual violence, mainly with female patients in Papua New Guinea. Please leave your questions and comments for Minja below her blog post.
Photo: Blood is drawn for an HIV test at the MSF Dipping Tank community testing campaign at Nhletsheni, in Shiselweleni region. Swaziland 2012 © Giorgos Moutafis
Trying Out New Approaches to HIV Treatment
Thirty years into the HIV/AIDS epidemic and more than a decade since the introduction of antiretroviral treatment (ART) in developing countries, the latest scientific evidence shows that the treatment keeps people healthy and prevents the virus from spreading. MSF is now treating more than 222,000 people for HIV/AIDS in 23 countries and introducing new approaches to treatment including earlier provision of ART to pregnant women living with HIV, expanded testing and treatment programs, and using improving technological monitoring techniques to track patient progress. Here, Micaela Serafini, MSF medical referent, discusses MSF’s efforts to treat HIV/AIDS in Swaziland.
Why is it important to provide antiretroviral treatment to people living with HIV while their immune system is still strong?
Today, we measure the level of an HIV-positive person’s white blood cells [CD4 cells] to determine when to start them on treatment, because this is an indicator of how strong their immune system is. Right now, the World Health Organization recommends starting people on ART when their CD4 cell count drops to 350 cells per mm3 of blood, but asks countries to consider earlier ART for pregnant women and HIV-positive partners in couples where one person is HIV-positive and the other is not, or “sero-discordant” couples. A healthy person’s CD4 count ranges from 800 to 1,200 cells per mm3—the lower the count, the more prone a person is to becoming ill from opportunistic infections like tuberculosis.
In Swaziland, MSF is studying the feasibility and acceptance of the “Test and Treat” (T&T) model, the most radical option of Treatment as Prevention (TasP). It involves providing all HIV-positive people with treatment, regardless of their CD4 count. This approach would allow us to have a maximum impact on reducing illness, as well as transmission of HIV in the community.
We are currently paving the way for TasP in Swaziland with the implementation of a greatly improved treatment protocol for pregnant women in order to better prevent mother-to-child transmission of HIV, or PMTCT, and help keep mothers healthy. The protocol is referred to as “Option B+.” In a nutshell, PMTCT Option B+ is T&T for pregnant women—we aim to start all HIV-positive pregnant women on life-long treatment, regardless of their CD4 count.
This new pilot project is just starting in the south of the country, in the Shiselweni region, which has a population of 208,000 people. We hope to start PMTCT B+ this month and from there put 3,000 pregnant women on ARV treatment every year. In 2013, we will expand this approach to other vulnerable groups and eventually to all HIV-positive adults in the region.

Photo: Blood is drawn for an HIV test at the MSF Dipping Tank community testing campaign at Nhletsheni, in Shiselweleni region. Swaziland 2012 © Giorgos Moutafis

Trying Out New Approaches to HIV Treatment


Thirty years into the HIV/AIDS epidemic and more than a decade since the introduction of antiretroviral treatment (ART) in developing countries, the latest scientific evidence shows that the treatment keeps people healthy and prevents the virus from spreading. MSF is now treating more than 222,000 people for HIV/AIDS in 23 countries and introducing new approaches to treatment including earlier provision of ART to pregnant women living with HIV, expanded testing and treatment programs, and using improving technological monitoring techniques to track patient progress. Here, Micaela Serafini, MSF medical referent, discusses MSF’s efforts to treat HIV/AIDS in Swaziland.

Why is it important to provide antiretroviral treatment to people living with HIV while their immune system is still strong?

Today, we measure the level of an HIV-positive person’s white blood cells [CD4 cells] to determine when to start them on treatment, because this is an indicator of how strong their immune system is. Right now, the World Health Organization recommends starting people on ART when their CD4 cell count drops to 350 cells per mm3 of blood, but asks countries to consider earlier ART for pregnant women and HIV-positive partners in couples where one person is HIV-positive and the other is not, or “sero-discordant” couples. A healthy person’s CD4 count ranges from 800 to 1,200 cells per mm3—the lower the count, the more prone a person is to becoming ill from opportunistic infections like tuberculosis.

In Swaziland, MSF is studying the feasibility and acceptance of the “Test and Treat” (T&T) model, the most radical option of Treatment as Prevention (TasP). It involves providing all HIV-positive people with treatment, regardless of their CD4 count. This approach would allow us to have a maximum impact on reducing illness, as well as transmission of HIV in the community.

