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1
Kovalik, Eugene C., and Steve J. Schwab. "Antibiotic prophylaxis for hemodialysis access placement." American Journal of Kidney Diseases 30, no. 3 (1997): 448. http://dx.doi.org/10.1016/s0272-6386(97)90294-8.
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Kaladharan, Sid, and Melissa Warner. "HIV- PEP (Post Exposure Prophylaxis) Access Project." International Journal of Integrated Care 17, no. 3 (2017): 87. http://dx.doi.org/10.5334/ijic.3199.
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Krakower, Douglas, and Julia L. Marcus. "Commercial Determinants of Access to HIV Preexposure Prophylaxis." JAMA Network Open 6, no. 11 (2023): e2342759. http://dx.doi.org/10.1001/jamanetworkopen.2023.42759.
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Barnett, Daniel, and Danielle Nance. "A Retrospective Analysis and Characterization of Female Patients with Bleeding Disorders Hemophilia B, Hemophilia B and Von Willebrand's Disease and Their Treatment Type at Banner MD Anderson Cancer Center." Blood 142, Supplement 1 (2023): 1254. http://dx.doi.org/10.1182/blood-2023-187656.
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Introduction: Women with bleeding disorders experience bleeding in mucocutaneous tissues, uterine bleeding, and in muscles and joints. In men, bleeding of more than 1 or 2 bleeds per year is justification for starting prophylaxis with factor and non-factor replacement therapy. At Banner MD Anderson Cancer Center (BMDACC), women are offered prophylaxis according to the same standard. Uterine bleeding classified as excessive or disruptive to daily activity is considered bleeding requiring prophylaxis. Aim: Describe the number of women in the bleeding disorder database from June 2018 to December 2022 with Hemophilia A (HemA), Hemophilia B (HemB) and Von Willebrand Disease (VWD) with respect to number on prophylaxis to prevent bleeds. Specific factor levels and subtype of VWD were not gathered as part of this project. Rather, patients were offered prophylaxis based on symptoms of bleeding. Prophylaxis is defined as treatment to prevent bleeding associated with day-to-day activity, but not prior to planned procedures. The type of treatment was recorded, type of access if needed (peripheral intravenous access v. central venous access) and why treatment was started. Results: Among 101 female patients in the BMDACC bleeding disorder database, 64 had a diagnosis of HemA, HemB or VWD. Among HemA, 13 of 17 (76%) were on prophylaxis with factor replacement or emicizumab. Joint bleeding and pain were the most common reasons for starting prophylaxis in 6 of 13 patients and menorrhagia was the second most common in 3 patients. Among HemB, 2 of 4 (50%) were on factor replacement. Rectal bleeding and menorrhagia were reasons to start prophylaxis. Among VWD, 24 of 43 (56%) were on prophylaxis with one or more of the following treatments: factor replacement, desmopressin or antifibrinolytic replacement. Menorrhagia was the most common reason for starting prophylaxis in 13 of 24 patients and joint bleeding was the next most common in 4 patients. Additional reasons were trauma, mucocutaneous, urinary tract bleeding, and bleeding during pregnancy. Patients with VWD were much more likely to require central IV access in the form of a chest port-a-cath 14 of 43 (33%) than patients with HemA or HemB, of which no patients required central access. Patients with HemA or HemB were more likely to use factor replacement than VWD to prevent bleeding symptoms. Patients with VWD were more likely than patients with HemA or Hem B to have a diagnosis prior to age 18; VWD had 16 of 43 (37%), HemA had 3 of 17 (18%) and HemB had 0 of 4 (0%). Conclusions: Female patients with inherited bleeding disorders have bleeding symptoms that may require the initiation of routine treatment to prevent bleeding and should be offered treatment with hemostatic agents to prevent bleeding when bleeding frequency exceeds more than 1 or 2 bleeds per year. Heavy menstrual bleeding, joint bleeding, joint pain, gastrointestinal and genitourinary bleeding are reported in this patient population as reasons to start prophylaxis with hemostatic agents. Further study is underway to assess the efficacy of starting prophylaxis in these patients. In the Author's experience, once factor replacement is started, patients are pleased with the change in their health status after initiation of treatment and continue to be compliant with treatment recommendations although they may have difficulty in administering those treatments. Patients with VWD were much more likely than those with HemA or HemB to require placement of a central venous access device. Further study into this observation is needed to understand why this is so.
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Keferstein, Rolf D., Cornelia Fiedler, Fritz W. Pelster, and Berthold Reers. "Infection Prophylaxis and Infection Control in Vascular Access Surgery." Vascular Surgery 26, no. 4 (1992): 300–306. http://dx.doi.org/10.1177/153857449202600408.
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Salman, Loay, and Arif Asif. "Antibiotic Prophylaxis: Is it Needed for Dialysis Access Procedures?" Seminars in Dialysis 22, no. 3 (2009): 297–99. http://dx.doi.org/10.1111/j.1525-139x.2009.00607.x.
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Fennell, Jérôme Patrick, Martin O'Donohoe, Martin Cormican, and Maureen Lynch. "Linezolid lock prophylaxis of central venous catheter infection." Journal of Medical Microbiology 57, no. 4 (2008): 534–35. http://dx.doi.org/10.1099/jmm.0.47665-0.
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Central venous catheter (CVC)-related infections are a major problem for patients requiring long-term venous access and may result in frequent hospital admissions and difficulties in maintaining central venous access. CVC-related blood stream infections are associated with increased duration of inpatient stay and cost approximately \#8364;13 585 per patient [Blot, S. I., Depuydt, P., Annemans, L., Benoit, D., Hoste, E., De Waele, J. J., Decruyenaere, J., Vogelaers, D., Colardyn, F. & Vandewoude, K. H. (2005). Clin Infect Dis 41, 1591–1598]. Antimicrobial lock therapy may prevent CVC-related blood stream infection, preserve central venous access and reduce hospital admissions. In this paper, the impact of linezolid lock prophylaxis in a patient with short bowel syndrome is described.
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McBride, Ali, Karen MacDonald, and Ivo Abraham. "Simulation Modeling of Cost-Savings from Conversion to Biosimilar Pegfilgrastim-Cbqv for the Prophylaxis of Chemotherapy-Induced Neutropenia, and Budget-Neutral Expanded Access to Prophylaxis and Anti-Neoplastic Therapy from Derived Cost-Savings in Non-Hodgkin Lymphoma." Blood 136, Supplement 1 (2020): 24–25. http://dx.doi.org/10.1182/blood-2020-136810.
