 Very good morning to one and all. I'm Himanshu from the India OCA mission. And today I'm here to share some preliminary findings from our MSF home-based MDR TB care model, which has been implemented in Manipur. Well, as we're all aware, that multi-drug resistance tuberculosis burden has been hampering the progress of TB control all over the world. And in 2015, India reported a burden of 0.062 million MDR TB cases. Poor treatment outcome has been one of the major public health challenge in control of MDR TB control treatment. And hence, WHO has suggested a five-point priority action of which provision of access to effective treatment is foremost. So with this in mind, we got to, with this in mind, we could go back to some of, I'm sorry, there have been some shuffles in the slide, with MDR treatment success rates that were, sorry, I'm sorry about this. The slides are quite old than what I presented. Anyway, I would make it up. Well, let us just look into some of the global success rates of MDR TB treatment. And we see that the global pool data shows a success rate of 54%. And some coming from higher-income countries report up to 93% of successes. While the success rates from lower-income countries range something from 11% to that of 67%. And studies in India report something between 44% to 67%. However, the WHO has set a target between 75% and 90%. So with this background, MSF has been working in an eastern state of India, which is experiencing low-intensity conflicts since 2004. And that is Manipur. And in Manipur, we are present in three clinics or three areas. That's Lanka, Chepikarong, and More, where we provide home-based MDR treatment care. And the success rates from such settings of conflict and lower social resources are quite sky-scanned and scarce in literature. While the Manipur TB prevalence is about 2.4%, the social and behavioral risk factors for MDR TB are quite prevalent. And hence, to address this, MSF implements a home-based care model for MDR TB treatment. So to understand this home-based care model treatment, we have the patients with MDR TB are treated in two phases, in the clinic as well as in the patient's home. In the clinic, the patient generally receives screening diagnosis and treatment and the initial counseling. And at home, the patient receives drugs in the form of daily observed treatment, where the patient is visited six days a week. And there is modification of the patient's home for a better environment and infection control. All patients do receive nutritional support and some screening for adverse events, as well as co-morbidities. And the patient does receive counseling at home. And the patient's family do get some education about supporting MDR TB patients. MSF also takes to some community engagement, community education for MDR TB treatment as well. So with this model, we expect that there is increased treatment adherence. And the environment, the nutritional, behavioral, social determinants are addressed. And there is no out-of-pocket expenditure for TB care and treatment. And hence, we aim to approximate our success proportions to that of the World Health Organization. So with this background, we tested the objective to test the treatment outcome and patterns and the success rate of this model in Manipur. So MDR TB patients who were on conventional WHO regime who completed treatment between 2009 June and February 2015 formed the sample of our study. And we considered variables in three different groups that were being demographic, clinical, and outcome variables. Among the clinical variables, we considered the previous TB treatment history, the duration of current treatment, sputum, and conversion time. And outcome were categorized as successful treatment, loss to follow-up, or death. So we described variables for the central tendencies and then analyzed the relationship between the demographic variables and the outcome and the clinical variables and the outcome. We used tri-square tests and logistic regression for statistical analysis. And this study was cleared by MSF Ethic Review Board, as well as a local ethical committee in the capital of Manipur. So as of February 2015, we had 1,662 patients in the MSF TB cohort, of which 118 had any kind of drug resistance. Of them, 43 had confirmed MDR TB. And six of them that formed 14% were HIV positive. And among the 43, 65% were male. And there were 14.45 years dispersion around the mean age of 37. And majority of them, that's being around 69%, had a history of treatment failure, while only 27% came with a relapse of tuberculosis. So the duration of treatment was 17.3 months, and sputum conversion time expectedly preceded that of culture's conversion time. So this was our outcome of the treatment cohort, wherein 72% of our patients with a reasonably wide confidence interval had a successful outcome, as against 18.6% were lost follow-up, and four patients amounting to 9.3% died during the treatment. And none of the demographic variables of the patients had any relationship with the outcome. Neither did the clinical variables, but for the TB treatment, where there was a weak evidence of previous TB treatment to have any relationship with the outcome. So the relationship was that patients with the relapse of tuberculosis had a higher chances of being a treatment failure than those who are coming with a previous history of treatment failure. Although, at this point in time, the evidence is weak. So what does this all amount to? It would say that our MSFTB cohort reports a success of a proportion of 72%. And this is higher than the reported Indian studies thus far, and also higher than the global analysis, which is about 58%, and lower than that of the ambulatory care model in Kenya, which is not a conflict setting and not comparable to our setting, and also lower than most of the cohorts in high-income countries, which is quite expected. So this highest success rate we attribute to the increased treatment adherence of favorable environment, which is facilitated by MSF, and the nutritional support provided by our model. So home-based care models may have higher success rates than the hospital-based models and ambulatory models in conflict settings, and also settings where there are social resources are poor. But nevertheless, these home-based care models do entail a significant amount of investments in terms of human resources. Well, globally, few cohorts report unfavorable outcomes in women. They have higher odds of unfavorable outcome, also with increase in age. But in our cohort, this was not the case that none of the demographic factors were related to outcome. Perhaps the home-based model overcame the barriers of access for women and the elderly, and hence had similar success rates as men and the younger age. The limitation, of course, was that we have a small sample size yet, and that limited our ability to make precise estimates as evidenced by a wide confidence interval. So in conclusion, MSF Money Poor TB Care Model demonstrates higher success proportions compared to global pool estimates, notwithstanding conflicts and low social resources, and our treatment, importantly, our treatment success is independent of age and gender. And home-based care models thus may help to achieve the WHO target of treatment success, more so in settings of conflict. And MDR TB case for relapse, TB merits close attention, and we believe that our preliminary analysis has set stage for in-depth analysis of our cohort in coming days as it grows. So thank you very much for your attention. Thank you, Himanshu, thank you very much. I can see many hands already raised, so I'll take one by one. Yes, Dixia. Compare these outcomes versus resistant patterns. Was it an impact of what is the resistant pattern of those patients and then what is outcome? Yes, we have... And number two is, do you have the similar outcomes compared with the other regions of Money Poor versus MSF clinics or the home-based care? Okay, thank you. Well, to answer your first questions, yes, we have, but those results were not part of this scientific presentation, but I may share the results with you that the outcomes are, does not depend on resistant patterns. But our study is limited that we do not have a good number of XTR TB patients to come to a reasonable conclusion. On the second question, we have no data on what is the outcome beyond our clinics in MSF, that's in Money Poor. So Mac, the RNTCP for MDR TB has not published the latest data state-wise for MDR TB, but gives a national picture. Yes. So we have a question from online audience, Sunita Abram from Nepal. Is there data available on comparison to other home-based care model within MSF? Not yet, but may come up henceforth. We look forward for this. Yes. Thank you. Last question, please, on the back row. Please introduce yourself. Hi, I'm Dr. Shomadip. So my question is that you mentioned about the Kenya ambulatory model, which has shown an higher prevalence. So has that model been tried in Money Poor or elsewhere in the MSF India? Well, it has not been tried in Money Poor because the setting is different. We work in a conflict zone where ambulatory model may not be very relevant because access to people is often blocked due to conflict, and the Kenya model works in an urban slum where the situation is quite different. So we are, and I don't see any plans to do that either in any of our cohorts or any of our settings. Okay, because of lack of time, I'm sorry I will not be able to take any more questions. So we come to the end of this session. You see, we talked about, thank you, Dr. Manshu.