scholarly journals HIV Pre-Exposure Prophylaxis (PrEP) purchase patterns and STI occurrence among Israeli men: A cohort analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259168
Author(s):  
Daniel Chemtob ◽  
Clara Weil ◽  
Jordan Hannink Attal ◽  
Elias Hawila ◽  
Enav Noff Sadeh
Keyword(s):  
Cohort Analysis ◽  
Health Maintenance Organizations ◽  
Syphilis Infection ◽  
Health Maintenance ◽  
Antiretroviral Medication ◽  
Hiv Test ◽  
Purchase Patterns ◽  
Exposure Prophylaxis ◽  
Continuous Use

Background HIV Pre-exposure prophylaxis (PrEP) is the regular use of antiretroviral medication by people who are not infected with HIV to prevent seroconversion. Israel approved PrEP for continuous use in 2017, and Israeli Health Maintenance Organizations (HMO) offered PrEP with a copayment to eligible members. Methodology This retrospective cohort study included all people who were dispensed PrEP between September 2017 to June 2019 in the second largest HMO in Israel. Statistical analysis, including Kaplan Meier, was conducted to evaluate user PrEP purchase, adherence to medical follow-up, and clinical outcomes. Results In total, a cohort of 757 PrEP users were followed for 657.8 person-years. All but one user were male; median age was 35 years. At baseline, 0.8% had gonorrhea and 1.5% had chlamydia infections and 4.4% had recent syphilis infection. Continuous use of PrEP (without interruption/discontinuation) was observed in 29.9%, while 39.9% interrupted and 30.3% discontinued use. Median time to first interruption/discontinuation was 4.0 months. At 6–12 months after initiation, 79.8% of users had a documented HIV test, 77.3% a Chlamydia-Gonorrhea panel, and 78.9% a creatinine test. There was one new case of HIV among the cohort, five months after PrEP discontinuation. Estimated first-year infection rates were 5.0%, 8.6% and 6.8% for gonorrhea, chlamydia and first-time syphilis, respectively. Conclusions This study shows heterogeneous PrEP purchase patterns and required medical follow-up, and an increase in STIs among consistent PrEP users. Improving adherence to recommended medical follow-up during PrEP use is essential in PrEP’s integration into Israel’s national HIV prevention strategy.

scholarly journals P616 Sustainability of thiopurines monotherapy in ulcerative colitis: a nationwide analysis from the epi-IIRN cohort

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S559-S559
Author(s):  
O Atia ◽  
C Friss ◽  
A Mendelovici ◽  
E Shteyer ◽  
E Orlanski-Meyer ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Treatment Duration ◽  
Cox Regression ◽  
Health Maintenance Organizations ◽  
Disease Course ◽  
Aminosalicylic Acid ◽  
Health Maintenance ◽  
Israeli Population ◽  
Pediatric Onset

Abstract Background Thiopurines have been long used to maintain remission in ulcerative colitis (UC) but are also associated with toxicity and therapeutic failure. We aimed to assess the sustainability rate of thiopurines commenced as monotherapy in UC, and to explore predictors of sustainability. Methods This study was performed on data from four Health Maintenance Organizations (HMOs), covering 98% of the Israeli population. We included all biologic-naïve UC patients diagnosed after 2005 and treated with thiopurines monotherapy for at least three months. Treatment with 5- aminosalicylic acid (ASA) was allowed if initiated prior to or during the first three months from initiation of thiopurines. Sustainability was defined as continued thiopurines treatment without switching therapy, adding biologics or requiring surgery. At most one short steroid course was allowed. Cox regression model was used to explore estimated predictors to sustainability. Results A total of 1,897 (370 [20%] pediatric-onset and 1,527 [80%] adults) thiopurines-treated patients were included with a 15,033 person-years of follow-up. The median time from UC diagnosis to initiation of thiopurines was 12.7 months (IQR 4.6–30.9), and the median treatment duration was 13.0 months (6.3–28.4). Sustainability rate was evident in 92% of patients after 6 months from initiation of thiopurines and 83%, 65% and 42% at one, three and five years, thereafter. Sustainability was associated with early initiation of thiopurines during disease course (HR 0.99 [95%CI 0.985–0.995]) and lack of 5-ASA at initiation of thiopurines (HR 0.7 [95%CI 0.6–0.8]). Conclusion As many as two thirds of biologic-naïve UC patients treated with thiopurines monotherapy sustain this treatment after five years, especially when initiated early and without 5-ASA.

ON SALE NOW AT YOUR HMO: ORGAN TRANSPLANTS DISCOUNT FEVER IS HITTING THE HIGH END OF MEDICINE: THE ORGAN-TRANSPLANT BUSINESS

PEDIATRICS ◽  
1995 ◽  
Vol 96 (3) ◽  
pp. 471-471
Author(s):  
J. F. L.
Keyword(s):  
Cleveland Clinic ◽  
Organ Transplant ◽  
Health Maintenance Organizations ◽  
Organ Transplants ◽  
Health Maintenance ◽  
Fixed Price ◽  
Duke University

Renowned transplant centers such as the Cleveland Clinic, Duke University, and Johns Hopkins are cutting rates for procedures and follow-up treatments by 30% to 60%. The centers figure that cheaper prices will help them win big contracts with health-maintenance organizations (HMOs) and other powerful insurers that mandate where their millions of members can go for care. Hospitals often discount their bills by about 20% for their biggest customers. But HMOs lately have been winning much steeper markdowns on fixed-price contracts that cover nearly all the expenses associated with organ transplants. See Table in the PDF File

scholarly journals A Strategy for PrEP Clinicians to Manage Ambiguous HIV Test Results During Follow-up Visits