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Introduction: Costs of prophylaxis of chemotherapy-induced (febrile) neutropenia (CIN/FN) have been reduced in recent years by the approval of several biosimilar filgrastim and pegfilgrastim agents. The savings from conversion to biosimilars can be reallocated to provide expanded access to CIN/FN prophylaxis or anti-neoplastic treatment. To illustrate this, we simulated in a panel of 20,000 non-Hodgkin lymphoma (NHL) patients: 1) the savings that could be realized from CIN/FN prophylaxis with biosimilar pegfilgrastim-cbqv over reference pegfilgrastim with or without on-body injector (PEG/PEG-OBI), 2) a model of expanded access to CIN/FN prophylaxis with biosimilar pegfilgrastim-cbqv from cost-savings achieved from conversion from PEG/PEG-OBI, and 3) a model of expanded access to chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab (R-CHOP) for NHL from cost-savings achieved from conversion from PEG/PEG-OBI. Methods: Simulation modeling for a panel of 20,000 NHL patients was conducted from the US payer perspective. Medication costs for PEG/PEG-OBI, pegfilgrastim-cbqv, and R-CHOP drugs were calculated in three ways 1) Q1 2020 average selling price (ASP) derived from CMS Q3 2020 reimbursement limits, 2) Wholesale Acquisition Cost (WAC) from Redbook, and 3) a blended ASP/WAC rate proportionate to the NHL age distribution per Surveillance, Epidemiology, and End Results Program data. These three cost estimate bases were applied to one through six cycles of prophylaxis with conversion rates from PEG/PEG-OBI to biosimilar pegfilgrastim-cbqv ranging from 10% to 100%. The number-needed-to-convert (NNC) to biosimilar pegfilgrastim-cbqv from PEG/PEG-OBI to purchase one additional treatment of pegfilgrastim-cbqv or one additional cycle of R-CHOP chemotherapy was also estimated. Results: Using ASP, cost-savings of biosimilar pegfilgrastim-cbqv over PEG/PEG-OBI in a panel of 20,000 NHL patients ranged from $371,444 (for 1 cycle of prophylaxis at 10% conversion) to $22,286,640 (6 cycles at 100% conversion). The corresponding savings ranged from $4,112,120 to $246,727,200 when using WAC; and from $1,976,194 to $118,571,640 when using the age-proportionate blended ASP/WAC rate. Focusing on the blended ASP/WAC rate, the savings in a single cycle of chemotherapy translated into expanded access to biosimilar pegfilgrastim-cbqv ranging from 524 cycles at 10% conversion from PEG/PEG-OBI to 5,243 cycles at 100% conversion. The savings over six cycles of biosimilar prophylaxis could provide between 3,146 (at 10% conversion) and 31,457 (at 100% conversion) additional cycles of biosimilar pegfilgrastim-cbqv. The NNC from one cycle of PEG/PEG-OBI to biosimilar pegfilgrastim-cbqv to purchase one additional cycle of biosimilar pegfilgrastim-cbqv is 4. In a single cycle of chemotherapy, savings using the blended ASP/WAC rate translated into expanded access to R-CHOP ranging from 282 cycles at 10% to 2,817 cycles at 100% conversion. The savings over six cycles of biosimilar prophylaxis could provide between 1,690 (at 10% conversion) and 16,900 cycles (at 100% conversion) additional cycles of R-CHOP. The NNC from one cycle of PEG/PEG-OBI to biosimilar pegfilgrastim-cbqv to purchase one additional cycle of R-CHOP is 8. Conclusions: These simulation models demonstrate that significant cost savings for supportive cancer care can be generated through conversion to biosimilar pegfilgrastim-cbqv for CIN/FN prophylaxis. The savings generated from conversion from PEG/PEG-OBI can be reallocated on a budget-neural basis to provide expanded access to additional patients/cycles of CIN/FN prophylaxis with biosimilar pegfilgrastim-cbqv or to curative anti-neoplastic treatment. Such efficiency and expanded access enhance the value of cancer care to payers and patients. Disclosures McBride: MorphoSys: Consultancy; Sandoz: Consultancy; Pfizer: Consultancy; Merck: Speakers Bureau; Coherus BioSciences: Consultancy, Speakers Bureau; Bristol-Myers Squibb: Consultancy. MacDonald:Sandoz: Consultancy; MorphoSys: Consultancy; Celgene: Consultancy; Terumo: Consultancy; Rockwell Medical: Consultancy; Janssen: Consultancy; Novartis: Consultancy; Mylan: Consultancy; Coherus BioSciences: Research Funding. Abraham:MorphoSys: Consultancy; Sandoz: Consultancy; Mylan: Consultancy; Janssen: Consultancy; Rockwell Medical: Consultancy; Terumo: Consultancy; Celgene: Consultancy; Coherus BioSciences: Research Funding, Speakers Bureau.
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Sadowski, Maciej. "The strategy of long-term central venous access infection prophylaxis." Zakażenia XXI wieku 2018, no. 5 (2018): 253–58. http://dx.doi.org/10.31350/zakazenia/2018/5/z2018039.
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Landers, Stewart, and Farzana Kapadia. "Preexposure Prophylaxis: Adapting HIV Prevention Models to Achieve Worldwide Access." American Journal of Public Health 107, no. 10 (2017): 1534–35. http://dx.doi.org/10.2105/ajph.2017.304035.
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Marcus, Julia L., and Douglas S. Krakower. "Working Toward Broad and Equitable Access to HIV Preexposure Prophylaxis." American Journal of Public Health 109, no. 9 (2019): 1160–61. http://dx.doi.org/10.2105/ajph.2019.305254.
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Wong, Keith Yiu Kei, and Jeffrey D. Klausner. "Geographic Access to Preexposure Prophylaxis and the Case for Telemedicine." American Journal of Public Health 110, no. 1 (2020): e3-e3. http://dx.doi.org/10.2105/ajph.2019.305401.
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Phillips, Andrew N., Euphemia Sibanda, Kenly Sikwese, et al. "Enabling timely HIV postexposure prophylaxis access in sub-Saharan Africa." AIDS 36, no. 10 (2022): 1473–75. http://dx.doi.org/10.1097/qad.0000000000003258.
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Choudhury, Devasmita. "HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Vascular Access Thrombosis Prophylaxis." Seminars in Dialysis 19, no. 4 (2006): 335–42. http://dx.doi.org/10.1111/j.1525-139x.2006.00182.x.
