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Oosterhof P, Van Luin M, Brinkman K, Burger DM. Negative impact of a health insurer-mandated de-simplification from a single-tablet regimen to a two-tablet regimen. AIDS 2024; 38:1257-1262. [PMID: 38597511 PMCID: PMC11139245 DOI: 10.1097/qad.0000000000003905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Antiretroviral therapy (ART) accounts for a considerable proportion of HIV care expenses. In June 2021, a Dutch healthcare insurer implemented a mandatory policy to de-simplify branded RPV/TDF/FTC (Eviplera) into a two-tablet regimen containing rilpivirine (Edurant) and generic TDF/FTC as part of cost-saving measures. The objectives of this study were to evaluate the acceptance of this policy, the trends in ART dispensation, and cost developments. DESIGN A retrospective database study. METHODS In this study, medication dispensation data were obtained from the Dutch Foundation for Pharmaceutical Statistics (SFK). This database covers 98% of all medication dispensations from Dutch pharmacies including people with HIV who receive ART. We received pseudonymized data exclusively from individuals insured by the insurer for the years 2020-2022. Costs were calculated using Dutch drug prices for each year. RESULTS In June 2021, 128 people with HIV were on branded RPV/TDF/FTC. Following the policy implementation, 59 (46%) had switched to RPV + generic TDF/FTC, but after 1.5 years, only 17 of 128 individuals (13%) used the proposed two-tablet regimen. The other 111/128 used RPV/TDF/FTC with prescriptions for 'medical necessity' ( n = 29), switched to RPV/TAF/FTC ( n = 51), or other ART ( n = 31). Despite expectations of cost-savings, costs increased from €72 988 in May 2021 to €75 649 in May 2022. CONCLUSION A mandatory switch from an STR to a TTR in people with HIV proved unsuccessful, marked by low acceptance, and increased costs after 1 year. This underscores the necessity of incorporating patient and prescriber involvement in changing medication policies.
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Affiliation(s)
- Piter Oosterhof
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam
- Department of Pharmacy, Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen
| | | | - Kees Brinkman
- Department of Internal Medicine, Division of Infectious Diseases, OLVG, Amsterdam, The Netherlands
| | - David M. Burger
- Department of Pharmacy, Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen
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2
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Sebothoma B. An Analysis of Risk Factors for Hearing Function in Adults Living with Human Immunodeficiency Virus in Gauteng, South Africa. Indian J Otolaryngol Head Neck Surg 2024; 76:1637-1644. [PMID: 38566657 PMCID: PMC10982266 DOI: 10.1007/s12070-023-04375-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/23/2022] [Indexed: 04/04/2024] Open
Abstract
The aim of this study was to explore risk factors for hearing loss or affecting hearing function in adults living with HIV. A quantitative cross-sectional design was employed. A non-probability purposive sampling method was used to select and recruit 132 participants aged 18 years and above from an HIV clinic within the Academic Hospital in Gauteng Province, South Africa. Participants' hearing were tested using, video otoscopy, tympanometry, pure tones, and speech audiometry. Of the 22.73% prevalence of hearing loss in the sample, the multiple logistic regression, controlling for other variables, indicated that age (AOR) = 1.049; 95%CI: 1.0005 to 1.0978) (p-value = 0.048) and extended use of antiretroviral therapy (AOR) = 1.0073; 95%CI: 0.9312 to 1.0896)) (p-value = 0.856) were strongly associated with the development of hearing loss. Although the odds of male participants to have hearing loss was 2.3572 (95%CI: 0.9394 to 5.915) compared to females, this association was marginal (p-value = 0.068). Current findings provide evidence for the risk factors for hearing loss in adults living with HIV. Given that an extended use of ART and a higher number of CD4 are strongly associated with hearing loss, these findings raise important implications for a focused monitoring for this population in order to identify early signs of hearing loss and implement timeous intervention to reduce the potential impact of hearing loss.
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Affiliation(s)
- Ben Sebothoma
- Department of Speech pathology and Audiology, University of the Witwatersrand, Private Bag X3, Wits, Johannesburg, 2050 South Africa
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3
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Perazzo H, Gonçalves JL, Cardoso SW, Grinsztejn B, Veloso VG, Luz PM. Pathways to Poor Adherence to Antiretroviral Therapy Among People Living with HIV: The Role of Food Insecurity and Alcohol Misuse. AIDS Behav 2024; 28:1173-1185. [PMID: 37523050 DOI: 10.1007/s10461-023-04141-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/01/2023]
Abstract
Daily adherence to antiretroviral therapy (ART) increases the length and quality of life of people living with HIV (PLHIV). We explored whether socioeconomic status directly impacts ART adherence and whether part of the effect is mediated by pathways through alcohol misuse or food insecurity. A cross-sectional study was conducted in Rio de Janeiro/Brazil (November/2019 to March/2020) with PLHIV aged ≥ 18 years. Validated instruments were used to measure alcohol use, food insecurity, and ART adherence. Using structural equation modeling we assessed the direct and indirect effects of variables on ART adherence. Participants reported significant challenges: hunger: 12%, alcohol use: 64%, and missing ART doses: 24%. Results showed that lower socioeconomic status increased poor adherence and that this effect was mediated through higher food insecurity. Alcohol misuse also increased poor adherence through a strong direct effect. Providing socio-economic support coupled with interventions to mitigate alcohol's harmful impact can aid HIV care.