2018 ◽  
Vol 5 (8) ◽  
Author(s):  
Dawn K Smith ◽  
William M Switzer ◽  
Philip Peters ◽  
Kevin P Delaney ◽  
Timothy C Granade ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Test Results ◽  
Hiv Status ◽  
Management Options ◽  
Hiv Test ◽  
Confirmatory Tests ◽  
Testing Algorithms ◽  
Effective Treatment Regimen ◽  
Exposure Prophylaxis

Abstract Prompt determination of HIV infection status is critical during follow-up visits for patients taking pre-exposure prophylaxis (PrEP) medication. Those who are uninfected can then continue safely taking PrEP, and those few who have acquired HIV infection can initiate an effective treatment regimen. However, a few recent cases have been reported of ambiguous HIV test results using common testing algorithms in PrEP patients. We review published reports of such cases and testing options that can be used to clarify true HIV status in these situations. In addition, we review the benefits and risks of 3 antiretroviral management options in these patients: (1) continue PrEP while conducting additional HIV tests, (2) initiate antiretroviral therapy for presumptive HIV infection while conducting confirmatory tests, or (3) discontinue PrEP to reassess HIV status after a brief antiretroviral-free interval. A clinical consultation resource is also provided.

scholarly journals DOP46 Sustainability rate of immunomodulators monotherapy in patients with Crohn’s Diseases: A population-based analysis from the epi-IIRN cohort

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S083-S083
Author(s):  
O Atia ◽  
C Friss ◽  
A Mendelovici ◽  
E Shteyer ◽  
D Yogev ◽  
...  
Keyword(s):  
Regression Model ◽  
Cox Regression ◽  
Health Maintenance Organizations ◽  
Population Based ◽  
Disease Course ◽  
Cox Regression Model ◽  
Health Maintenance ◽  
Israeli Population ◽  
Type Of Failure

Abstract Background Immunomodulators (IMM), including thiopurines and methotrexate (MTX), have been long used to maintain remission in Crohn’s disease (CD), both associated with remission, but also with toxicity and therapeutic failure. We aim to compare the sustainability of thiopurines and MTX commenced as monotherapy in patients with CD, and to explore predictors of sustainability. Methods This study was performed on data from four Health Maintenance Organizations (HMOs), covering 98% of the Israeli population. We included all biologic-naïve CD patients diagnosed after 2005 and treated with IMM monotherapy for at least three months. Sustainability was defined as continues IMM treatment without switching therapy, adding biologics or requiring surgery. In addition, at most one short steroid course was allowed. Cox regression model was used to explore estimated predictors to sustainability. To compare sustainability rate between thiopurines and MTX we used propensity score (PS) matching, and thereafter Cox regression model. Results A total of 4,891 (1,551 [32%] pediatric-onset and 3,340 [68%] adults) IMM-treated patients were included with 37,825 person-years of follow up, of whom 4,339 (89%) were treated with thiopurines and 552 (11%) with MTX. The median time from CD diagnosis to initiation of IMM was 6.1 months (IQR 1.7–19.7), and the median course duration was 11.9 months (6.1–25.3). Sustainability rate was recorded in 92% of patients after 6 months from initiation of IMM and 81%, 69% and 65% at one, three and five years, thereafter. The most common type of failure was escalation to biologics (67%), while 17% required repeated steroid courses and 15% underwent surgery. Sustainability was associated with earlier initiation of IMM during the disease course (HR 0.98 [95%CI 0.97–0.985]) and lack of steroids at initiation of IMM (HR 0.7 [95%CI 0.6–0.8]). A PS adjusted analysis that included 337 thiopurnes-treated patients individually matched with 337 MTX-treated patients, showed sustainability was significantly better with thiopurines (HR 0.7 [95%CI 0.5–0.8]). Conclusion Two thirds of biologic-naïve CD patients treated with IMM monotherapy sustain this treatment after five years, especially when initiated early during the disease course. Sustainability was more likely in those treated with thiopurines compared with MTX.

The Effect of Physician and Corporate Interests on the Formation of Health Maintenance Organizations

1993 ◽  
Vol 99 (1) ◽  
pp. 164-200 ◽  
Author(s):  
Douglas R. Wholey ◽  
Jon B. Christianson ◽  
Susan M. Sanchez
Keyword(s):  
Health Maintenance Organizations ◽  
Health Maintenance ◽  
Corporate Interests

scholarly journals Adherence to follow-up recommendation guidelines in long term breast cancer survivors, a SURBCAN cohort analysis using administrative databases

The Breast ◽  
2021 ◽  
Vol 56 ◽  
pp. S80-S81
Author(s):  
P. Santiá ◽  
A. Jansana ◽  
T. Sanz ◽  
I. de la Cura ◽  
M. Padilla-Ruiz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Cohort Analysis ◽  
Administrative Databases

scholarly journals 986. Improvement in Administration of HIV Post-Exposure Prophylaxis in the Emergency Department Following Sexual Assault

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S521-S522
Author(s):  
Jennifer R Silva-Nash ◽  
Stacie Bordelon ◽  
Ryan K Dare ◽  
Sherrie Searcy
Keyword(s):  
Emergency Department ◽  
Sexual Assault ◽  
Hiv Transmission ◽  
Post Exposure Prophylaxis ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Exposure ◽  
Assault Victims ◽  
Exposure Prophylaxis

Abstract Background Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines. Methods A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period. Results During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P< 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P< 0.001) in pre and post periods respectively. Renal function (37.3% vs 88.6%; P< 0.001), pregnancy (39.0% vs 79.6%; P< 0.001), syphilis (3.4% vs 89.8%; P< 0.001), hepatitis B (15.3% vs 95.5%; P< 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period. Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP Conclusion The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)

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