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Botwin, Kimberly J., Jeannie Chan, Richard Jacobs, and B. Joseph Guglielmo. "Restricted access to automated dispensing machines for surgical antimicrobial prophylaxis." American Journal of Health-System Pharmacy 58, no. 9 (2001): 797–99. http://dx.doi.org/10.1093/ajhp/58.9.797.
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Nogara, Bibiana Letícia, Jarbas da Silva Ziani, Mileny Rosalina Galvão, et al. "Sociodemographic profile of users and discontinuation rate of HIV pre-exposure Prophylaxis after the expansion of access." Revista Eletrônica Acervo Saúde 24, no. 12 (2024): e17866. https://doi.org/10.25248/reas.e17866.2024.
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Objective: To evaluate whether there was a change in the sociodemographic profile of users of Pre-exposure Prophylaxis (PrEP) for HIV and in the discontinuation/abandonment rate after the expansion of access to the entire population at increased risk of infection. Methods: This is a retrospective cross-sectional study conducted with 180 (Group 1) and 205 (Group 2) users who started PrEP before and after the expansion of access, respectively. Results: Both groups presented the same sociodemographic profile, characterized by men, cisgender, homosexual, white, aged between 18 and 24 years, with more than 12 years of education, residing in the central region, and belonging to the target population of homosexuals and other men who have sex with men. Comparing the groups, it was observed that after the expansion of access, users aged 40 to 49 adhered to prophylaxis more (p=0.025), as well as those with 4 to 7 years of education (p=0.037). There was a 6.8% increase in the discontinuation rate, exceeding 50% of users in Group 2. Conclusion: The same profile of PrEP users is observed before and after the expansion of access; however, older users and those with lower education levels are adhering more to prophylaxis. The discontinuity rate remains high.
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McBride, Ali, Karen MacDonald, and Ivo Abraham. "Cost efficiency and budget-neutral expanded access to antineoplastic therapy from cost-savings derived from conversion to biosimilar pegfilgrastim-cbqv for the prophylaxis of chemotherapy-induced (febrile) neutropenia (CIN/FN):Simulation modeling in metastatic pancreatic cancer." Journal of Clinical Oncology 39, no. 3_suppl (2021): 441. http://dx.doi.org/10.1200/jco.2021.39.3_suppl.441.
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441 Background: Biosimilars have contributed to the reduction in the cost of prophylaxis of CIN/FN in recent years. Savings generated from conversion to biosimilars could be reallocated on a budget-neutral basis to provide expanded access to additional prophylaxis or to anti-neoplastic treatment. To demonstrate this, we simulated: 1) the savings that could be realized from CIN/FN prophylaxis with biosimilar pegfilgrastim-cbqv (BIOSIM-PEG) over reference pegfilgrastim with or without on-body injector (PEG/PEG-OBI), 2) a model of expanded access to BIOSIM-PEG from cost-savings achieved from conversion from PEG/PEG-OBI, 3) a model of expanded access to chemotherapy with oxaliplatin, leucovorin, irinotecan, and fluorouracil (FOLFIRINOX) for metastatic pancreatic cancer (mPC), 4) the number-needed-to-convert (NNC) to BIOSIM-PEG to purchase one additional treatment of BIOSIM-PEG, and 5) the NNC to purchase one cycle of FOLFIRINOX. Methods: This simulation modeling from the US payer perspective utilized: 1) a blended rate of average selling price (ASP; derived from CMS Q4 2020 reimbursement) and wholesale acquisition cost (WAC; Redbook) for PEG/PEG-OBI, BIOSIM-PEG, and all FOLFIRINOX agents proportionate to the estimated 2020 incident pancreatic cancer age distribution per Surveillance, Epidemiology, and End Results Program (67.6% Medicare-insured patients ≥65 years of age; 32.4% commercially insured patients <65 years); 2) between one and twelve cycles of prophylaxis in a panel of 2,500 mPC patients treated with FOLFIRINOX; and 3) conversion rates from PEG/PEG-OBI to BIOSIM-PEG ranging from 10%—100%. Results: Using a current blended ASP/WAC rate, cost-savings of BIOSIM-PEG over PEG/PEG-OBI in a panel of 2,500 mPC patients range from $188,780 (for 1 cycle of prophylaxis at 10% conversion) to $22,653,609 (12 cycles at 100%). In a single cycle of chemotherapy, these savings translate into expanded access to additional BIOSIM-PEG prophylaxis ranging from 53 cycles at 10% conversion from PEG/PEG-OBI to 528 cycles at 100% or to between 321 to 3,214 cycles of FOLFIRINOX, respectively. The savings over twelve cycles could provide up to 6,330 additional cycles of BIOSIM-PEG or 38,571 cycles of FOLFIRINOX (at 100% conversion). The NNC from PEG/PEG-OBI to purchase one additional cycle of BIOSIM-PEG is 4.74; the NNC to purchase once cycle of FOLFIRINOX is 0.78. Conclusions: These simulated models demonstrate the magnitude of the cost savings for CIN/FN prophylaxis that can be generated by conversion to biosimilar pegfilgrastim-cbqv. Further, these savings could be reallocated to provide access to anti-neoplastic treatment on a budget-neutral basis, thus enhancing the value of cancer care to both payers and patients.
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McBride, Ali, Karen MacDonald, and Ivo Abraham. "Simulation modeling of cost-savings from conversion of pegfilgrastim to biosimilar pegfilgrastim-cbqv for the prophylaxis of chemotherapy-induced (febrile) neutropenia (CIN/FN) and expanded access to biosimilar prophylaxis." Journal of Clinical Oncology 38, no. 15_suppl (2020): e19372-e19372. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19372.