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Affiliation(s)
- Hugo Perazzo
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Juliana L Gonçalves
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
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4
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Meireles G, Nobre AA, Cardoso SW, Velasque L, Veloso VG, Grinsztejn B, Luz PM. Real-world effectiveness of WHO recommended first-line antiretroviral therapies: a cohort study from a middle-income country. AIDS Care 2023; 35:1891-1903. [PMID: 37001113 DOI: 10.1080/09540121.2023.2190954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/08/2023] [Indexed: 04/03/2023]
Abstract
We estimate the effectiveness of antiretroviral therapy (ART) among individuals receiving HIV care in Rio de Janeiro, Brazil. Adults (18y+) initiating ART between Jan/2008 and Dec/2018 (follow-up through Dec/2020) were included. First-line ART (two nucleoside reverse transcriptase inhibitors plus one antiretroviral from another class) was categorized into four categories: non-nucleoside reverse transcriptase inhibitor/NNRTI-based, protease inhibitor/PI-based, integrase strand transfer inhibitor/INSTI-based, and single-tablet regimen (STR, Tenofovir 300mg + Lamivudine 300mg + Efavirenz 600mg). Effectiveness (viral load ≤50 copies/µL) was evaluated at 6(3-9) and 12(9-15) months from ART initiation. Bayesian logistic regression models were used to quantify the association between exposure and outcomes while accounting for missing data. Overall, 1863(57%), 652(19.9%), 412(12.6%), and 342(10.5%) individuals used, respectively, NNRTI-based, PI-based, INSTI-based regimens, and STR. Compared to NNRTIs, the odds of viral suppression with INSTI-based regimens was 76% higher (adjusted OR:1.76, 95%CI:1.23-2.51) at six months but no higher at 12 months. Older age, higher education, CD4 count ≥500 cells/mm3 and viral load <100,000 copies/µL at ART initiation increased the odds of viral suppression. Viral suppression at six months was the strongest predictor of viral suppression at 12 months. These results highlight population groups that could benefit from close monitoring during the first year of ART.
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Affiliation(s)
- Glaucia Meireles
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Aline A Nobre
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luciane Velasque
- Centro de Ciências Exatas e Tecnologia, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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5
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Swai IU, ten Bergen LL, Mtenga A, Maro R, Ngowi K, Mtesha B, Lekashingo N, Msosa T, Rinke de Wit TF, Aarnoutse R, Sumari-de Boer M. Developing contents for a digital adherence tool: A formative mixed-methods study among children and adolescents living with HIV in Tanzania. PLOS DIGITAL HEALTH 2023; 2:e0000232. [PMID: 37851616 PMCID: PMC10584100 DOI: 10.1371/journal.pdig.0000232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/26/2023] [Indexed: 10/20/2023]
Abstract
Optimal adherence (>95%) to antiretroviral treatment (ART) remains a challenge among children and adolescents living with HIV (CALHIV). Digital adherence tools (DAT) with reminder cues have proven feasible among adult people living with HIV (PLHIV), with some concerns about the risk of HIV status disclosure. We aimed to assess the needs, contents and acceptability of an SMS-based DAT among CALHIV. We first conducted a survey to understand potential barriers to using DAT among CALHIV, then tested the DAT intervention among purposively selected participants. The DAT intervention included using the Wisepill device, receiving daily reminder SMS and receiving adherence reports on how they had taken medication in the past month. The content of the reminder SMS differed over time from asking if the medication was taken to a more neutral SMS like "take care". Afterwards, we conducted exit interviews, in-depth interviews, and focus-group discussions. We analysed quantitative findings descriptively and used thematic content analysis for qualitative data. We included 142 children and 142 adolescents in the survey, and 20 of each used the intervention. Eighty-five percent (121/142) of surveyed participants indicated they would like to receive reminder SMS. Most of them (97/121-80%) of children and 94/121(78%) of adolescents would prefer to receive daily reminders. Participants who used the DAT mentioned to be happy to use the device. Ninety percent of them had good experience with receiving reminders and agreed that the SMS made them take medication. However, 25% experienced network problems. Participants preferred neutral reminder SMSs that did not mention the word 'medication', but preserved confidentiality. The provided adherence reports inspired participants to improve their adherence. None of the participants experienced unwanted disclosure or stigmatisation due to DAT. However, 5% of adolescents were concerned about being monitored daily. This study showed that DAT is acceptable and provided insight of the needed SMS content for a customized DAT for CALHIV.
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Affiliation(s)
- Iraseni Ufoo Swai
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- UMC Amsterdam, Location AMC, Amsterdam, the Netherlands
| | - Lisa Lynn ten Bergen
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alan Mtenga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Ifakara Health Institute, Bagamoyo, Tanzania
| | - Rehema Maro
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Ifakara Health Institute, Bagamoyo, Tanzania
| | - Kennedy Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- UMC Amsterdam, Location AMC, Amsterdam, the Netherlands
| | - Benson Mtesha
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Takondwa Msosa
- UMC Amsterdam, Location AMC, Amsterdam, the Netherlands
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Tobias F. Rinke de Wit
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- PharmAccess Foundation, Amsterdam, the Netherlands
| | - Rob Aarnoutse
- Radboud university medical center, Department of Pharmacy, Research Institute for Medical Innovation, Nijmegen, the Netherlands
| | - Marion Sumari-de Boer
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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6
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Luz PM, Deshpande V, Kazemian P, Scott JA, Shebl FM, Spaeth H, Pimenta C, Stern M, Pereira G, Struchiner CJ, Grinsztejn B, Veloso VG, Freedberg KA. Impact of pre-exposure prophylaxis uptake among gay, bisexual, and other men who have sex with men in urban centers in Brazil: a modeling study. BMC Public Health 2023; 23:1128. [PMID: 37308858 PMCID: PMC10262537 DOI: 10.1186/s12889-023-15994-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/23/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) in Brazil remain disproportionately affected by HIV. We estimated the potential incidence reduction by five years with increased uptake of publicly-funded, daily, oral tenofovir/emtricitabine (TDF/FTC) for HIV pre-exposure prophylaxis (PrEP) among MSM using the Cost Effectiveness of Preventing AIDS Complications microsimulation model. We used national data, local studies, and literature to inform model parameters for three cities: Rio de Janeiro, Salvador, and Manaus. RESULTS In Rio de Janero, a PrEP intervention achieving 10% uptake within 60 months would decrease incidence by 2.3% whereas achieving 60% uptake within 24 months would decrease incidence by 29.7%; results were similar for Salvador and Manaus. In sensitivity analyses, decreasing mean age at PrEP initiation from 33 to 21 years increased incidence reduction by 34%; a discontinuation rate of 25% per year decreased it by 12%. CONCLUSION Targeting PrEP to young MSM and minimizing discontinuation could substantially increase PrEP's impact.
