scholarly journals Number of people requiring post-exposure prophylaxis to end leprosy: A modeling study

2021 ◽  
Vol 15 (2) ◽  
pp. e0009146
Author(s):  
Anneke T. Taal ◽  
David J. Blok ◽  
Wim H. van Brakel ◽  
Sake J. de Vlas ◽  
Jan Hendrik Richardus
Keyword(s):  
Contact Tracing ◽  
Post Exposure Prophylaxis ◽  
First Year ◽  
Post Exposure ◽  
Leprosy Patients ◽  
Using Data ◽  
The Individual ◽  
Exposure Prophylaxis ◽  
The Impact

Background Worldwide, around 210,000 new cases of leprosy are detected annually. To end leprosy, i.e. zero new leprosy cases, preventive interventions such as contact tracing and post-exposure prophylaxis (PEP) are required. This study aims to estimate the number of people requiring PEP to reduce leprosy new case detection (NCD) at national and global level by 50% and 90%. Methodology/Principal findings The individual-based model SIMCOLEP was fitted to seven leprosy settings defined by NCD and MB proportion. Using data of all 110 countries with known leprosy patients in 2016, we assigned each country to one of these settings. We predicted the impact of administering PEP to about 25 contacts of leprosy patients on the annual NCD for 25 years and estimated the number of contacts requiring PEP per country for each year. The NCD trends show an increase in NCD in the first year (i.e. backlog cases) followed by a significant decrease thereafter. A reduction of 50% and 90% of new cases would be achieved in most countries in 5 and 22 years if 20.6 and 40.2 million people are treated with PEP over that period, respectively. For India, Brazil, and Indonesia together, a total of 32.9 million people requiring PEP to achieve a 90% reduction in 22 years. Conclusion/Significance The leprosy problem is far greater than the 210,000 new cases reported annually. Our model estimates of the number of people requiring PEP to achieve significant reduction of new leprosy cases can be used by policymakers and program managers to develop long-term strategies to end leprosy.

scholarly journals The long-term impact of the Leprosy Post-Exposure Prophylaxis (LPEP) program on leprosy incidence: A modelling study

2021 ◽  
Vol 15 (3) ◽  
pp. e0009279
Author(s):  
David J. Blok ◽  
Peter Steinmann ◽  
Anuj Tiwari ◽  
Tanja Barth-Jaeggi ◽  
Mohammad A. Arif ◽  
...  
Keyword(s):  
Index Patient ◽  
Routine Activities ◽  
Control Programme ◽  
Contact Tracing ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Long Term Impact ◽  
Exposure Prophylaxis ◽  
The Impact

Background The Leprosy Post-Exposure Prophylaxis (LPEP) program explored the feasibility and impact of contact tracing and the provision of single dose rifampicin (SDR) to eligible contacts of newly diagnosed leprosy patients in Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. As the impact of the programme is difficult to establish in the short term, we apply mathematical modelling to predict its long-term impact on the leprosy incidence. Methodology The individual-based model SIMCOLEP was calibrated and validated to the historic leprosy incidence data in the study areas. For each area, we assessed two scenarios: 1) continuation of existing routine activities as in 2014; and 2) routine activities combined with LPEP starting in 2015. The number of contacts per index patient screened varied from 1 to 36 between areas. Projections were made until 2040. Principal findings In all areas, the LPEP program increased the number of detected cases in the first year(s) of the programme as compared to the routine programme, followed by a faster reduction afterwards with increasing benefit over time. LPEP could accelerate the reduction of the leprosy incidence by up to six years as compared to the routine programme. The impact of LPEP varied by area due to differences in the number of contacts per index patient included and differences in leprosy epidemiology and routine control programme. Conclusions The LPEP program contributes significantly to the reduction of the leprosy incidence and could potentially accelerate the interruption of transmission. It would be advisable to include contact tracing/screening and SDR in routine leprosy programmes.

scholarly journals Leprosy Post-Exposure Prophylaxis (LPEP) programme: study protocol for evaluating the feasibility and impact on case detection rates of contact tracing and single dose rifampicin