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e19372 Background: Biosimilars have the potential to reduce the cost of prophylaxis of CIN/FN. To demonstrate this, we: 1) conducted a US comparative cost-efficiency analysis of CIN/FN prophylaxis with biosimilar pegfilgrastim-cbqv over reference pegfilgrastim without or with on-body injector (PEG/PEG-OBI), 2) modeled budget-neutral expanded access to biosimilar pegfilgrastim-cbqv from cost-savings achieved from conversion from PEG/PEG-OBI, and 3) estimated the number-needed-to-convert (NNC) to biosimilar pegfilgrastim-cbqv from PEG/PEG-OBI to purchase one additional treatment of biosimilar pegfilgrastim-cbqv. Methods: Simulation modeling from the US payer perspective utilizing: average selling price (ASP) derived from CMS Q1 2020 reimbursement limits for PEG/PEG-OBI and pegfilgrastim-cbqv;between one and six cycles of prophylaxis in a panel of 20,000 cancer patients at risk for CIN/FN; and conversion rates from PEG/PEG-OBI to biosimilar pegfilgrastim-cbqv ranging from 10% to 100% in this panel. Results: Using current ASP, cost-savings per patient of biosimilar pegfilgrastim-cbqv over PEG/PEG-OBI ranged from $223 (for 1 cycle) to $1,335 (6 cycles). In a panel of 20,000 cancer patients, the savings range from $445,163 (for one cycle of prophylaxis at 10% conversion) to $26,709,788 (6 cycles at 100% conversion). In a single cycle of chemotherapy, these savings translate into expanded access to prophylaxis with biosimilar pegfilgrastim-cbqv ranging from 115 doses at 10% conversion from PEG/PEG-OBI to 1,154 doses at 100% conversion. The savings over six cycles of chemotherapy could provide between 692 additional doses of biosimilar pegfilgrastim-cbqv prophylaxis (at 10% conversion) to 6,921 doses (at 100% conversion). The NNC from PEG/PEG-OBI to purchase one additional dose of biosimilar pegfilgrastim-cbqv is 18. Conclusions: These models demonstrate that CIN/FN prophylaxis with biosimilar pegfilgrastim-cbqv can generate significant cost savings that could be reallocated on a budget-neutral basis to provide more patients and/or more cycles with CIN/FN prophylaxis.
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Olifant, Lerato L., Edith Phalane, and Refilwe N. Phaswana-Mafuya. "Innovative pre-exposure prophylaxis interventions among adolescent girls and young women during COVID-19 lockdown period in sub-Saharan Africa: A systematic review." African Journal of Reproductive Health 28, no. 9 (2024): 191–213. http://dx.doi.org/10.29063/ajrh2024/v28i9.18.
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Adolescent girls and young women are key, and priority populations impacted by a higher risk of acquiring human immunodeficiency virus. In 2015, pre-exposure prophylaxis was introduced as a biomedical human immunodeficiency virus prevention tool. However, its uptake continues to be lower in sub-Saharan countries, particularly among adolescent girls and young women. The uptake may have worsened during the Coronavirus disease 2019 lockdown restrictions. Innovative interventions to improve its uptake were implemented, this review aimed to identify and describe these interventions in sub-Saharan Africa. We searched four electronic databases (PubMed, Scopus, Google Scholar, and MEDLINE) between 01 April 2019 and 30 April 2024 and 1212 articles were identified. Of these 287 full-text articles were assessed and ultimately, 14 articles were included since they reported on the pre-exposure prophylaxis interventions implemented before and during the lockdown period among adolescent girls and young women. Innovative interventions like using social media platforms and decentralizing pre-exposure prophylaxis through community delivery were identified across Sub-Saharan African countries. Irrespective of the challenges in implementing these interventions, improvements in pre-exposure prophylaxis uptake and adherence were observed. These interventions can potentially improve access to traditionally hard-to-reach individuals and address structural barriers to better access human immunodeficiency virus prevention service delivery.
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Agada, Simon J,. "Barriers to Uptake of Oral Pre-exposure Prophylaxis for HIV among Adolescents’ Young boys and Girls an Assessment of Cross River North Nigeria." TEXILA INTERNATIONAL JOURNAL OF PUBLIC HEALTH 11, no. 2 (2023): 281–90. http://dx.doi.org/10.21522/tijph.2013.11.02.art026.
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Antiretroviral pre-exposure prevention (PrEP) to stop HIV transmission was 1st approved by the USA Food and Drug Administration in 2012. Despite correlations of decreases in new HIV infections being greatest wherever PrE-exposure prophylaxis has been deployed, the uptake of PrE-exposure prophylaxis is insulant, significantly among populations with disproportionate HIV burden. This narrative review seeks to spot individual and general barriers to PrE-exposure prophylaxis usage in African country. A comprehensive search of recent literature uncovered a fancy array of structural, social, clinical, and behavioral barriers, as well as knowledge/awareness of PrE exposure prophylaxis, perception of HIV risk, stigma from care suppliers or family/partners/friends, distrust of care providers/systems, access to school assignment, prices of PrE exposure prophylaxis, and issues around school assignment facet effects/medication interactions. significantly, these barriers might have totally different effects on specific populations in danger. The complete potential of PrE-exposure prophylaxis for HIV interference won't be realized till these problems area unit self-addressed. Ways to realize this goal ought to embody academic interventions, innovative approaches to delivery of HIV care, resource, and DE stigmatization of PrE-exposure prophylaxis and PrE-exposure prophylaxis users. Until then, PrE-exposure prophylaxis `uptake can still be suboptimal, significantly among people who would like it most. Results: Stigma influences uptake of pre-exposure prophylaxis; HIV risk perception does not affect uptake of pre-exposure prophylaxis; and a significant negative relationship between stigma and pre-exposure prophylaxis uptake. Conclusion: This study was conducted to investigate barriers to oral pre-exposure prophylaxis. Significant findings of the study conclude: stigma influences uptake of oral pre-exposure prophylaxis for HIV. Keywords: Acquired immunodeficiency syndromes, Barriers, Adolescents, Human immunodeficiency virus, Human immunodeficiency virus testing, Young Boys, Young Girls, Pre-exposure Prophylaxis.
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McBride, Ali, Karen MacDonald, and Ivo Abraham. "Simulation modeling of budget-neutral expanded access to antineoplastic therapy from cost-savings derived from conversion to biosimilar pegfilgrastim-cbqv for the prophylaxis of chemotherapy-induced (febrile) neutropenia (CIN/FN) in early-stage breast cancer." Journal of Clinical Oncology 38, no. 15_suppl (2020): e19371-e19371. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19371.