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Affiliation(s)
- Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Rio de Janeiro, 21040-360, Brazil.
| | - Vijeta Deshpande
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
| | - Pooyan Kazemian
- Department of Operations, Weatherhead School of Management, Case Western Reserve University, 11119 Bellflower Road, Cleveland, OH, 44106, USA
| | - Justine A Scott
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
| | - Fatma M Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
| | - Hailey Spaeth
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
| | - Cristina Pimenta
- Ministry of Health of Brazil, SRTVN Quadra 701, Lote D, Edifício PO700, 5º Andar, Brasília/DFBrasilia, 70719-040, Brazil
| | - Madeline Stern
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
| | - Gerson Pereira
- Ministry of Health of Brazil, SRTVN Quadra 701, Lote D, Edifício PO700, 5º Andar, Brasília/DFBrasilia, 70719-040, Brazil
| | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Rio de Janeiro, 21040-360, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Rio de Janeiro, 21040-360, Brazil
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Harvard University Center for AIDS Research, Harvard Medical School, 42 Church Street, Cambridge, MA, 02138, USA
- Division of General Internal Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
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7
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Gibson B, Rosser BA, Schneider J, Forshaw MJ. The role of uncertainty intolerance in adjusting to long-term physical health conditions: A systematic review. PLoS One 2023; 18:e0286198. [PMID: 37267292 DOI: 10.1371/journal.pone.0286198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 05/10/2023] [Indexed: 06/04/2023] Open
Abstract
Long-term physical health conditions (LTPHCs) are associated with poorer psychological well-being, quality of life, and longevity. Additionally, individuals with LTPHCs report uncertainty in terms of condition aetiology, course, treatment, and ability to engage in life. An individual's dispositional ability to tolerate uncertainty-or difficulty to endure the unknown-is termed intolerance of uncertainty (IU), and may play a pivotal role in their adjustment to a LTPHC. Consequently, the current review sought to investigate the relationship between IU and health-related outcomes, including physical symptoms, psychological ramifications, self-management, and treatment adherence in individuals with LTPHCs. A systematic search was conducted for papers published from inception until 27 May 2022 using the databases PsycINFO, PubMed (MEDLINE), CINAHL Plus, PsycARTICLES, and Web of Science. Thirty-one studies (N = 6,201) met the inclusion criteria. Results indicated that higher levels of IU were associated with worse psychological well-being outcomes and poorer quality of life, though impacts on self-management were less clear. With the exception of one study (which looked at IU in children), no differences in IU were observed between patients and healthy controls. Although findings highlight the importance of investigating IU related to LTPHCs, the heterogeneity and limitations of the existing literature preclude definite conclusions. Future longitudinal and experimental research is required to investigate how IU interacts with additional psychological constructs and disease variables to predict individuals' adjustment to living with a LTPHC.
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Affiliation(s)
- Benjamin Gibson
- School of Applied Social Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Benjamin A Rosser
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Jekaterina Schneider
- Centre for Appearance Research, School of Social Sciences, College of Health, Science and, University of the West of England, Bristol, United Kingdom
| | - Mark J Forshaw
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
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Milward de Azevedo Meiners MM, Araújo Cruz I, de Toledo MI. Adherence to antiretroviral therapy and viral suppression: Analysis of three periods between 2011 and 2017 at an HIV-AIDS center, Brazil. Front Pharmacol 2023; 14:1122018. [PMID: 37063259 PMCID: PMC10102605 DOI: 10.3389/fphar.2023.1122018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
The increased effectiveness of antiretroviral therapy (ART) in the last 30 years is a scientific landmark, and viral suppression is directly associated with treatment adherence. The aim of this study was to compare the results of ART adherence and viral load suppression with the evolution of the protocols and other associated factors, in people living with HIV. A panel analysis of three descriptive longitudinal studies investigating ART adherence and viral load suppression was conducted in people with HIV treated at a drug dispensing unit in the Federal District. The studies were carried out during periods of 2011, 2013, and 2017, coinciding with the three different recommended treatment schemes for the country. Adherence was assessed using drug dispensing records. Viral load data were obtained from the Ministry of Healthʼs Laboratory Examination Information System. Analysis of the data of 522 individuals in the three periods showed sociodemographic differences such as a decline in the percentage of women (from 33% in period 1 to 4% in period 3) and an increase in the percentage of young people. ART adherence was higher in period 2 (tenofovir/lamivudine/efavirenz scheme). Viral load suppression was greater in period 3 (tenofovir/lamivudine/dolutegravir scheme). The relative detectable viral load risk was nearly two-fold higher (RR 1.83) in people living with HIV with less than 80% adherence when compared to those above 80%. With respect to the different schemes recommended in Brazil during the periods studied, ART containing dolutegravir was the most effective in achieving viral load suppression. By contrast, there was better ART adherence in the daily combined fixed dose consisting of tenofovir/lamivudine/efavirenz in tablet form. Adherence to ART above 80% seemed to be enough to promote an effective treatment in therapeutic schemes including efavirenz or dolutegravir.