BMJ Open ◽  
2016 ◽  
Vol 6 (11) ◽  
pp. e013633 ◽  
Author(s):  
Tanja Barth-Jaeggi ◽  
Peter Steinmann ◽  
Liesbeth Mieras ◽  
Wim van Brakel ◽  
Jan Hendrik Richardus ◽  
...  
Keyword(s):  
Single Dose ◽  
Study Protocol ◽  
Contact Tracing ◽  
Post Exposure Prophylaxis ◽  
Case Detection ◽  
Detection Rates ◽  
Post Exposure ◽  
Exposure Prophylaxis

HIV seroconversions among male non-occupational post-exposure prophylaxis service users: a data linkage study

Sexual Health ◽  
2011 ◽  
Vol 8 (2) ◽  
pp. 179 ◽  
Author(s):  
Anna B. Pierce ◽  
Keflemariam Yohannes ◽  
Rebecca Guy ◽  
Kerrie M. Watson ◽  
Jude Armishaw ◽  
...  
Keyword(s):  
Risk Behaviour ◽  
Linkage Study ◽  
Incidence Rates ◽  
Post Exposure Prophylaxis ◽  
Hiv Incidence ◽  
Hiv Surveillance ◽  
Post Exposure ◽  
Hiv Seroconversion ◽  
Exposure Prophylaxis ◽  
The Impact

Background: Despite widespread prescription of non-occupational post-exposure prophylaxis (NPEP) in Victoria, little is known about subsequent HIV acquisition among NPEP users. We linked the Victorian NPEP Service (VNPEPS) database and the Victorian HIV Surveillance Registry to determine the number, incidence rate and predictive factors of HIV seroconversions among users of the VNPEPS. Methods: Records from male patients that received NPEP in the VNPEPS database (n = 1420) between January 2001 and February 2008 were linked with all entries in the Victorian HIV Surveillance Registry up to May 2008. Results: Sixty-one men who presented to the VNPEPS were identified as HIV seropositive; 16 of these were diagnosed at initial presentation for NPEP. The incidence of HIV seroconversion in males who were HIV seronegative at first presentation for NPEP was 1.27 (95% confidence interval 0.95–1.70) per 100 person-years. There was no association between HIV seroconversion and number of NPEP presentations or age. The median age of seroconversion was 34.6 years. Conclusion: The incidence of HIV infection among men presenting to the VNPEPS is slightly lower than the HIV incidence in NPEP users in a recent Australian cohort study of men who have sex with men, but higher than HIV incidence in general gay male populations. Frequency of NPEP use was not associated with risk of HIV seroconversion. Examination of risk behaviour before and after NPEP use in this population is required to further assess the impact of NPEP availability and use on HIV incidence rates and risk behaviour in Australia.

scholarly journals Data linkage to evaluate the long-term risk of HIV infection in individuals seeking post-exposure prophylaxis

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Frédérique Hovaguimian ◽  
◽  
Huldrych F. Günthard ◽  
Christoph Hauser ◽  
Anna Conen ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Data Linkage ◽  
Tertiary Hospital ◽  
First Episode ◽  
Post Exposure Prophylaxis ◽  
Hiv Diagnosis ◽  
Post Exposure ◽  
Sex With Men ◽  
Exposure Prophylaxis

AbstractEvidence on the long-term risk of HIV infection in individuals taking HIV post-exposure prophylaxis remains limited. In this retrospective data linkage study, we evaluate the occurrence of HIV infection in 975 individuals who sought post-exposure prophylaxis in a tertiary hospital between 2007 and 2013. Using privacy preserving probabilistic linkage, we link these 975 records with two observational databases providing data on HIV events (Zurich Primary HIV Infection study and the Swiss HIV Cohort Study). This enables us to identify 22 HIV infections and to obtain long-term follow-up data, which reveal a median of 4.1 years between consultation for post-exposure prophylaxis and HIV diagnosis. Even though men who have sex with men constitute only 35.8% of those seeking post-exposure prophylaxis, all 22 events occur in this subgroup. These findings should strongly encourage early consideration of pre-exposure prophylaxis in men who have sex with men after a first episode of post-exposure prophylaxis.

scholarly journals Knowledge regarding rabies and its prevention among first year medical college students, Mandya