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e19371 Background: Biosimilars not only have the potential to reduce the cost of prophylaxis of CIN/FN but such savings could be reallocated to provide access to anti-neoplastic treatment. To demonstrate this, we simulated in a 20,000-patient panel: 1) the savings that could be realized from CIN/FN prophylaxis with biosimilar pegfilgrastim-cbqv over reference pegfilgrastim with or without on-body injector (PEG/PEG-OBI), 2) a model of expanded access to adjuvant chemotherapy with doxorubicin/cyclophosphamide for localized breast cancer from cost-savings achieved from conversion from PEG/PEG-OBI, and 3) the number-needed-to-convert (NNC) to biosimilar pegfilgrastim-cbqv from PEG/PEG-OBI to purchase one additional treatment of doxorubicin/cyclophosphamide chemotherapy. Methods: Simulation modeling from the US payer perspective utilizing:average selling price (ASP) derived from CMS Q1 2020 reimbursement limits for PEG/PEG-OBI, pegfilgrastim-cbqv, doxorubicin and cyclophosphamide;between one and six cycles of prophylaxis in a panel of 20,000 cancer patients at risk for CIN/FN; and conversion rates from PEG/PEG-OBI to biosimilar pegfilgrastim-cbqv ranging from 10% to 100%. Results: Using current ASP, cost-savings of biosimilar pegfilgrastim-cbqv over PEG/PEG-OBI in a panel of 20,000 breast cancer patients range from $445,163 (for one cycle of prophylaxis at 10% conversion) to $26,709,788 (6 cycles at 100% conversion). In a single cycle of chemotherapy, these savings translate into expanded access to doxorubicin/cyclophosphamide ranging from 1,286 cycles at 10% conversion from PEG/PEG-OBI to 12,861 cycles at 100% conversion. The savings over six cycles could provide between 7,717 additional cycles of doxorubicin/cyclophosphamide (at 10% conversion) to 77,166 cycles (at 100% conversion). The NNC from PEG/PEG-OBI to purchase one additional cycle of doxorubicin/cyclophosphamide is 2. Conclusions: These models demonstrate that CIN/FN prophylaxis with biosimilar pegfilgrastim-cbqv can generate significant cost savings for supportive cancer care. Further, these savings could be reallocated to provide access to curative anti-neoplastic treatment on a budget-neutral basis, thus enhancing the value of cancer care to both payers and patients.
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Gandhi, Monica. "Long-acting ART and preexposure prophylaxis: profound promise but stunted access." Current Opinion in HIV and AIDS 20, no. 1 (2024): 1–3. https://doi.org/10.1097/coh.0000000000000902.
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Zibari, Gazi B., Merit F. Gadallah, Michael Landreneau, et al. "Preoperative vancomycin prophylaxis decreases incidence of postoperative hemodialysis vascular access infections." American Journal of Kidney Diseases 30, no. 3 (1997): 343–48. http://dx.doi.org/10.1016/s0272-6386(97)90277-8.
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Mir, Joan Francesc, Manuel F. Mazarío, and Pep Coll. "Implementation models and access to HIV pre-exposure prophylaxis in Spain." Enfermedades infecciosas y microbiologia clinica (English ed.) 38, no. 5 (2020): 234–37. http://dx.doi.org/10.1016/j.eimce.2019.05.012.
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Krakower, Douglas, and Julia L. Marcus. "Free the PrEP — Over-the-Counter Access to HIV Preexposure Prophylaxis." New England Journal of Medicine 389, no. 6 (2023): 481–83. http://dx.doi.org/10.1056/nejmp2305644.
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Brundrett, Megan E. "Human Immunodeficiency Virus Preexposure Prophylaxis in Adolescents and Young Adults." Pediatrics In Review 43, no. 1 (2022): 28–36. http://dx.doi.org/10.1542/pir.2020-002048.
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Human immunodeficiency virus (HIV) prevention holds the promise of decreasing the burden of HIV infections worldwide. Access to HIV prevention services, including preexposure prophylaxis (PrEP), is a key strategy in reducing HIV transmission, but it continues to be underused. PrEP, a once-daily medication for HIV prevention, is approved for adolescents. A pediatrician’s role is critical in identifying and increasing access for adolescents and young adults to PrEP services and reducing HIV acquisition in youth.
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Solano, M. H., A. Linares, C. Sossa, et al. "Secondary prophylaxis with anti-inhibitor coagulant complex (AICC) : from anecdote to reality." Revista Colombiana de Hematología y Oncología 4, no. 2 (2017): 37. http://dx.doi.org/10.51643/22562915.231.
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Background. Evidence of prophylaxis benefit in patients without inhibitors to reduce hemarthrosis and severe bleeding have not been demonstrate in patients with hemophilia A (HA) and inhibitors, however, we could assume the reduction in bleeding episodes. Several publications have shown good results of secondary prophylaxis with AICC agents to reduce safely the number of bleeding events. We report the results in hemophilia treatment centers of two cities in a developing country, with access difficulties related to the high cost of this therapy to the health system. Objective. To describe the frequency of hemarthrosis and other bleeding episodes in patients with HA and inhibitors under AICC (Feiba®) prophylaxis.
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West, Victoria. "Use of arteriovenous fistula in children with bleeding disorders." Journal of Haemophilia Practice 3, no. 2 (2016): 74–77. http://dx.doi.org/10.17225/jhp00087.
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Abstract Haemophilia and associated bleeding disorders are chronic conditions that require easy, accessible, and reliable venous access for treatment. Peripheral venous access is traditionally the first option considered for prophylaxis. The initial introduction of prophylaxis to a child is during the first two years of life, and peripheral access can be problematic. Central venous catheters (CVC), for example port-a-caths, are widely used among this group; however, these devices require surgical insertion and are not without their own complications. Data were collected on venous access methods used at the paediatric centre at the Evelina London Children’s Hospital, where 242 children are registered at the comprehensive care centre, 48 of whom have a severe bleeding disorder. Of these 48, 27 have a CVC currently (PICC n=1, Port-a-Cath n=25, Hickman line n=1) and 3 have an arteriovenous fistula (AVF). Patient 1 is a 12 year-old boy with severe haemophilia A and an intracranial haemorrhage at the age of 9 months. He remains on prophylaxis and had an AVF created 5 years ago following repeated port-a-cath infections and poor venous access. Patient 2 is a 7 year-old boy with severe haemophilia B and an inhibitor, who has also had repeated port-a-cath infections. An AVF was constructed 2 years ago. Patient 3 is a 12 year-old girl with type III von Willebrand disease and an inhibitor. Due to need for regular factor treatment in the context of poor venous access, an AVF was formed. We have had a 100% success rate with all three AVFs at a follow-up period of 8-69 months. Our experience suggests AVF is a viable option of venous access in patients with haemophilia and other bleeding disorders, especially so for children with repeated CVC infections or poor peripheral venous access. However, this is not a straightforward option and further evidence on long-term use based on multicentre research will be beneficial in managing AVF in this group of patients.
