scholarly journals Desimplification of Single Tablet Antiretroviral (ART) Regimens—A Practical Cost-Savings Strategy?

2019 ◽  
Vol 18 ◽  
pp. 232595821882230 ◽  
Author(s):  
Hartmut Krentz ◽  
Shayna Campbell ◽  
John Gill
Keyword(s):  
Antiretroviral Therapy ◽  
Side Effects ◽  
Cost Control ◽  
Generic Drugs ◽  
Cost Savings ◽  
Hiv Care ◽  
First Year ◽  
Increased Risk ◽  
Southern Alberta ◽  
And Control

Introduction: The use of lifelong antiretroviral therapy (ART) results in increased costs of care; the ability to finance and control sustained costs of ART needs to be discussed. Approach: The Southern Alberta Clinic initiated a practical cost savings approach that switched select patients from a branded ART to a less expensive generic variation. Our approach surveyed physicians and patients on their acceptance of switching and then launched a program asking patients if they would switch to generic variations for cost control purposes. Results: Our early findings found >50% of patients approached agreed to switch. We found no evidence of increased risk of viral breakthrough, resistance, side effects, or displeasure with generic drugs. Measured cost savings in the first year were >$1.1 million with annual projected savings of between $4.3 million and $2.6 million (in 2017 Cdn$). Conclusion: Our approach can provide an option for controlling costs of HIV care without compromising quality.

scholarly journals The Direct Medical Costs of Late Presentation (<350/mm3) of HIV Infection over a 15-Year Period

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Hartmut B. Krentz ◽  
M. John Gill
Keyword(s):  
Cost Savings ◽  
Medical Costs ◽  
Late Presentation ◽  
Hiv Care ◽  
First Year ◽  
Late Presenters ◽  
Cd4 Counts ◽  
Direct Medical Costs ◽  
Southern Alberta ◽  
Routine Hiv Testing

We describe the immediate- and longer-term direct medical costs of care for individuals diagnosed with HIV at CD4 counts <350/mm3(“late presenters”). We collected and stratified by initial CD4 count all inpatient, outpatient, and drug costs for all newly diagnosed patients accessing HIV care within Southern Alberta from 1/1/1995 to 1/1/2010. 59% of new patients were late presenters. We found significantly higher costs for late presenters, especially inpatient costs, during the first year after accessing care. Direct medical costs remained almost twice as high for late presenters in subsequent years compared to patients presenting with CD4 counts >350/mm3despite significantly their improved CD4 counts. The sustained high cost for late presenters has implications for recent recommendations for wider routine HIV testing and the earlier initiation of cART. Earlier diagnosis and treatment, while increasing the immediate expenditures within a population, may produce both direct and indirect cost savings in the longer term.

Predicting Direct Costs of HIV Care During the First Year of Darunavir-Based Highly Active Antiretroviral Therapy Using CD4 Cell Counts

2010 ◽  
Vol 28 (S1) ◽  
pp. 169-181 ◽  
Author(s):  
Andrew M. Hill ◽  
Kelly Gebo ◽  
Lindsay Hemmett ◽  
Mickael Löthgren ◽  
Gabriele Allegri ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Direct Costs ◽  
Hiv Care ◽  
First Year ◽  
Highly Active ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Cd4 Cell

scholarly journals Incidence and Predictors of Tuberculosis Occurrence among Adults on Antiretroviral Therapy at Debre Markos Referral Hospital, Northwest Ethiopia: Retrospective Follow-up Study

2020 ◽  
Author(s):  
Agazhe Aemro ◽  
Abebaw Jember ◽  
Degefaye Zelalem Anlay
Keyword(s):  
Antiretroviral Therapy ◽  
Incidence Rate ◽  
Northwest Ethiopia ◽  
Referral Hospital ◽  
Hiv Care ◽  
First Year ◽  
Art Adherence ◽  
Follow Up Study ◽  
Debre Markos

Abstract Background : In resource limited settings, Tuberculosis (TB) is a major cause of morbidity and mortality among patients on antiretroviral treatment. Ethiopia is one of the 30 high TB burden countries. TB causes burden in healthcare system and challenge the effectiveness of HIV care. This study was to assess incidence and predictors of Tuberculosis among adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia, 2019. Methods : Institution based retrospective follow up study was conducted among adults on ART newly enrolled from 2014 to 2018 at Debre Markos Referral Hospital. Simple random sampling technique was used to select patients chart. Data was entered to EPI- INFO version 7.2.2.6 and analyzed using Stata 14.0. Tuberculosis incidence rate was computed and described using frequency tables. Both bivariable and multivariable Cox proportional hazard models was fitted to identify predictors of TB. Results : Out of the 536 patients chart reviewed, 494 patient records were included in the analysis. A total of 62 patients developed new TB cases during the follow up period of 1000.22 Person Years (PY); which gives an overall incidence rate of 6.19 cases per 100 PY (95% CI: 4.83 - 7.95). The highest rate was seen within the first year of follow up. After adjustment base line Hemoglobin < 10 g/dl (AHR= 5.25; 95% CI: 2.52 - 10.95), ambulatory/bedridden patients at enrolment (AHR = 2.31; 95% CI: 1.13 - 4.73), having fair or poor ART adherence (AHR = 3.22; 95% CI: 1.64 – 6.31) were associated with increased risk of tuberculosis whereas taking Isoniazid Preventive Therapy (IPT) (AHR = 0.33; 95% CI: 0.12 - 0.85) were protective factors of TB occurrence. Conclusion : TB incidence was high among adults on ART especially in the first year of enrollment to ART. Low hemoglobin level, ambulatory or bedridden functional status, non-adherence to ART and IPT usage status were found to be independent predictors. Hence, continuous follow up for ART adherence and provision of IPT has a great importance to reduce the risk of TB.