2018 ◽  
Vol 5 (11) ◽  
pp. 4905
Author(s):  
M. Manjunath ◽  
L. M. Manuja ◽  
B. R. Harish
Keyword(s):  
Cross Sectional Study ◽  
Post Exposure Prophylaxis ◽  
First Year ◽  
Medical Sciences ◽  
Cross Sectional ◽  
Post Exposure ◽  
Medical College ◽  
Mode Of Transmission ◽  
Exposure Prophylaxis ◽  
First Year Medical Students

Background: Rabies is a zoonotic disease that is caused by a virus and is always fatal which can be prevented by timely and appropriate post exposure prophylaxis. The large number of deaths due to rabies can be attributed to the fact that in spite of availability of effective vaccination against rabies, people are unaware of various aspects of rabies and its prevention. Hence this study was conducted to assess the knowledge regarding rabies and its prevention among first year medical students.Methods: This descriptive cross sectional study was conducted among first year medical students of Mandya Institute of Medical Sciences, Mandya. The data was collected using pretested semi-structured questionnaire and analysed using descriptive statistics.Results: Of the total 80 students who were included, 90.0% knew that rabies is a disease caused by a virus. All of them knew that dogs transmit rabies. 96.3% were aware of the mode of transmission. 30.0% answered that rabies can be transmitted by scratch. 25% had the wrong perception that rabid person can present with epileptic features. 28.8% had given correct answer regarding the number of doses of vaccination. 86.3% knew that rabies can be prevented by vaccinating animal.Conclusions: Majority of the students had incomplete knowledge about rabies and its cause and mode of transmission and unaware of post exposure prophylaxis. 

scholarly journals Review: Insights on Current FDA-Approved Monoclonal Antibodies Against Ebola Virus Infection

2021 ◽  
Vol 12 ◽  
Author(s):  
Olivier Tshiani Mbaya ◽  
Philippe Mukumbayi ◽  
Sabue Mulangu
Keyword(s):  
Ebola Virus ◽  
Virus Disease ◽  
Controlled Trial ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Robust Immune Response ◽  
Critical Knowledge ◽  
Republic Of The Congo ◽  
Exposure Prophylaxis ◽  
The Impact

The unprecedented 2013-2016 West Africa Ebola outbreak accelerated several medical countermeasures (MCMs) against Ebola virus disease (EVD). Several investigational products (IPs) were used throughout the outbreak but were not conclusive for efficacy results. Only the Randomized Controlled Trial (RCT) on ZMapp was promising but inconclusive. More recently, during the second-largest Ebola outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo (DRC), four IPs, including one small molecule (Remdesivir), two monoclonal antibody (mAb) cocktails (ZMapp and REGN-EB3) and a single mAb (mAb114), were evaluated in an RCT, the Pamoja Tulinde Maisha (PALM) study. Two products (REGN-EB3 and mAb114) demonstrated efficacy as compared to the control arm, ZMapp. There were remarkably few side effects recorded in the trial. The FDA approved both medications in this scientifically sound study, marking a watershed moment in the field of EVD therapy. These products can be produced relatively inexpensively and can be stockpiled. The administration of mAbs in EVD patients appears to be safe and effective, while several critical knowledge gaps remain; the impact of early administration of Ebola-specific mAbs on developing a robust immune response for future Ebola virus exposure is unknown. The viral mutation escape, leading to resistance, presents a potential limitation for single mAb therapy; further improvements need to be explored. Understanding the contribution of Fc-mediated antibody functions such as antibody-dependent cellular cytotoxicity (ADCC) of those approved mAbs is still critical. The potential merit of combination therapy and post-exposure prophylaxis (PEP) need to be demonstrated. Furthermore, the PALM trial has accounted for 30% of mortality despite the administration of specific treatments. The putative role of EBOV soluble Glycoprotein (sGP) as a decoy to the immune system, the virus persistence, and relapses might be investigated for treatment failure. The development of pan-filovirus or pan-species mAbs remains essential for protection. The interaction between FDA-approved mAbs and vaccines remains unclear and needs to be investigated. In this review, we summarize the efficacy and safety results of the PALM study and review current research questions for the further development of mAbs in pre-exposure or emergency post-exposure use.

scholarly journals Protocol, rationale and design of PEOPLE (Post ExpOsure Prophylaxis for LEprosy in the Comoros and Madagascar): a cluster randomized trial on effectiveness of different modalities of implementation of post-exposure prophylaxis of leprosy contacts