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Affiliation(s)
- Micheline Marie Milward de Azevedo Meiners
- Programa de Pós-Graduação em Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Curso de Farmácia e Grupo de Pesquisa Acesso a Medicamentos e Uso Responsável (AMUR), Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
- *Correspondence: Micheline Marie Milward de Azevedo Meiners,
| | - Igor Araújo Cruz
- Programa de Pós-Graduação em Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | - Maria Inês de Toledo
- Programa de Pós-Graduação em Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
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9
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de Resende NH, de Miranda SS, Reis AMM, de Pádua CAM, Haddad JPA, da Silva PVR, da Silva DI, Carvalho WDS. Factors Associated with the Effectiveness of Regimens for the Treatment of Tuberculosis in Patients Coinfected with HIV/AIDS: Cohort 2015 to 2019. Diagnostics (Basel) 2023; 13:diagnostics13061181. [PMID: 36980489 PMCID: PMC10046969 DOI: 10.3390/diagnostics13061181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/15/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: Infection with the Human Immunodeficiency Virus (HIV) is a significant challenge for tuberculosis (TB) control, with increasing mortality rates worldwide. Moreover, the loss to follow-up is very high, with low adherence to treatment, resulting in unfavorable endpoints. This study aimed to analyze the effectiveness of TB treatment in patients coinfected with HIV/AIDS and its associated factors. (2) Methods: Patients coinfected with TB and HIV/AIDS at a Reference Hospital for infectious diseases were followed up for a maximum of one year from the start of TB treatment until cure or censorship (death, abandonment, and transfer) from 2015 to 2019. The Cox proportional model was used to identify risk factors for effectiveness. (3) Results: Of the 244 patients included in the cohort, 58.2% (142/244) had no treatment effectiveness, 12.3% (30/244) died, and 11.1% (27/244) abandoned treatment. Viral suppression at the onset of TB treatment (HR = 1.961, CI = 1.123-3.422), previous use of Antiretroviral Therapy (HR = 1.676, CI = 1.060-2.651), new cases (HR = 2.407, CI = 1.197-3.501), not using illicit drugs (HR = 1.763, CI = 1.141-2.723), and using the basic TB regimen (HR = 1.864, CI = 1.084-3.205) were significant variables per the multivariate Cox regression analysis. (4) Conclusion: TB treatment for most TB patients coinfected with HIV/AIDS was not effective. This study identified that an undetectable viral load at the beginning of the disease, previous use of ART, not using illicit drugs and not having previously taken anti-TB treatment are factors associated with successful TB treatment.
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Affiliation(s)
| | | | | | | | | | | | - Dirce Inês da Silva
- Hospital Foundation of the State of Minas Gerais/Eduardo de Menezes Hospital, Belo Horizonte 30622-020, Brazil
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10
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HIV and Substance Use in Latin America: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127198. [PMID: 35742448 PMCID: PMC9222977 DOI: 10.3390/ijerph19127198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/13/2022]
Abstract
This scoping review aims to explore the interplay between substance use (SU) and HIV in Latin America (LA). Database searches yielded 3481 references; 196 were included. HIV prevalence among people who used substances (PWUS) ranged from 2.8–15.2%. SU definitions were variable throughout studies, and thus data were not easily comparable. In 2019, only 2% of new HIV infections were attributed to injection drug use (IDU) in LA. Factors associated with HIV among PWUS included being female, IDU and homelessness, and PWUS were likely to engage in risky sexual behaviors, start antiretroviral treatment late, have poor adherence, have treatment failure, be lost to follow-up, have comorbidities, and experience higher mortality rates and lower quality of life, as has been reported in PLWH with SU in other regions. Five intervention studies were identified, and only one was effective at reducing HIV incidence in PWUS. Interventions in other regions have varying success depending on context-specific characteristics, highlighting the need to conduct more research in the LA region. Though progress has been made in establishing SU as a major concern in people living with HIV (PLWH), much more is yet to be done to reduce the burden of HIV and SU in LA.
