Kristian R. Olson

Achieving high treatment success for multidrug-resistant TB in Africa: initiation and scale-up of MDR TB care in Ethiopia—an observational cohort study

Background In Africa, fewer than half of patients receiving therapy for multidrug-resistant TB (MDR TB) are successfully treated, with poor outcomes reported for HIV-coinfected patients. Methods A standardised second-line drug (SLD) regimen was used in a non-governmental organisation–Ministry of Health (NGO-MOH) collaborative community and hospital-based programme in Ethiopia that included intensive side effect monitoring, adherence strategies and nutritional supplementation. Clinical outcomes for patients with at least 24 months of follow-up were reviewed and predictors of treatment failure or death were evaluated by Cox proportional hazards models. Results From February 2009 to December 2014, 1044 patients were initiated on SLD. 612 patients with confirmed or presumed MDR TB had ≥24 months of follow-up, 551 (90.0%) were confirmed and 61 (10.0%) were suspected MDR TB cases. 603 (98.5%) had prior TB treatment, 133 (21.7%) were HIV coinfected and median body mass index (BMI) was 16.6. Composite treatment success was 78.6% with 396 (64.7%) cured, 85 (13.9%) who completed treatment, 10 (1.6%) who failed, 85 (13.9%) who died and 36 (5.9%) who were lost to follow-up. HIV coinfection (adjusted HR (AHR): 2.60, p<0.001), BMI (AHR 0.88/kg/m2, p=0.006) and cor pulmonale (AHR 3.61, p=0.003) and confirmed MDR TB (AHR 0.50, p=0.026) were predictive of treatment failure or death. Conclusions We report from Ethiopia the highest MDR TB treatment success outcomes so far achieved in Africa, in a setting with severe resource constraints and patients with advanced disease. Intensive treatment of adverse effects, nutritional supplementation, adherence interventions and NGO-MOH collaboration were key strategies contributing to success. We argue these approaches should be routinely incorporated into programmes.

The Ethics of Medical Volunteerism

Responding to disparities in health, thousands of health care providers volunteer annually for short-term medical service trips (MSTs) to serve communities in need as a result of environmental, geographic, historical, or sociopolitical factors. Although well intentioned, short-term MSTs have the potential to benefit and harm those involved, including participants and communities being served. The contexts, resource and time limitations, and language and cultural barriers present ethical challenges. There have been increasing requests for standardized global guidelines, transparency, and open review of MSTs and their outcomes. Principles of mission, partnership, preparation, reflection, support, sustainability, and evaluation inform and equip those engaging in medical volunteerism.

Global Health Technology 2.0

Collaborative approach for global health technology is reported. The Global Health Initiative (GHI) at the Center for Integration of Medicine and Innovative Technology, the Center for Global Health at Massachusetts General Hospital (MGH), and Innovations in International Health at Massachusetts Institute of Technology (IIH@MIT) have formed a collaboration that puts our research and development model, Global Health Technology 2.0, to work and advances a growing global health portfolio.

Affordable medical technologies: bringing Value-Based Design into global health

The implementation of the Affordable Care Act (ACA) has spurred a renewed focus on the concept of value , or health outcome per cost expended.1 Though interventions have generally centred around insurance reform and healthcare delivery, medical technology comprises a significant component of US healthcare costs and is an underemphasised sector in the push for reform. The drivers of medical technology costs, accounting for as much as 65% of the increase in overall healthcare spending, include developing new or improved medical procedures, pharmaceutical products and devices or diagnostics.2 Currently, medical technology development and sales are concentrated in high income countries (HICs). In 2009, approximately 75% of the sales of medical devices were in the USA, Japan and Europe.3 Currently, only 13% of manufacturers are located in low and middle income countries (LMICs). Despite this asymmetric market, there is both growing interest and market potential in investing in health technologies in LMICs, as evidenced by a recent WHO report analysing medical devices in LMICs.4 Nine of the top 10 medical device companies state in their annual report that they hope to expand their activities in emerging markets.5 In Africa alone, there has been a 7.5% annual increase in the importation of medical devices.6 With a new emphasis on value in the US healthcare sector, and an increased interest globally in the development of medical technologies, investing in low cost health technologies could be of mutual benefit to both high and low income countries.4 In addition to filling a great need in LMICs, ideas can flow from LMICs to more developed countries in a process called Reverse Innovation. 7 Traditional medical technology innovation arises in academic medical centres, pharmaceutical companies or biotechnology companies in HICs. In the traditional model, products were stripped down or donated …