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Nimer Ortuno-Gutierrez ◽  
Assoumani Younoussa ◽  
Andriamira Randrianantoandro ◽  
Sofie Braet ◽  
Bertrand Cauchoix ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Link Type ◽  
High Incidence ◽  
Leprosy Patients ◽  
Household Members ◽  
Cluster Randomized ◽  
Exposure Prophylaxis

Abstract Background Leprosy is an ancient infectious disease with a global annual incidence that has plateaued above 200,000 new cases since over a decade. New strategies are required to overcome this stalemate. Post-exposure prophylaxis (PEP) with a single dose of Rifampicin (SDR) has conditionally been recommended by the World Health Organization (WHO), based on a randomized-controlled-trial in Bangladesh. More evidence is required. The Post ExpOsure Prophylaxis for Leprosy (PEOPLE) trial will assess effectiveness of different modalities of PEP on the Comoros and Madagascar. Methods PEOPLE is a cluster-randomized trial with villages selected on previous leprosy-incidence and randomly allocated to four arms. Four annual door-to-door surveys will be performed in all arms. All consenting permanent residents will be screened for leprosy. Leprosy patients will be treated according to international guidelines and eligible contacts will be provided with SDR-PEP. Arm-1 is the comparator in which no PEP will be provided. In arms 2, 3 and 4, SDR-PEP will be provided at double the regular dose (20 mg/kg) to eligible contacts aged two years and above. In arm 2 all household-members of incident leprosy patients are eligible. In arm 3 not only household-members but also neighbourhood contacts living within 100-m of an incident case are eligible. In arm 4 such neighbourhood contacts are only eligible if they test positive to anti-PGL-I, a serological marker. Incidence rate ratios calculated between the comparator arm 1 and each of the intervention arms will constitute the primary outcome. Discussion Different trials on PEP have yielded varying results. The pivotal COLEP trial in Bangladesh showed a 57% reduction in incidence over a two-year period post-intervention without any rebound in the following years. A study in a high-incidence setting in Indonesia showed no effect of PEP provided to close contacts but a major effect of PEP provided as a blanket measure to an entire island population. High background incidence could be the reason of the lack of effect of PEP provided to individual contacts. The PEOPLE trial will assess effectiveness of PEP in a high incidence setting and will compare three different approaches, to identify who benefits most from PEP. Trial registration Clinicaltrials.Gov. NCT03662022. Initial Protocol Version 1.2, 27-Aug-2018.

Post-exposure prophylaxis in the era of pre-exposure prophylaxis: a study of post-exposure prophylaxis use in South-East Queensland since the Pharmaceutical Benefits Scheme listing of pre-exposure prophylaxis

2020 ◽  
Vol 31 (5) ◽  
pp. 426-431
Author(s):  
Karen Biggs ◽  
Maree O’Sullivan ◽  
Cheryn Palmer ◽  
Jacqualine McLellan ◽  
Fiona Marple-Clark ◽  
...  
Keyword(s):  
Health Services ◽  
Sexual Health ◽  
Condom Use ◽  
Antiretroviral Drugs ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Hiv Acquisition ◽  
Exposure Prophylaxis ◽  
The Impact ◽  
Pharmaceutical Benefits Scheme

Both post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) involve the use of antiretroviral drugs taken by HIV-uninfected individuals to reduce HIV acquisition risk. While PEP has been available in Australia for many years, PrEP became widely accessible in 2018 after listing on the Pharmaceutical Benefits Scheme (PBS). Studies have reported on the impact of PrEP on condom use. The impact of PrEP on the use of PEP in Australia has not been reported. This project examined PEP use across three public sexual health services in South-East Queensland, Australia, comparing rates in 2016 (prePBS-listed PrEP) and 2019 (postPBS-listed PrEP), to determine if PEP prescribing, and the characteristics of people accessing PEP, have changed. Results showed that PEP prescribing made up 2.85% of all clients seen in 2016, dropping to 2.33% in 2019, reflecting a decrease of 0.5% (p = 0.048). There was a significant increase in Medicare-ineligible clients accessing PEP (9% in 2016; 21% in 2019; p = 0.002) and a significant increase in PrEP-experienced clients accessing PEP between the two study periods (4% in 2016; 14% in 2019; p ≤ 0.001). The marginal decrease in PEP prescribing highlights that PEP remains an important option especially for those with barriers to accessing and adhering to daily PrEP.