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11
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Borghetti A, Farinacci D, Ciccullo A, Dusina A, Moschese D, Iannone V, D'Angelillo A, Lombardi F, Donne VD, Massaroni V, Visconti E, Tamburrini E, Di Giambenedetto S. Are we ready for long-acting? A feasibility evaluation of long-acting cabotegravir-rilpivirine in clinical practice. J Med Virol 2022; 94:4970-4974. [PMID: 35638227 DOI: 10.1002/jmv.27890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cabotegravir and rilpivirine are the first drugs to be approved as injectable therapy to treat individuals with HIV. Despite encouraging results, the guidelines specify strict criteria for eligibility that could limit the feasibility of this strategy. METHODS We collected the clinical data of HIV-positive patients who were being treated at a single, third-level center in Italy. All patients were on stable therapy and showed suppressed viral load on their most recent analyses. We performed a cross-sectional analysis of the clinical and viro-immunological characteristics of this population and excluded patients who had had previous virological failures, RAMs to rilpivirine or integrase inhibitors in the historical genotype, hepatitis B infection, absence of previous genotypes and the co-existence of HIV-subtype A and obesity. Our aim was to evaluate the proportion of patients who could be eligible for switching to this strategy. RESULTS 1,752 patients were eligible. 148 were excluded because of a detectable viral load. With regard to the exclusion criteria, 48 patients had coinfection with HBV and 744 had a history of previous virological failures. Of the 896 patients with at least one genotypic resistance test, 161 had one or more RAMs to rilpivirine and 3 had RAMs to cabotegravir. None of the patients presented the combination of obesity and the A viral subtype. Overall, 31.2% of the patients were ineligible for cabotegravir-rilpivirine and the proportion increased to 47.3% when we considered only patients with all available information concerning resistance tests. CONCLUSION Approximately half of our cohort of patients did not fulfill the criteria and even more patients were potentially ineligible for cabotegravir-rilpivirine due to the lack of genotypic resistance tests. Also, fertile women had to be excluded due to the lack of data about this combination during pregnancy and breastfeeding. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alberto Borghetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Roma, Italia
| | - Damiano Farinacci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Roma, Italia
| | | | - Alex Dusina
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Roma, Italia
| | - Davide Moschese
- Dipartimento di Malattie Infettive, I Divisione di Malattie Infettive ASST Fatebenefratelli-Sacco, Milano, Italia
| | - Valentina Iannone
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Anna D'Angelillo
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Francesca Lombardi
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Valentina Delle Donne
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Valentina Massaroni
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Elena Visconti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Roma, Italia
| | - Enrica Tamburrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Roma, Italia.,Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Simona Di Giambenedetto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Roma, Italia.,Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italia
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12
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Gonzales P, Bachireddy C, Grieco A, Ding R, de Leon SJG, Ulrich A, Lama J, Duerr AC, Altice FL. Viral Suppression Levels in Men Who Have Sex With Men and Transgender Women With Newly Diagnosed HIV and Alcohol Use Disorder in Peru: Results From a Randomized, Double-Blind, Placebo-Controlled Trial Using Oral Naltrexone. J Acquir Immune Defic Syndr 2022; 89:462-471. [PMID: 34897226 PMCID: PMC8881312 DOI: 10.1097/qai.0000000000002889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Alcohol use disorders (AUDs) are common in men who have sex with men (MSM) and transgender women (TGW) in Peru and undermine antiretroviral therapy (ART) adherence. Oral naltrexone (NTX) is an evidence-based treatment for AUD that has not been assessed in cotreating AUD in MSM/TGW with HIV. SETTING AND DESIGN A multi-site, randomized, double-blind, placebo-controlled trial among MSM/TGW with AUD and newly diagnosed with HIV in Lima, Peru. METHODS Newly diagnosed MSM/TGW with HIV and AUD were prescribed a single-treatment regimen of EFV/TDF/FTC from 2014 to 2015 and randomized 2:1 to oral NTX (N = 103) or placebo (N = 53) for 24 weeks. The primary and secondary outcomes were proportion achieving viral suppression (VS: HIV-1 RNA < 400 copies/mL) or maximal viral suppression (MVS: HIV-1 RNA < 40 copies/mL) at 24 weeks. RESULTS There were no significant differences between the arms in VS (81.6% NTX arm vs 75.5% placebo arm; P = 0.37) or MVS (61.2% NTX arm vs 66.0% placebo arm; P = 0.48). Adherence to study medication was low (mean = 34.6%) overall with only 21.4% of participants meeting recommended adherence levels (≥80% daily doses/month). Participants allocated to NTX had significantly lower adherence compared with placebo for both the first and second 12-week study periods, respectively (44.0% vs 35.2%, P = 0.04; 31.4% vs 35.2%, P = 0.03). CONCLUSIONS Findings are inconclusive regarding the use of NTX for treatment of AUD in MSM/TGW newly diagnosed with HIV. VS and MVS levels were high irrespective of allocation. Adherence to study medication was low, requiring further exploration of strategies to optimize adherence to NTX as AUD treatment.
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Affiliation(s)
| | - Chethan Bachireddy
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Philadelphia, USA
| | - Arielle Grieco
- Vaccine and Infectious Disease and Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Rona Ding
- Vaccine and Infectious Disease and Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Samy J. Galvez de Leon
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, New Haven, USA
| | - Angela Ulrich
- Vaccine and Infectious Disease and Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, MN, USA
| | - Javier Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru
- Vaccine and Infectious Disease and Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Ann C Duerr
- Vaccine and Infectious Disease and Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Frederick L Altice
- Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, New Haven, USA
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, USA
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13
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Lottes M, Bremer V, Prugger C, Kollan C, Schmidt D. Cost-savings and potential cost-savings through the distribution of generic antiretroviral drugs within the statutory health insurance market of Germany between January 2017 and June 2019. BMC Health Serv Res 2022; 22:63. [PMID: 35027062 PMCID: PMC8756633 DOI: 10.1186/s12913-021-07390-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract Background Recent patent losses for antiretroviral drugs (ARV) have led to the debate of cost-saving through the replacement of patented drugs with generic drugs. The split of recommended single-tablet regimens (STR) into their single substance partners is one of the considerations mentioned in said debate. Particularly, generic tenofovir disoproxil/emtricitabine (TDF/FTC) is expected to hold untapped cost-saving potential, which may curb increasing overall expenditures for combined antiretroviral therapy (cART) within the statutory health insurance (SHI) of Germany. Methods Data of ARV reimbursed by the SHI were used to describe the trends of defined daily doses (DDD) as well as the revenue within the German ARV market. They were also used to determine the cost-savings of moving to generic drugs. The time period observed was between January 2017 and June 2019. The potential cost-savings were determined with following assumption in mind: the maximum possible use of generic ARV, including 1) the split of STR and replacing all substance partners with generic ones, and 2) replacing patented tenofovir alafenamide/emtricitabine (TAF/FTC) with generic TDF/FTC. Results Throughout the observation period, the DDD of generic ARV increased nearly five-fold while their revenue increased more than four-fold. Total cost-saving showed a sharp increase over the same period, with generic TDF/FTC accounting for a share of around 70%. The largest potential cost-saving could have been achieved through replacing patented TAF/FTC with generic TDF/FTC, peaking at nearly 10% of total revenue, but showing decreasing trends in general. Conclusion The progressive distribution of generic ARV ensured increasing cost-savings, but consequently curbed the potential cost-savings. Unique price reductions of generic TDF/FTC have played a pivotal role for these effects. In any case, substituting with generic ARV should not fail to adhere to the treatment guidelines and continue to consider the medical requirements for the treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07390-4.
