MSF Scientific Day: what happened next?
Amrit Todd and Sarah Venis Manson Unit, MSF, London, UK (sarah.venis@london.msf.org) Introduction In 2004, Médecins Sans Frontières (MSF) held its first Scientific Day. The event has been held every year since and although the venues and audiovisual technology have changed, the purpose of the conference remains the same: to present and debate research carried out in MSF programmes with delegates from across MSF and with external academics, students, aid organisations, journal editors, and anyone with an interest in humanitarian research issues. Tracking publication and citation of research provides one measure of dissemination and impact but does not capture the impact of research on policy or programmes. The aim of the Scientific Day has always been to improve the quality of research presented by MSF and ultimately it is hoped the quality of MSF’s medical programmes.
Type of research
Effect on MSF operations and policy
The most common study type was retrospective programme data analysis (n=20, 65%; Fig. 2)
25 (81%) of presentations were described as having had an effect on MSF operations. Some examples are shown in the Table.
Cross sectional Qualitative survey 0% research
Randomised controlled trial 10% (n=3)
Other* 13% (n=4)
Other prospective study 6% (n=2)
14 (45%) presentations had an effect on MSF policies and 16 (52%) on policies of governments or international organisations with 39% being used in advocacy campaigns and 29% cited in policy documents and presented at policy meetings.
6% (n=2)
Retrospective programme data analysis 65% (n=20)
Figure 2: Type of research presented
Research topics
Aim We did a survey of speakers and poster authors from previous MSF Scientific Days to determine the dissemination and impact of the research they presented.
The most popular topic was HIV and AIDS (9 studies), followed by tuberculosis (4); in another 4 the main topic was HIV/TB coinfection: overall 17 of 31 studies (55%) were on HIV or TB. Hepatitis E (3 studies) and visceral leishmaniasis (kala azar, 4 studies) were the next most common (Fig. 3).
Psychological programming
Mortality
Malnutrition Co-infection TB (inc MDR TB)/HIV Surgical care
Method An online survey was constructed in SurveyMonkeyTM and emailed to all MSF speakers from 2004-2010 where we could find contact details and to poster authors from 2009 (when posters were first presented) and 2010. We included authors from Epicentre (a research and training organisation affiliated with MSF) but excluded external speakers. Where no contact details could be found for first authors, other authors listed were contacted. Questions were designed to determine the year, type and topic of research; dissemination; and authors’ assessment of the impact of their research on MSF programmes and on MSF and external policies.
Hepatitis E
Sleeping sickness
Reproductive health
Lab testing
*Some of the changes relate to MSF sections rather than the whole organisation.
HIV/AIDS
Malaria
Conclusion
Kala azar (inc HIV coinfection) TB 0
1
2
3
4
5
6
7
8
9
10
Number of responses
In 2004-2010 there were 106 presentations (88 by MSF authors) and 33 posters. 102 MSF presenters and poster authors were successfully contacted, 31 replied (5 poster authors, 26 speakers; 30% response rate overall). Most responses were from 2009/2010 (Fig. 1).
All research had been disseminated further than the Scientific Day and most (81%) in >1 place. 58% had been published in a peer-reviewed journal and >60% presented at another conference. Just over 40% was used in internal/external MSF publications. 19% had fed into news or other media (Fig. 4).
60
12
50
% of presentations (n=31)
Number of responses
8
6
40
•It is encouraging that >80% of research fed into MSF operations and ~50% into policy in and outside MSF. The absence of some research methods and topics suggests that MSF should consider how to plan a research agenda that reflects and meets the needs of its programme activities.
30
20
4
10 2
0 0
Peer reviewed journal 2004
2005
2006
2007
2008
2009
2010
Another conference
News story or magazine article
TV, radio or film
External/internal MSF MSF internal groups publications
Year
Figure 1: Year of presentation of research 1M
•The most common topic was HIV/TB reflecting the large datasets available in many MSF programmes. These topics form the majority of MSF’s publications1 hence research reported here is representative of MSF’s publication output. Topics such as surgical care and maternal/child health were absent although they are common in MSF programmes, suggesting more attention to these areas is needed. Additionally the main method was retrospective data analyses while other methods such as qualitative research were rare. •The main limitation was the low response rate. However, a PubMed analysis revealed a publication rate of 53% for research at 2006-2010 Scientific Days (Nathan Ford, pers. comm.); the rate of publication in our study was 58% suggesting responses were not biased by publication. Most responses were from recent years limiting historical value of results. Evidence of impact on operations and policy was author assessed thus not impartial.
70
14
10
•Research presented at MSF Scientific Days was disseminated widely and had substantial effects on MSF operations and internal and external policies.
Figure 3: Topic of research
Where was research disseminated? Results
Table: Effects of research on MSF operations* • Modified diagnostic algorithm and screening (HAT) • Supported choice of rapid diagnostic test (malaria) • Miltefosine on national essential drug list and in treatment protocols for HIV/VL co-infected patients • Change from mono-to combination therapy for HIV/VL • Affected decisions on implementing sputum conc. (TB) • Decided to suspend the TB culture programme • Further decentralized patients (TB/HIV) • Impacted lab quality control procedures (HIV) • Future costs prediction of HIV programmes • Help lobbying for TDF rather than AZT or D4T (HIV) • Treatment of HIV/TB co-infected patients adapted • Adapted, expanded project (MDR-TB/HIV) • Community programme in Swaziland used results (TB) • Change of treatment protocols for HIV/VL co-infection • New project implemented (community HIV care) VL=visceral leishmaniasis. of the changes to individual MSF (TB) • Introduced routine *Some assessment ofrelate sputum quality sections rather than the whole organisation. • Introduced HIV confirmation testing • More aid mobilised by MSF (mortality, Darfur) • HIV routine viral load introduced in paediatric care • Malaria patients get plumpynut • Routine HbA1c and screening for diabetes complications introduced
Figure 4: Where else was research disseminated?
Other
Acknowledgements We thank Philipp du Cros and Beverly Collin for helpful comments and Nathan Ford for the PubMed analysis of publication rate of Scientific Day articles.
Brinkman, O Yun. Brief summary of MSF medical publications, 2010. Presented at MSF Scientific Day, London, UK, 2011. Available at: http://fieldresearch.msf.org/msf/bitstream/10144/221032/1/MSF-Med-Pub%20Summary%202010%20Poster_FINAL.pdf (accessed May 2012).