scholarly journals 2526. Side Effects of Antiretroviral Therapy in Children with HIV in a Referral Center in Mexico

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S878-S878 ◽  
Author(s):  
Luis Xochihua Diaz ◽  
Javier Ordoñez Ortega ◽  
Karen Alejandra Linares Lopez ◽  
Itzel Villanueva Garcia ◽  
Jose Luis Copado Gutierrez
Keyword(s):  
Antiretroviral Therapy ◽  
Side Effects ◽  
Adverse Effects ◽  
Pediatric Population ◽  
Common Effect ◽  
The Mean ◽  
And Control ◽  
Mean Time ◽  
Observational Descriptive Study ◽  
Complete Medical Record

Abstract Background Human Inmunodeficiency Virus infection (HIV) is still a challenge in many parts of the world, mainly in children. In Mexico the infection has been decreasing, however we still have cases, in 2018 we had 40 perinatal new cases reported. The antiretroviral therapy has shown to be effective to control the disease but it is not free of adverse effects, the children with vertical transmission are exposed to many years of the antiretroviral therapy. Methods Retrospective, observational descriptive study at Instituto Nacional de Pediatría during 2004–2019. We included every children under 18 years old who received treatment for HIV and had a complete medical record. Results We found 61 patients under 18 years that fulfill the data for the analysis. 37 (60%) were male, the mean age at diagnosis of HIV infection was 47 months, the antiretroviral therapy that received 57 patients (93.4%) of the study was zidovudine, lamivudine and lopinavir/ritonavir, only 4 received another therapy: 3 of them received abacavir, lamivudine, and lopinavir/ritonavir and the missing one received abacavir, lamivudine and raltegravir. 43% of the children of our study showed adverse effects after the antiretroviral therapy, the mean time of adverse effects presentation was 37 months after the beginning of the treatment. The most common effect was hypertriglyceridemia with 13 cases, in second place we found hypercholesterolemia in 7 cases, and both in 5 cases, other frequent effects were hepatotoxicity in 5 cases, diarrhea in 4 cases, anemia in 3 cases, vomit in 3 cases, abdominal pain and night terrors in 2 cases each one. It was necessary the change of the therapy because of adverse effects in 6 cases (9.8%). Conclusion Antiretroviral therapy is effective although it has many side effects. We observe that adverse effects are frequent, almost the half, in pediatric population, it depends on the antiretroviral selection, for children we had only a few options because of the little doses they need or the inability to swallow tablets. It′s important to monitor and control all the adverse effects because they increase morbidity and mortality, especially dyslipidemia, that has been associated with cardiovascular risk and it was the most common effect found in our study. Disclosures All authors: No reported disclosures.

scholarly journals A Cascade of Interventions to Promote Adherence to Antiretroviral Therapy in African Countries

2020 ◽  
Vol 17 (5) ◽  
pp. 529-546 ◽  
Author(s):  
Rebecca Jopling ◽  
Primrose Nyamayaro ◽  
Lena S Andersen ◽  
Ashraf Kagee ◽  
Jessica E Haberer ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Point Of Care ◽  
Cost Effective ◽  
Economic Incentives ◽  
Hiv Care ◽  
People Living With Hiv ◽  
African Countries ◽  
Treatment Cascade ◽  
Art Initiation ◽  
Increased Risk

Abstract Purpose of Review We reviewed interventions to improve uptake and adherence to antiretroviral therapy (ART) in African countries in the Treat All era. Recent Findings ART initiation can be improved by facilitated rapid receipt of first prescription, including community-based linkage and point-of-care strategies, integration of HIV care into antenatal care and peer support for adolescents. For people living with HIV (PLHIV) on ART, scheduled SMS reminders, ongoing intensive counselling for those with viral non-suppression and economic incentives for the most deprived show promise. Adherence clubs should be promoted, being no less effective than facility-based care for stable patients. Tracing those lost to follow-up should be targeted to those who can be seen face-to-face by a peer worker. Summary Investment is needed to promote linkage to initiating ART and for differentiated approaches to counselling for youth and for those with identified suboptimal adherence. More evidence from within Africa is needed on cost-effective strategies to identify and support PLHIV at an increased risk of non-adherence across the treatment cascade.

scholarly journals Relationship between bottle feeding in supine position in infants and the presence of asthma among preschoolers