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14
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Dias FA, Höfelmann DA, Rattmann YD. Virologic success under antiretroviral therapy among people living with HIV/AIDS in the state of Paraná, Brazil. EINSTEIN-SAO PAULO 2021; 19:eAO5800. [PMID: 34817033 PMCID: PMC8687700 DOI: 10.31744/einstein_journal/2021ao5800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/27/2020] [Indexed: 11/24/2022] Open
Abstract
Objective: To characterize the sociodemographic profile of the population undergoing antiretroviral treatment in the state of Paraná, Brazil, to investigate the proportion of people undergoing treatment among all those diagnosed, and to analyze the proportion of patients with suppressed viral load in different regions of the state. Methods: Observational descriptive and analytical study carried out with information referring to the period from January 2018 to January 2019. Data were obtained from the Sistema Informatizado de Monitoramento Clínico das Pessoas Vivendo com HIV/AIDS [Computerized System for Clinical Monitoring of People Living with HIV/AIDS] and Sistema de Controle Logístico de Medicamentos[Drug Supply Control System]. The proportion of people on antiretroviral treatment in the state and the proportion of patients with viral load ≤1,000 copies/mL and ≤50 copies/mL were calculated. The results were compared with the corresponding parameters of the World Health Organization goal 90-90-90. Results: The state of Paraná managed to reach the second and third parameters of the 90-90-90 goal of the World Health Organization. Among those diagnosed, 93.12% were on antiretroviral treatment, and 90.0% of them had a viral load below 50 copies of viral RNA/mL of blood, indicating virologic success. Conclusion: The health policy aimed at the population living with HIV/AIDS, and the health services available in Paraná have been successful in parameters relevant to the control of the epidemic. However, it is necessary to ensure the diagnosis of people infected with HIV in the population.
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15
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Rogers AH, Neighbors C, Sharp C, Giordano TP, Woods SP, Zvolensky MJ. The relationship between sex-related alcohol expectancies and hazardous drinking among persons with HIV disease. AIDS Care 2021; 33:1475-1481. [PMID: 33225738 DOI: 10.1080/09540121.2020.1845290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Hazardous drinking is a clinically significant problem among persons with HIV (PWH) disease, and is associated with a number of poor outcomes. Hazardous drinking among PWH is associated with risky substance use and sexual behavior, but little work has examined factors that may be associated with greater hazardous drinking and subsequent risky sexual behaviors among PWH. Research among the general population suggests that sex-related alcohol expectancies, defined as drinking to enhance sexual experience, increase sexual risk-taking, and disinhibition of sexual behavior, are associated with greater hazardous alcohol use and risky sexual behavior, but these relations have not been explored among PWH. Therefore, the current study examined the associations of sex-related alcohol expectancies with hazardous alcohol consumption, dependence, and problems among 146 PWH (Mage = 50.99, SD = 9.41) \ enrolled in a clinical trial examining a personalized feedback intervention to reduce hazardous drinking in primary HIV care. Results showed that only sexual disinhibition-related alcohol expectancies were significantly associated with the criterion variables, such that greater drinking alcohol for sexual disinhibition was associated with greater hazardous drinking behaviors. These results sit on the backdrop of a larger literature documenting the links between disinhibition and hazardous alcohol use and provide explanatory specificity to PWH who are hazardous drinkers.