scholarly journals 987. Improving Patient Access to HIV Post-Exposure Prophylaxis with Pharmacist Involvement

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S522-S522
Author(s):  
Katlyn H Grossman
Keyword(s):  
Hospital Pharmacy ◽  
Medical Center ◽  
Cost Savings ◽  
The United States ◽  
Post Exposure Prophylaxis ◽  
Total Cost ◽  
Post Exposure ◽  
Exposure Prophylaxis ◽  
The Impact

Abstract Background Appropriate use of post-exposure prophylaxis (PEP) after isolated sexual, injection drug use, or other exposures to HIV is an effective tool to reduce the risk of HIV acquisition. PEP completion rates are low, with literature reporting only 40% of sexual assaulted persons adhering to a full 28-day course. One important barrier to adherence can be access to medications in a timely manner. In the United States, a four week course of PEP costs nearly $4,000 without insurance and can remain unaffordable with high copays and deductibles for patients who are underinsured. Methods A pharmacist in the Infectious Disease (ID) clinic was notified of all non-occupational post-exposure prophylaxis (nPEP) cases referred from the Emergency Department for follow up and coordinated benefits investigation, ensured low or no cost medication access, completed medication reconciliation, counseled on PEP adherence, and coordinated filling of same day prescriptions at the hospital based pharmacy. To assess the impact of pharmacist involvement, a retrospective review of nPEP cases over a 6 month period were compared to a 6 month period prior to pharmacist presence in clinic. Results 16 nPEP cases were seen by a pharmacist compared to 8 nPEP cases seen in the ID clinic without pharmacist involvement. 100% of patients received medications prior to leaving the medical center, compared to 63% of cases filling at the hospital pharmacy prior to pharmacist presence. 25% of patients required an insurance related override in order to access PEP urgently. The average out of pocket cost was $2.25 with maximum total cost being $7.30. Prior to pharmacist involvement, the average out of pocket cost was $475 for complete PEP regimen with a maximum total cost of $3,733.40. 42% of patients completed their entire PEP course and came to follow up appointment after pharmacist involvement, compared to 31% of patients prior to pharmacist presence. Conclusion Pharmacist involvement led to a substantial cost savings to patients receiving nPEP. It was also associated with higher capture rates of prescriptions filled at the hospital pharmacy along with a higher rate of PEP completion and follow up. Disclosures All Authors: No reported disclosures

scholarly journals A dog bite study in a dog rabies-affected area in South Africa

2020 ◽  
Vol 35 (1) ◽  
Author(s):  
Jacqueline Weyer ◽  
Chantel A. Le Roux ◽  
Charles Kajese ◽  
Lucy Fernandes
Keyword(s):  
Developing Countries ◽  
Temporal Distribution ◽  
Healthcare Facility ◽  
Post Exposure Prophylaxis ◽  
Dog Bite ◽  
Healthcare Facilities ◽  
Post Exposure ◽  
Direct Training ◽  
Using Data ◽  
Exposure Prophylaxis

Background: Rabies is an untreatable and highly fatal viral zoonosis. Despite the ability to control and prevent the disease, it is estimated that one person dies of rabies every 10 minutes in developing countries. However, the true burden of the disease remains undefined in most developing countries because of a lack of systematic surveillance. Dog bite data obtained from healthcare facilities where dog bite victims seek medical care may provide an additional source of information that can be used to inform the burden of disease and identify points for interventions for improved delivery of post-exposure prophylaxis (PEP) to prevent the disease.Methods: A descriptive epidemiological study was conducted using data obtained from dog bite registers and patient case files at a healthcare facility for a two year period (2015-2017).Results: The study reported frequency, demographics, source, geographic and temporal distribution of bite cases reported to a hospital serving a rabies-affected community. In addition, the post-exposure management of dog bite cases at this facility is described.Conclusion: Dog bites was not an infrequently reported at the healthcare facility, with up to 29 cases reported in a month during the study period. The affected population was defined and it is motivated that this information is useful for targeted health interventions. Findings related to the delivery of PEP may also be used to direct training and re-training of healthcare workers for improved delivery of PEP.

Sign in / Sign up

Export Citation Format

Share Document