We are currently paving the way for TasP in Swaziland with the implementation of a greatly improved treatment protocol for pregnant women in order to better prevent mother-to-child transmission of HIV, or PMTCT, and help keep mothers healthy. The protocol is referred to as “Option B+.” In a nutshell, PMTCT Option B+ is T&T for pregnant women—we aim to start all HIV-positive pregnant women on life-long treatment, regardless of their CD4 count.

This new pilot project is just starting in the south of the country, in the Shiselweni region, which has a population of 208,000 people. We hope to start PMTCT B+ this month and from there put 3,000 pregnant women on ARV treatment every year. In 2013, we will expand this approach to other vulnerable groups and eventually to all HIV-positive adults in the region.

Photo: A child at MSF’s intensive feeding center in Guidam Roumdji, Maradi region. Niger 2011 © Alessandra Vilas Boas
Rotavirus Research Results Show Need to Tailor Vaccines to Improve Their Impact
Cape Town/Geneva/New York, November 8, 2012- Research presented today by Epicentre, the epidemiological research arm of MSF and other African researchers, contributes to the growing body of evidence that the two existing rotavirus vaccines may not be best adapted for use in Africa.
“Vaccine developers have not taken into account the full rotavirus picture in places that are hardest hit by diarrheal illness and deaths caused by rotavirus,” said Dr. Anne-Laure Page, an epidemiologist at Epicentre. “This study adds to the growing body of research that underscores the need to ensure that vaccines are developed that effectively address the needs of developing countries.”
The two available rotavirus vaccines were developed and tested in industrialized countries, and have an efficacy rate of 90 percent against severe diarrhea in these countries, compared to an estimated 50-60 percent in countries in Africa and Asia. The current vaccines are also bulky and have a limited shelf life at room temperature, further making them unsuitable for developing countries that lack adequate refrigeration capacity.
“The fact that currently available vaccines are not easy to use in the places that are hardest to reach contributes to the fact that 22 million children born each year do not receive even the basic vaccination package,” said Elder.

Photo: A child at MSF’s intensive feeding center in Guidam Roumdji, Maradi region. Niger 2011 © Alessandra Vilas Boas

Rotavirus Research Results Show Need to Tailor Vaccines to Improve Their Impact

Cape Town/Geneva/New York, November 8, 2012- Research presented today by Epicentre, the epidemiological research arm of MSF and other African researchers, contributes to the growing body of evidence that the two existing rotavirus vaccines may not be best adapted for use in Africa.

“Vaccine developers have not taken into account the full rotavirus picture in places that are hardest hit by diarrheal illness and deaths caused by rotavirus,” said Dr. Anne-Laure Page, an epidemiologist at Epicentre. “This study adds to the growing body of research that underscores the need to ensure that vaccines are developed that effectively address the needs of developing countries.”

The two available rotavirus vaccines were developed and tested in industrialized countries, and have an efficacy rate of 90 percent against severe diarrhea in these countries, compared to an estimated 50-60 percent in countries in Africa and Asia. The current vaccines are also bulky and have a limited shelf life at room temperature, further making them unsuitable for developing countries that lack adequate refrigeration capacity.

“The fact that currently available vaccines are not easy to use in the places that are hardest to reach contributes to the fact that 22 million children born each year do not receive even the basic vaccination package,” said Elder.

I’ve lost count with the negative sputum results I’ve been receiving lately. Things are looking rather promising; surely I’m close to the finishing line.
It is not an easy road ahead. The challenges are many. But […] I also know what is possible. If the will is there, if the effort and resources are put forth, lives will be saved. People will be treated and cured and will go on to live healthy and productive lives. If these diseases are no longer neglected, they will not be nearly as fatal.
Dr. Unni Karunakara, International MSF President, on speaking out and fighting neglected.
Photo: Paraguay © Anna Surinyach
Fighting Neglect
MSFhas taken a stand for the millions of people affected by visceral leishmaniasis, sleeping sickness and Chagas. These diseases are neglected by drug developers, policy makers, and media, making it difficult to get patients the treatment they need. Treatment is possible with the existing medical tools and drugs, but additional research and development toward new and more effective diagnostics and treatments are desperately needed to address the overwhelming neglect of people whose needs are not met by pharmaceutical companies.
Learn more about neglected tropical diseases (NTDs) in our Special Report.