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Affiliation(s)
- Andrew H Rogers
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Clayton Neighbors
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Carla Sharp
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Thomas P Giordano
- Health Services Research Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Steven P Woods
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Michael J Zvolensky
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,HEALTH Institute, University of Houston, Houston, TX, USA
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16
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Berra TZ, Gomes D, Ramos ACV, Alves YM, Bruce ATI, Arroyo LH, dos Santos FL, Souza LLL, Crispim JDA, Arcêncio RA. Effectiveness and trend forecasting of tuberculosis diagnosis after the introduction of GeneXpert in a city in south-eastern Brazil. PLoS One 2021; 16:e0252375. [PMID: 34048490 PMCID: PMC8162696 DOI: 10.1371/journal.pone.0252375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To evaluate the effectiveness of a rapid molecular test for the detection of tuberculosis (TB) and to predict the rates of disease in a municipality of Brazil where TB is endemic. METHODS An ecological study was carried out in Ribeirão Preto-SP on a population of TB cases notified between 2006 and 2017. Monthly TB incidence rates and the average monthly percentage change (AMPC) were calculated. In order to identify changes in the series, the breakpoint technique was performed; the rates were modelled and predictions of the incidence of TB until 2025 were made. RESULTS AMPC showed a fall of 0.69% per month in TB and human immunodeficiency virus (TB-HIV) co-infection, a fall of 0.01% per month in general and lung TB and a fall of 0.33% per month in extrapulmonary TB. With the breakpoint technique, general and pulmonary TB changed in structure in late 2007, and extrapulmonary TB and TB-HIV co-infection changed in structure after 2014, which is considered the cut-off point. The IMA(3) models were adjusted for general and pulmonary TB and TB-HIV co-infection, and the AR(5) models for extrapulmonary TB, and predictions were performed. CONCLUSIONS The rapid molecular test for TB is the method currently recommended by the WHO for the diagnosis of the disease and its main advantage is to provide faster, more accurate results and to already check for drug resistance. It is necessary that professionals encourage the use of this technology in order to optimize the diagnosis so that the treatment begins as quickly as possible and in an effective way. Only by uniting professionals from all areas with health policies aimed at early case identification and rapid treatment initiation it is possible to break the chain of TB transmission so that its rates decrease and the goals proposed by the WHO are achieved.
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Affiliation(s)
- Thaís Zamboni Berra
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Dulce Gomes
- Mathematics Department in University of Évora, Évora, Portugal
| | - Antônio Carlos Vieira Ramos
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Yan Mathias Alves
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Alexandre Tadashi Inomata Bruce
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Luiz Henrique Arroyo
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Felipe Lima dos Santos
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Ludmilla Leideanne Limirio Souza
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Juliane de Almeida Crispim
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
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Stellbrink HJ, Lazzarin A, Woolley I, Llibre JM. The potential role of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) single-tablet regimen in the expanding spectrum of fixed-dose combination therapy for HIV. HIV Med 2021; 21 Suppl 1:3-16. [PMID: 32017355 DOI: 10.1111/hiv.12833] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2019] [Indexed: 12/15/2022]
Abstract
Single-tablet regimens (STRs) of highly safe and effective combination antiretroviral therapy (cART) have had a significant beneficial impact on the clinical outcomes and lives of people living with HIV (PLHIV). As a consequence, healthcare professionals caring for PLHIV in high-income countries have increasingly focused on issues beyond those related to HIV itself, i.e. HIV-related neurological disease, or associated opportunistic infections, which include co-infections, and primarily age- and lifestyle-related comorbidities such as cardiovascular disease, diabetes mellitus, renal impairment, osteoporosis and frailty. This review considers drug side effects and comorbidities seen in PLHIV and evaluates the role of a recently licensed STR - bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) - in mitigating some of those challenges. Factors that need to be evaluated for initial cART regimens include: pretreatment CD4 cell count; plasma HIV RNA; HIV drug resistance; hepatitis B co-infection; HLA-B*5701 status; drug-drug interactions; pregnancy and pregnancy potential; psychiatric and physical comorbidities such as renal or bone disease, as well as simplicity and adherence-friendliness, all of which need to be considered in all lines of therapy. BIC/FTC/TAF constitutes a new STR that includes an unboosted integrase strand transfer inhibitor with a high barrier against resistance with TAF and FTC. Its virological efficacy was non-inferior to dolutegravir-based regimens previously recommended by most guidelines for treatment initiation in large double-blind, randomised clinical trials in treatment-naïve or switch patients over 96 weeks. Tolerability and pharmacological properties of the regimen make it a useful tool to address several of the clinical management issues raised above.
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Affiliation(s)
| | - A Lazzarin
- San Raffaele Scientific Institute, Milan, Italy
| | - I Woolley
- Monash Medical Centre, Monash University, Melbourne, Vic, Australia
| | - J M Llibre
- University Hospital Germans Trias i Pujol and the "Fight AIDS" Foundation, Badalona, Spain
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18
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Teixeira LDSL, Ceccato MDGB, Carvalho WDS, Costa JDO, Bonolo PDF, Mendes JC, Silveira MR. Prevalence of smoking and associated factors in people living with HIV undergoing treatment. Rev Saude Publica 2020; 54:108. [PMID: 33175026 PMCID: PMC7647468 DOI: 10.11606/s1518-8787.2020054001828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 02/13/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of smoking and evaluate the factors associated with this outcome in people living with HIV (PLHIV). METHODS This is a cross-sectional study of a prospective concurrent cohort of 462 individuals initiating antiretroviral therapy at three HIV/AIDS specialized services in Belo Horizonte between 2015 and 2017. The following smoking status were used: current smoker (CS), former smoker (FS) and non-smoker (NS). Multinomial logistic regression was performed with NS as the reference category. RESULTS Most participants were men (81.4%), young (up to 34 years old; 57.2%) and non-white (75.7%). Of the total number of individuals, 27.7% were CS, 22.9% FS, and 49.4% NS. Most smokers were light smokers (65.1%), consumed up to 10 cigarettes per day and had been smoking for more than 10 years (63.3%), starting on average at 17.2 years of age (SD = 5.1). In the multivariate analysis, higher chances of being CS were associated with: being female, having up to 9 years of schooling, current or prior use of alcohol and illicit drugs (marijuana, cocaine and crack) and presenting signs and/or symptoms of anxiety or depression. Higher chances of being FS were associated with having up to 9 years of schooling and current or prior use of alcohol and illicit drugs (marijuana and crack). CONCLUSIONS The results show that smoking is highly prevalent among PLHIV, indicating the need for HIV specialized services to prioritize smoking cessation interventions. These interventions should consider the use of alcohol and illicit drugs and be targeted especially to young people, those with low schooling and with signs and/or symptoms of anxiety or depression.