2009 ◽  
Vol 49 (3) ◽  
pp. 182
Author(s):  
Pertiwi Febriana Chandrawati ◽  
Roni Naning ◽  
Ekawaty Lutfia Haksari
Keyword(s):  
Supine Position ◽  
Sleep Time ◽  
Bottle Feeding ◽  
Control Group ◽  
Case Group ◽  
First Year ◽  
Smoking During Pregnancy ◽  
Increased Risk ◽  
Group Feeding ◽  
And Control

Background Asthma is a common chronic respiratory disease.The risk factors of asthma are allergic factors, familial atopy,race, gender, and smoking during pregnancy. Other risk factorsare gastroesophageal reflux and micro-aspiration which causebronchospasm and bronchial hyperreactivity due to repeatedairway irritation.Objective To determine the association between bottle feedinggiven in supine position before sleep time in the first year of lifewith asthma in 4 to 7 years old.Methods A case control study was conducted on pediatricpatients from Sardjito Hospital and Muhammadiyah kindergarten, Yogyakarta. Two structured questionnaires were used; the first identified the case group (asthma) and control group (nonasthma), whereas the second one identified whether the subjects had bottle feeding in supine position in the first year of life or not.Results 122 subjects were studied, 62 subjects in asthma groupand 60 in control group. In asthma group, feeding in supineposition before sleep time in the first year had OR of 2.45 (95%CI 1.21 to 6.93), whereas regurgitation when bottle-feeding insupine position had OR of 4.53 (95% CI 1.54 to 13.16). Suddencry when bottle-feeding in supine position had OR of 5.02 (95%CI 1.69 to 15.71). Asthma in the family increased risk of asthma[OR 3.12 (95% CI 1.16 to 6.50)] and atopicfamily has OR 3.25(95% CI 1.01 to 6.27).Conclusion Bottle feeding in supine position before sleep timeduring first year oflife is associated with occurrence of asthma inpreschool children.

scholarly journals Age Matters: Increased Risk of Inconsistent HIV Care and Viremia Among Adolescents and Young Adults on Antiretroviral Therapy in Nigeria

2016 ◽  
Vol 59 (3) ◽  
pp. 298-304 ◽  
Author(s):  
Aimalohi A. Ahonkhai ◽  
Bolanle Banigbe ◽  
Juliet Adeola ◽  
Abdulkabir B. Adegoke ◽  
Susan Regan ◽  
...  
Keyword(s):  
Young Adults ◽  
Antiretroviral Therapy ◽  
Adolescents And Young Adults ◽  
Hiv Care ◽  
Increased Risk

scholarly journals Incidence and Predictors of Tuberculosis Occurrence among Adults on Antiretroviral Therapy at Debre Markos Referral Hospital, Northwest Ethiopia: Retrospective Follow-up Study

2020 ◽  
Author(s):  
Agazhe Aemro ◽  
Abebaw Jember ◽  
Degefaye Zelalem Anlay
Keyword(s):  
Antiretroviral Therapy ◽  
Incidence Rate ◽  
Northwest Ethiopia ◽  
Referral Hospital ◽  
Hiv Care ◽  
First Year ◽  
Art Adherence ◽  
Follow Up Study ◽  
Debre Markos

Abstract Background: In resource limited settings, Tuberculosis (TB) is a major cause of morbidity and mortality among patients on antiretroviral treatment. Ethiopia is one of the 30 high TB burden countries. TB causes burden in healthcare system and challenge the effectiveness of HIV care. This study was to assess incidence and predictors of Tuberculosis among adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia, 2019. Methods: Institution based retrospective follow up study was conducted among adults on ART newly enrolled from 2014 to 2018 at Debre Markos Referral Hospital. Simple random sampling technique was used to select patients chart. Data was entered to EPI- INFO version 7.2.2.6 and analyzed using Stata 14.0. Tuberculosis incidence rate was computed and described using frequency tables. Both bivariable and multivariable Cox proportional hazard models was fitted to identify predictors of TB. Results: Out of the 536 patients chart reviewed, 494 patient records were included in the analysis. A total of 62 patients developed new TB cases during the follow up period of 1000.22 Person Years (PY); which gives an overall incidence rate of 6.19 cases per 100 PY (95% CI: 4.83 - 7.95). The highest rate was seen within the first year of follow up. After adjustment base line Hemoglobin < 10 g/dl (AHR= 5.25; 95% CI: 2.52 - 10.95), ambulatory/bedridden patients at enrolment (AHR = 2.31; 95% CI: 1.13 - 4.73), having fair or poor ART adherence (AHR = 3.22; 95% CI: 1.64 – 6.31) were associated with increased risk of tuberculosis whereas taking Isoniazid Preventive Therapy (IPT) (AHR = 0.33; 95% CI: 0.12 - 0.85) were protective factors of TB occurrence. Conclusion: TB incidence was high among adults on ART especially in the first year of enrollment to ART. Low hemoglobin level, ambulatory or bedridden functional status, non-adherence to ART and IPT usage status were found to be independent predictors. Hence, continuous follow up for ART adherence and provision of IPT has a great importance to reduce the risk of TB.

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