Photo: Paraguay © Anna Surinyach

Fighting Neglect

MSFhas taken a stand for the millions of people affected by visceral leishmaniasis, sleeping sickness and Chagas. These diseases are neglected by drug developers, policy makers, and media, making it difficult to get patients the treatment they need. Treatment is possible with the existing medical tools and drugs, but additional research and development toward new and more effective diagnostics and treatments are desperately needed to address the overwhelming neglect of people whose needs are not met by pharmaceutical companies.


Learn more about neglected tropical diseases (NTDs) in our Special Report.

Photo: Due to living conditions for earthquake survivors and the general population that help enable the spread of cholera in Haiti, the disease remains a lethal threat two years after the epidemic first appeared in the county. Haiti 2012 © Mathieu Fortoul/MSF
For Haitians, Cholera Remains a Major Public Health Problem
It’s been two years since a cholera epidemic first swept through Haiti, infecting hundreds of thousands of people who’d never before encountered the disease. It was clear that cholera was likely to be a recurring issue in Haiti, but even today, new patients cannot be certain that they will get the treatment they need, and little has been done to improve the environmental conditions that enable the continued spread of the disease.
MSF has treated 12,000 cholera patients in five cholera treatment centers since the beginning of the year. During the recent spike of new cases in May, MSF treated more than 70 percent of the total number of patients registered in Port-au-Prince. 

Photo: Due to living conditions for earthquake survivors and the general population that help enable the spread of cholera in Haiti, the disease remains a lethal threat two years after the epidemic first appeared in the county. Haiti 2012 © Mathieu Fortoul/MSF

For Haitians, Cholera Remains a Major Public Health Problem

It’s been two years since a cholera epidemic first swept through Haiti, infecting hundreds of thousands of people who’d never before encountered the disease. It was clear that cholera was likely to be a recurring issue in Haiti, but even today, new patients cannot be certain that they will get the treatment they need, and little has been done to improve the environmental conditions that enable the continued spread of the disease.

MSF has treated 12,000 cholera patients in five cholera treatment centers since the beginning of the year. During the recent spike of new cases in May, MSF treated more than 70 percent of the total number of patients registered in Port-au-Prince. 

I went to the public hospital, but they told me that they couldn’t treat me and I was sent to an MSF treatment center, where I received care.
Wilsème on receiving aid at MSF’s cholera treatment centers in Haiti.
Photo: Two-year-old Fadilla before and after receiving treatment for severe malnutrition and tuberculosis. 
When Fadilla’s grandmother brought her to the Doctors Without Borders/Médecins Sans Frontières (MSF) hospital in Am Timan, Chad, she wasn’t just malnourished – she was sick and in danger of dying.
At just 13 pounds, Fadilla weighed only about half of what a two-year-old child should. At the hospital, our teams diagnosed her with severe acute malnutrition and tuberculosis – two life-threatening medical conditions.
Malnutrition is a serious medical condition, and recovery only gets more difficult when illnesses like malaria or tuberculosis are also present. But with quality medical treatment, even children as sick as Fadilla can make a full recovery. It’s possible thanks to innovations like 33-cent packets of milk-based ready-to-use therapeutic food that are so simple to administer – most malnourished children can be treated by their parents or caregivers at home.
Fadilla’s tuberculosis meant she had to stay in the hospital, but after months of intensive treatment, the brightness returned to Fadilla’s eyes and she reached her target weight. “Look at Fadilla now!” her grandmother exclaimed to the hospital staff. “She is doing so much better!”
Thanks to the support of our donors, we treated 408,000 malnourished children last year. Our medical teams are able to travel to some of the most remote, dangerous, and neglected parts of the world to identify and treat children, like Fadilla, suffering from malnutrition.
There’s hope for even the most severely malnourished child. If we can reach them in time, treatments like therapeutic foods can help children who might not otherwise survive.
Donate to help Doctors Without Borders save the lives of malnourished children and bring quality medical care to people in nearly 70 countries around the world.

Photo: Two-year-old Fadilla before and after receiving treatment for severe malnutrition and tuberculosis. 

When Fadilla’s grandmother brought her to the Doctors Without Borders/Médecins Sans Frontières (MSF) hospital in Am Timan, Chad, she wasn’t just malnourished – she was sick and in danger of dying.

At just 13 pounds, Fadilla weighed only about half of what a two-year-old child should. At the hospital, our teams diagnosed her with severe acute malnutrition and tuberculosis – two life-threatening medical conditions.