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Affiliation(s)
- Luciane de Souza Leal Teixeira
- Universidade Federal de Minas Gerais. Faculdade de Farmácia. Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica. Belo Horizonte, MG, Brasil
| | - Maria das Graças Braga Ceccato
- Universidade Federal de Minas Gerais. Faculdade de Farmácia. Departamento de Farmácia Social. Belo Horizonte, MG, Brasil
| | - Wânia da Silva Carvalho
- Universidade Federal de Minas Gerais. Faculdade de Farmácia. Departamento de Farmácia Social. Belo Horizonte, MG, Brasil
| | - Juliana de Oliveira Costa
- Centre for Big Data Research in Health. Faculty of Medicine. UNSW Sydney, Sydney, Australia.,Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, st, Brasil
| | - Palmira de Fátima Bonolo
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Medicina Preventiva e Social. Belo Horizonte, MG, Brasil
| | - Jullye Campos Mendes
- Universidade Federal de Minas Gerais. Faculdade de Farmácia. Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica. Belo Horizonte, MG, Brasil
| | - Micheline Rosa Silveira
- Universidade Federal de Minas Gerais. Faculdade de Farmácia. Departamento de Farmácia Social. Belo Horizonte, MG, Brasil
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Abstract
Purpose of review To describe how countries in Latin America and the Caribbean are (or are not) meeting 2016 WHO guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, that is, their progress on the adoption of ‘Treat All’ and of preexposure prophylaxis (PrEP) as an additional prevention tool for people at substantial risk of HIV infection. Recent findings The HIV epidemic in the region continues largely concentrated in vulnerable populations with MSM and transgender women (TGW) suffering the highest burden. On treatment, the challenges of late initiation as well as suboptimal adherence persist. On prevention, recent studies on PrEP willingness in key populations show promising results, meanwhile PrEP implementation projects as well as actual PrEP adoption by national health systems is expanding. A glimpse of real-world PrEP uptake is shown through Brazil's first-year experience of offering PrEP in multiple cities in all regions of the country. Summary In conclusion, accomplishments have been made though challenges for fully addressing the HIV epidemic persist. The impact of both treatment and PrEP will be limited by the availability and prompt use of all services, including HIV testing.
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20
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Godman B, McCabe H, D Leong T. Fixed dose drug combinations - are they pharmacoeconomically sound? Findings and implications especially for lower- and middle-income countries. Expert Rev Pharmacoecon Outcomes Res 2020; 20:1-26. [PMID: 32237953 DOI: 10.1080/14737167.2020.1734456] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: There are positive aspects regarding the prescribing of fixed dose combinations (FDCs) versus prescribing the medicines separately. However, these have to be balanced against concerns including increased costs and their irrationality in some cases. Consequently, there is a need to review their value among lower- and middle-income countries (LMICs) which have the greatest prevalence of both infectious and noninfectious diseases and issues of affordability.Areas covered: Review of potential advantages, disadvantages, cost-effectiveness, and availability of FDCs in high priority disease areas in LMICs and possible initiatives to enhance the prescribing of valued FDCs and limit their use where there are concerns with their value.Expert commentary: FDCs are valued across LMICs. Advantages include potentially improved response rates, reduced adverse reactions, increased adherence rates, and reduced costs. Concerns include increased chances of drug:drug interactions, reduced effectiveness, potential for imprecise diagnoses and higher unjustified prices. Overall certain FDCs including those for malaria, tuberculosis, and hypertension are valued and listed in the country's essential medicine lists, with initiatives needed to enhance their prescribing where currently low prescribing rates. Proposed initiatives include robust clinical and economic data to address the current paucity of pharmacoeconomic data. Irrational FDCs persists in some countries which are being addressed.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Holly McCabe
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Trudy D Leong
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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21
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Cardoso TS, Costa JDO, Reis EA, Silveira MR, Bonolo PDF, Santos SFD, Ceccato MDGB. Which antiretroviral regimen is associated with higher adherence in Brazil? A comparison of single, multi, and dolutegravir-based regimens. CAD SAUDE PUBLICA 2019; 35:e00115518. [PMID: 31531518 DOI: 10.1590/0102-311x00115518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 04/05/2019] [Indexed: 11/22/2022] Open
Abstract
We evaluated adherence to highly active antiretroviral therapy (HAART) and its associated factors according to the type of regimen in patients initiating treatment in Belo Horizonte, Minas Gerais State, Brazil. We measured adherence using the eight items Morisky Therapeutic Adhesion Scale (MMAS-8) and compared the use of "backbone" tenofovir/lamivudine plus efavirenz one tablet once-daily (STR) or dolutegravir in multi-tablet once-daily (MTR-DTG), or other multi-tablet regimens (MTR-other). We conducted a multivariate logistic regression analysis to address factors associated with adherence. A total of 393 patients were included, 254 used STR, 106 MTR-DTG, and 33 MTR-other. The overall adhesion rate was 44.8% (95%CI: 39.4; 50.1), 50% for MTR-DTG, 43.3% for STR and 39.4% for MTR-other. Multivariate analysis showed a higher chance of adherence among patients using MTR-DTG, those who received and understood counseling about their treatment and with a higher quality of life. Prior use of illicit drugs in the lifetime was associated with poorer adherence. Overall adherence was low, highlighting the need for strategies focusing on counseling about medicines and substance use. Pill burden was not an issue for patients using MTR-DTG once-daily, who achieved better results.
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