Health hackathons: theatre or substance? A survey assessment of outcomes from healthcare-focused hackathons in three countries

Background Healthcare-focused hackathons are 48-hour platforms intended to accelerate novel medical technology. However, debate exists about how much they contribute to medical technology innovation. The Consortium for Affordable Medical Technologies (CAMTech) has developed a three-pronged model to maximise their effectiveness. To gauge the success of this model, we examined follow-up outcomes. Methods Outcomes of 12 hackathons from 2012 to 2015 in India, Uganda and the USA were measured using emailed surveys. To minimise response bias, non-responding teams were coded as having made no progress. Results 331 individuals provided information on 196 of 356 projects (55.1% response rate), with no difference in responses from teams participating in different countries (Cramers V=0.09, p=0.17). 30.3% of projects had made progress after a mean of 12.2 months. 88 (24.7%) teams had initiated pilot testing, with 42 (11.8%) piloting with care providers and 24 (6.7%) with patients. Overall, 97 teams (8.1 per hackathon) drafted business plans, 22 (1.8 per hackathon) had filed patents on their innovations and 15 (1.3 per hackathon) had formed new companies. Teams raised US

Community-based newborn resuscitation among frontline providers in a low-resource country

64.08 million in funding (average US

Health Hackathons Drive Affordable Medical Technology Innovation Through Community Engagement

5.34 million per hackathon; median award size of

Designing an early stage prototype using readily available material for a neonatal incubator for poor settings

1800). In addition, 108 teams (30.3%) reported at least one member working on additional technologies with people they met at a hackathon. Individual confidence to address medical technology challenges was significantly increased after attending (t(1282)=192.77, p 0.001). Conclusion CAMTech healthcare hackathons lead to consistent output with respect to medical technology innovation, including clinical trials, business plan development, securing investment capital/funding and new company formation.

Case 2-2017

To evaluate a birth asphyxia management program among community midwives in a low‐resource rural setting.

Case records of the Massachusetts General Hospital. Case 36-2014. An 18-year-old woman with fever, pharyngitis, and double vision.

Health hackathons are multidisciplinary events bringing together diverse stakeholders to solve key health challenges through a process of co-creation. Health hackathons have gained significant traction as sources of medical innovation globally. They carry particular significance for addressing health discrepancies in resource-limited settings, where there is dire need for cost-effective medical technologies that can deliver high-quality health in an affordable and sustainable way. This paper discusses the model of MIT Hacking Medicine’s health hackathons, and its application to hackathons in India and Uganda for medical innovation by the Consortium for Affordable Medical Technologies (CAMTech) of the Massachusetts General Hospital (MGH) Center for Global Health. Case studies of successful projects coming out of these hackathons are discussed to illustrate the potential of such innovations for real-world impact and sustainable growth in frontier markets. Examples of the tools developed to support further project development after the end of the hackathon and to keep track of project progress and impact are presented. The hacking philosophy pioneered by MIT Hacking Medicine is taken one step further with the establishment of CAMTech Co-creation Labs on the ground in India and Uganda and the CAMTech Innovation Platform. The CAMTech Co-creation Labs and Innovation Platform form long-lasting international partnerships that seek to reinvent healthcare in low- and middle-income countries and offer promise for cost-effective medical solutions in both resource-limited and resource-rich settings.