Malnutrition is a serious medical condition, and recovery only gets more difficult when illnesses like malaria or tuberculosis are also present. But with quality medical treatment, even children as sick as Fadilla can make a full recovery. It’s possible thanks to innovations like 33-cent packets of milk-based ready-to-use therapeutic food that are so simple to administer – most malnourished children can be treated by their parents or caregivers at home.

Fadilla’s tuberculosis meant she had to stay in the hospital, but after months of intensive treatment, the brightness returned to Fadilla’s eyes and she reached her target weight. “Look at Fadilla now!” her grandmother exclaimed to the hospital staff. “She is doing so much better!”

Thanks to the support of our donors, we treated 408,000 malnourished children last year. Our medical teams are able to travel to some of the most remote, dangerous, and neglected parts of the world to identify and treat children, like Fadilla, suffering from malnutrition.

There’s hope for even the most severely malnourished child. If we can reach them in time, treatments like therapeutic foods can help children who might not otherwise survive.

Donate to help Doctors Without Borders save the lives of malnourished children and bring quality medical care to people in nearly 70 countries around the world.

Photo: Young MDR-TB patients take part in developmental activities at the pediatric hospital in Dushanbe. Tajikistan 2012 © Natasha Sergeeva/MSF
Treating “Family Tuberculosis” in Tajikstan
For the first time, children in Tajikistan with multidrug-resistant tuberculosis (MDR-TB) are receiving treatment for the life-threatening disease. MSF’s new ward in Tajikstan will treat 60-100 children with TB, with special attention to family treatment.
“For MSF, a child often serves as an entry point into a family with TB,” says Zarkua. “When we identify a sick child, we can provide the family with information on how to reduce the spread of the disease, and we can trace contacts within the family to see who else might be infected.”

Photo: Young MDR-TB patients take part in developmental activities at the pediatric hospital in Dushanbe. Tajikistan 2012 © Natasha Sergeeva/MSF

Treating “Family Tuberculosis” in Tajikstan

For the first time, children in Tajikistan with multidrug-resistant tuberculosis (MDR-TB) are receiving treatment for the life-threatening disease. MSF’s new ward in Tajikstan will treat 60-100 children with TB, with special attention to family treatment.

“For MSF, a child often serves as an entry point into a family with TB,” says Zarkua. “When we identify a sick child, we can provide the family with information on how to reduce the spread of the disease, and we can trace contacts within the family to see who else might be infected.”


Every year, our annual report provides us with the opportunity to explain to our supporters how we have allocated your generous donations and to give you details about the lifesaving programs we’re running in clinics, hospitals, and feeding centers all across the globe. 

In short, it gives us the opportunity to be accountable to the people who make our work possible.

View our 2011 annual report.

Photo: An MSF doctor examines a young MDR-TB patient as a mental health counselor reads to him from a TB health education book. Tajikistan 2012 © Natasha Sergeeva

Tajikistan’s “Heartbreaking Mosaic of ‘Family TB’”
Voice From the Field

For the first time, children in Tajikistan with multi drug-resistant tuberculosis (MDR-TB) are receiving treatment for the life-threatening disease. MSF has opened a new ward in Machiton hospital, near Tajikistan’s capital of Dushanbe, where it plans to treat 60 to 100 children with TB and their family members over the next three months.

"Pediatric TB is a neglected disease, and there isn’t enough research and development, or any clear-cut advice, on how to treat it in children. Our project is significant—both for MSF and the world—because we are developing guidelines that simply didn’t exist before," says Cindy Gibb, a MSF nurse working in this new treatment program. Read more of Cindy’s experience with this ground breaking work.

Photo: An MSF doctor examines a young MDR-TB patient as a mental health counselor reads to him from a TB health education book. Tajikistan 2012 © Natasha Sergeeva

Tajikistan’s “Heartbreaking Mosaic of ‘Family TB’”
Voice From the Field

For the first time, children in Tajikistan with multi drug-resistant tuberculosis (MDR-TB) are receiving treatment for the life-threatening disease. MSF has opened a new ward in Machiton hospital, near Tajikistan’s capital of Dushanbe, where it plans to treat 60 to 100 children with TB and their family members over the next three months.

"Pediatric TB is a neglected disease, and there isn’t enough research and development, or any clear-cut advice, on how to treat it in children. Our project is significant—both for MSF and the world—because we are developing guidelines that simply didn’t exist before," says Cindy Gibb, a MSF nurse working in this new treatment program. Read more of Cindy’s experience with this ground breaking work.