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Windyga, Jerzy. "Is Continuous Low-Dose Prophylaxis Superior to On-Demand Treatment for Patients with Hemophilia?" Seminars in Thrombosis and Hemostasis 42, no. 05 (2016): 533–40. http://dx.doi.org/10.1055/s-0036-1579639.
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Long-term (or continuous) prophylaxis is generally accepted as the best form of treatment for patients with severe hemophilia A and B. Results of recent prospective, randomized clinical trials, as well as observational studies performed in the last decades, have provided strong and convincing evidence that continuous prophylaxis leads to reduction in the number of bleeding episodes, better joint status and improved health-related quality of life as compared with on-demand (or episodic) treatment. Nevertheless, many questions regarding long-term prophylaxis still remain open, for instance: when should prophylaxis be started (before or after the first joint bleeding), what is the optimal dosage to replace the missing factor, when should discontinuation of long-term prophylaxis be considered, what is the best way to measure the outcome of prophylaxis, etc. Moreover, there are numerous obstacles to widespread use of prophylactic therapy. The most challenging seem to be adequate venous access (particularly in younger patients) and patients' adherence. The crucial barrier to long-term prophylaxis is, however, the remarkably high cost of clotting factor concentrates. For most countries high-dose or intermediate-dose prophylaxis regimens are not affordable due to lack of economic resources. So, is continuous prophylaxis reserved exclusively for wealthy societies? Fortunately, there is an increasing body of evidence to suggest that low-dose prophylaxis offers significant benefits over on-demand treatment with comparable amounts of factor concentrate (and much lower amounts if compared with intermediate or high-dose prophylaxis regimens). The aim of this article is to discuss the clinical and economical aspects of continuous prophylaxis in hemophilia with emphasis on the low-dose regimens.
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Pokharel, Prenit Kumar, and Shrijana Chapagain. "Awareness among the Dental students and Dental Interns of Kantipur Dental College and Hospital regarding Antibiotics Prophylaxis for Infective Endocarditis." Journal of College of Medical Sciences-Nepal 15, no. 2 (2019): 112–18. http://dx.doi.org/10.3126/jcmsn.v15i2.22162.
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Background: Infective Endocarditis is relatively a rare disease and is believed to be caused by the vegetative growth on the previously damaged or congenitally malformed cardiac valves or endocardium. Several factors determines that the dentist practicing prophylaxis measures, the foremost important one is the knowledge which is taught to them during dental school, which is the main reason to conduct this study to test the awareness among the dental students of Kantipur Dental College and Hospital, Kathmandu regarding the prophylaxis guideline awareness.
 Methods: BDS Third, Fourth, Fifth year students and Dental Interns of Kantipur Dental College and Hospital were asked to fill the self-answered questionnaires. The questions were divided into two parts each part containing ten questions each. The first part was to access the knowledge of participants regarding the cardiac conditions that require antibiotics prophylaxis, the second part was to access the knowledge of participants regarding the dental procedures that requires antibiotics prophylaxis.
 Results: Thirty two percentage of our participants responded that forceps extraction does not require antibiotics prophylaxis which is not true as per AHA guideline, so the participants should be taught regarding the risk of forceps extraction leading to infective endocarditis if the prophylaxis is not administered. We postulated that majority of the Dental Students and Interns have heard about AHA 2007 guideline and will follow it when necessary.
 Conclusions: The participants who are the Dental Students and Dental Interns in a Dental School at Kathmandu, Nepal will be practicing Dentistry in near future, the knowledge they acquire during their learning period will help them to prevent the Infective endocarditis among the risk population whom they will be treating in near future. Measures should be taken to prevent the incidence of Infective Endocarditis with dental origin.
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Kabami, Jane, Catherine A. Koss, Helen Sunday, et al. "Randomized Trial of Dynamic Choice HIV Prevention at Antenatal and Postnatal Care Clinics in Rural Uganda and Kenya." JAIDS Journal of Acquired Immune Deficiency Syndromes 95, no. 5 (2024): 447–55. http://dx.doi.org/10.1097/qai.0000000000003383.
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Background: Pregnant and postpartum women in Sub-Saharan Africa are at high risk of HIV acquisition. We evaluated a person-centered dynamic choice intervention for HIV prevention (DCP) among women attending antenatal and postnatal care. Setting: Rural Kenya and Uganda. Methods: Women (aged 15 years or older) at risk of HIV acquisition seen at antenatal and postnatal care clinics were individually randomized to DCP vs. standard of care (SEARCH; NCT04810650). The DCP intervention included structured client choice of product (daily oral pre-exposure prophylaxis or postexposure prophylaxis), service location (clinic or out of facility), and HIV testing modality (self-test or provider-administered), with option to switch over time and person-centered care (phone access to clinician, structured barrier assessment and counseling, and provider training). The primary outcome was biomedical prevention coverage—proportion of 48-week follow-up with self-reported pre-exposure prophylaxis or postexposure prophylaxis use, compared between arms using targeted maximum likelihood estimation. Results: Between April and July 2021, we enrolled 400 women (203 intervention and 197 control); 38% were pregnant, 52% were aged 15–24 years, and 94% reported no pre-exposure prophylaxis or postexposure prophylaxis use for ≥6 months before baseline. Among 384/400 participants (96%) with outcome ascertained, DCP increased biomedical prevention coverage 40% (95% CI: 34% to 47%; P < 0.001); the coverage was 70% in intervention vs. 29% in control. DCP also increased coverage during months at risk of HIV (81% in intervention, 43% in control; 38% absolute increase; 95% CI: 31% to 45%; P < 0.001). Conclusion: A person-centered dynamic choice intervention that provided flexibility in product, testing, and service location more than doubled biomedical HIV prevention coverage in a high-risk population already routinely offered access to biomedical prevention options.
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Mahlangu, J., F. Bassa, M. Bassingthwaighte, et al. "Prophylaxis is the new standard of care in patients with haemophilia." South African Medical Journal 112, no. 6 (2022): 405–8. http://dx.doi.org/10.7196/samj.2022.v112i6.16362.
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Randomised controlled clinical trial evidence on prophylaxis as optimal care for patients with haemophilia was generated more than a decade ago. However, this knowledge has not translated into clinical practice in South Africa (SA) owing to many barriers to prophylaxis. These include the high treatment burden imposed by prophylaxis (frequent injections two to four times a week), the need for intravenous access to administer replacement clotting factor therapies, and the higher volume of clotting factor required compared with episodic treatment. The recently introduced non-factor therapies in haemophilia care have addressed many of these barriers. For example, emicizumab, which is currently the only globally approved non-factor therapy, can be administered subcutaneously less frequently (weekly, fortnightly or every 4 weeks) and has led to global adoption of prophylaxis as the standard of care in haemophilia by the bleeding disorders community. Haemophilia A is the most prevalent clotting factor deficiency in SA, with >2 000 people diagnosed to date. However, only a few of these patients are currently on prophylaxis. In this ‘In Practice’ article, we review the rationale for prophylaxis, outline its goals and benefits, and provide evidence-based guidance on which haemophilia patients should be prioritised for emicizumab prophylaxis. This consensus guidance facilitates the adoption of prophylaxis as a national policy and the new standard of care in haemophilia in SA.
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Oredo, Pascal O., Harun M. Kimani, and Judy Mugo. "Access to reproductive health services by female survivors of sexual gender-based violence: a descriptive cross-sectional study of Nairobi City County, Kenya." International Journal Of Community Medicine And Public Health 11, no. 9 (2024): 3348–54. http://dx.doi.org/10.18203/2394-6040.ijcmph20242530.
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Background: Sixty percent of women globally are exposed to reproductive health problems related to sexual gender-based violence. In Kenya, sexual violence is one of the top 10 risk factors for disease burden. The study aimed to determine access to reproductive health services by female survivors of sexual gender-based violence in Nairobi city county, Kenya. Methods: The study adopted descriptive cross-sectional design using pretested questionnaires. Study population was 269 female survivors of sexual gender-based violence. Data was analysed thematically and presented by use of percentages and frequencies distribution tables. Binary logistic regression model was used to determine relationships between dependent and independent variables. Odds ratios were evaluated for significance by considering the 95% confidence interval at p value ≤0.05. Results: Access to reproductive health services by female survivors of sexual gender-based violence was 26%. Service availability for survivors in the facilities had a 3 times likelihood of access sexual, knowledge on failure to seek immediate medical attention had 4 times likelihood to increase access while awareness of the period to have prophylaxis had 4.66 times likelihood to increase access. Services provided to survivor had 39% likelihood to increase access, survivors screened for sexually transmitted disease before admission had 10% more likelihood to access and survivors who received post exposure prophylaxis had 0.62 times likelihood of access to sexual reproductive health services. Conclusions: Availability of comprehensive sexual reproductive health services at the facility and good knowledge would increase access to reproductive health services.
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Sutarsa, I. Nyoman. "Where do we go with HIV pre-exposure prophylaxis in Indonesia?" Public Health and Preventive Medicine Archive 5, no. 2 (2017): 77. http://dx.doi.org/10.15562/phpma.v5i2.17.
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Mantled by discrimination and exclusion, HIV/AIDS became a major epidemic of present-day globalization. Access to antiretroviral therapy (ART) and numerous preventative measures have resulted in reduced mortality and morbidity rates.1 However, the burden of disease associated with HIV infection remains tremendous. Total number of people living with HIV in 2016 were 36.7 million. PrEP is an effective additional prevention strategy at trial settings. Decision to adopt PrEP as a public health intervention must be made based on the need and capacity of current systems. Instead of allocating substantial resources for PrEP, the limited resources could be wisely allocated to scale-up the existing prevention strategies including access to ART, as well as to ensure equality of access of people to full-range of HIV prevention and treatment measures.
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Takahashi, Daijiro, Tomohiko Nakamura, Reiko Shigematsu, et al. "Fosfluconazole for Antifungal Prophylaxis in Very Low Birth Weight Infants." International Journal of Pediatrics 2009 (2009): 1–3. http://dx.doi.org/10.1155/2009/274768.
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We conducted a retrospective case series study to evaluate the safety of fosfluconazole prophylaxis for preventing invasive fungal infection in VLBW infants with a central vascular access. Fosfluconazole was administered intravenously at a dose of 6 mg/kg everyday during which time a central venous catheter was placed. A total of 23 infants met the criteria for enrollment in our study. No cases of fungal infection were detected during the central venous catheter placement in the group. None of the infants had an elevatedβ-D-glucan, and all of them were still alive at discharge. Regarding the liver and renal function, no statistically significant differences were observed before and at the end of fosfluconazole prophylaxis. The results of this study demonstrate that fosfluconazole prophylaxis in preventing invasive fungal infection was well tolerated by VLBW infants. This is a first report to describe antifungal prophylaxis using fosfluconazole for VLBW infants.
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Sutarsa, I. Nyoman. "Where do we go with HIV pre-exposure prophylaxis in Indonesia?" Public Health and Preventive Medicine Archive 5, no. 2 (2017): 77–78. http://dx.doi.org/10.53638/phpma.2017.v5.i2.p01.
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PrEP is an effective additional prevention strategy at trial settings. Decision to adopt PrEP as a public health intervention must be made based on the need and capacity of current systems. Instead of allocating substantial resources for PrEP, the limited resources could be wisely allocated to scale-up the existing prevention strategies including access to ART, as well as to ensure equality of access of people to full-range of HIV prevention and treatment measures.
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Paul, Lincy, Vijayakumar Narayana Pillai, Rema Ganapathy, et al. "Comparison of Improvement in Hemophilia Care in Children over a Decade and Outcomes - a Retrospective Study from Southern Part of India." Blood 144, Supplement 1 (2024): 5484. https://doi.org/10.1182/blood-2024-212030.
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Background: Hemophilia, an X-linked recessive bleeding disorder, presents significant challenges in management but can be mitigated with appropriate clotting factor replacement therapy. Resource limited settings across the world face unique challenges in implementing prophylaxis as the standard of care. The objective of this study is to assess the improvement in prophylaxis and comprehensive care of children with Hemophilia(CwH) attached to a newly established Hemophilia Treatment Center (HTC) in India during the last decade. Methodology: Study was retrospective from January 2015 to June 2024. The HTC started functioning in a Government District Hospital in 2014. It had access to an accredited blood center. A coagulation laboratory doing factor and Bethesda assays was established and accredited. Educational sessions were conducted for patients , caregivers and healthcare workers. Fortnightly comprehensive care clinics were conducted with Hematologist , Paediatrician, Physiatrist , Physiotherapist and Laboratory Technologist. Cost of treatment was borne by local self-government and state. All patients &lt;18 years with Hemophilia A and B registered in the center were included for analysis . Those staying near the center (&lt; 50 km) were evaluated for access to prophylaxis. Clotting factor concentrate(CFC) are plasma-derived or recombinant CFCs and it provides convenient high doses of clotting factor for the treatment and prevention of bleeds. Standard half life CFCs need frequent venipunctures for prophylaxis as it has short half life when compared to Extended half life CFCs. Emicizumab is a chimeric bispecific antibody directed against the enzyme activated Factor IX and the zymogen FX that mimics the co-factor function of Factor VIII in patients with hemophilia A, with or without inhibitors. Proportion of adults and children on prophylaxis , age at initiation of prophylaxis , Annual bleed rates (ABR), Functional Independence Score in Hemophilia(FISH), Hemophilia Joint Health Score(HJHS) and Prevalence of inhibitors were measured. Patients on prophylaxis were regularly reviewed and treatment changes made to keep annual bleed rates 0-3. Outcomes of 2024 were compared against 2015. We used longitudinal mixed effects Poisson regression with a random intercept for patients and a fixed effect for time to model trends in the bleeding rate. Quantitative patient characteristics are summarised by means and standard deviations and categorical patient characteristics are summarized by frequencies and percentages. p values &lt;0.05 is considered as statistically significant. Analysis were performed in R version 4.4.1. Results: Patients with Hemophilia(PwH) resgistered in the HTC were 441 in 2015 and increased to 874 in 2024, out of which 734(84%) had Hemophilia A(HA) ; 726(83.1%) had severe disease. Children with Hemophilia (CwH)in 2024 was 281(38.7%) against 128(38.3%) in 2015. CwH living in close proximity and eligible for prophylaxis from center were 37. No CwH were on prophylaxis in January 2015 and 32(86.5%) CwH received Prophylaxis in 2024. CFC use was 1894 IU/kg/year/person and 46.57 mg/kg/year/person for Emicizumab. ABR of 1.13(p=0.006) in 2024 vs 11 in 2015 and over the years, ABR has decreased significantly by a rate ratio of 0.8(95% CI: 0.76-0.85, p &lt;0.001).The mean HJHS score was 1.43 (SD 2.06). There was a significant decrease in the average HJHS score per year by 0.84(95% CI: 0.71 - 1, p= 0.05). The mean FISH score was 31.7(SD 1.09) and FISH score did not change significantly over the years(p=0.83). Proportion of adults receiving prophylaxis were 7(12.7%). Conclusion: The establishment of HTC and its comprehensive approach, including prophylaxis, education, and financial support, has substantially improved the care of CwH in a resource-limited setting. Increased prophylaxis coverage, reduced ABR, improved HJHS and maintained FISH scores reflect improvement in care. Enhanced access to newer treatments like Emicizumab reflect significant progress in patient management and outcomes over the past decade. Limitations are retrospective, single center study.
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McBride, Ali, Karen MacDonald, and Ivo Abraham. "Conversion to Biosimilar Pegfilgrastim-Jmdb from Pegfilgrastim with on-Body Injector Device in Diffuse Large B-Cell Lymphoma: Simulation Modeling of Cost-Savings and Budget-Neutral Expanded Access to Prophylaxis and Anti-Neoplastic Therapy Considering Device Failure Rate." Blood 136, Supplement 1 (2020): 22. http://dx.doi.org/10.1182/blood-2020-142749.
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Introduction: Approvals of biosimilar pegfilgrastim products in recent years have reduced the costs of single-dose prophylaxis of chemotherapy-induced (febrile) neutropenia (CIN/FN). While reference pegfilgrastim with on-body injector (PEG-OBI) offers convenience to patients over use of next day pre-filled syringe (PFS), PEG-OBI has a reported failure rate of 1.7-6.9% that predisposes patients to increased risk of CIN/FN episodes. Incremental FN-related hospitalizations (FN-HOSP) associated with PEG-OBI failure contribute to the cost differential between PEG-OBI and assured prophylaxis with biosimilar PEG-PFS. Cost savings generated from conversion to biosimilar PEG-jmdb create opportunities for providing expanded access on a budget-neutral basis to additional CIN/FN prophylaxis or anti-neoplastic treatment. Hence, in a panel of 15,000 patients with diffuse large B-cell lymphoma (DLBCL), we aimed to: 1) quantify the cost-savings from assured prophylaxis with biosimilar PEG-jmdb over PEG-OBI accounting for device failures, 2) simulate the additional CIN/FN prophylaxis that could be achieved from the cost-savings, and 3) model the expanded access to anti-neoplastic treatment with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) that could be provided on a budget-neutral basis through reallocation of cost-savings. Methods: Simulation analysis in a panel of 15,000 DLBCL patients at risk for CIN/FN from the US payer perspective utilized. Costs of medication were based on Q1 2020 average selling price (ASP) for PEG-OBI, PEG-jmdb, and R-CHOP drugs derived from CMS Q3 2020 reimbursement limits; cost of PEG-OBI and PEG-jmdb administration per CMS Outpatient Prospective Payment System; between one and six cycles of prophylaxis; conversion rates from PEG-OBI to biosimilar PEG-jmdb ranging from 10% to 100%; and PEG-OBI failure rates of 1% to 7%. Differential base rate of FN-HOSP in NHL (rate of FN-HOSP without colony-stimulating factor [CSF] minus rate with CSF) was 10.03% over a 6-cycle regimen with 56% occurring in cycle 1 (Chrischilles et al., Cancer Control 2002; 13.25% with CSF, 23.28% without). FN-HOSP costs in 2012 of $25,676 per episode for NHL patients (Tai, J Oncol Pract 2017) were adjusted per the Consumer Price Index for Medical Care to $31,914 for 2020. Results: Conversion from PEG-OBI to biosimilar PEG-jmdb in a panel of 15,000 DLBCL patients generated savings ranging from $379,230 (for one cycle of prophylaxis at 10% conversion) to $22,753,800 (6 cycles at 100%) considering the cost of medication plus administration. These cost-savings could provide access to between 110 (1 cycle at 10% conversion) and 6,623 (6 cycles at 100%) additional cycles of PEG-jmdb on a budget-neutral basis, or between 58 and 3,452 cycles of R-CHOP, respectively. Taking incremental FN-HOSP costs due to PEG-OBI failure into consideration, cost-savings in cycle one from conversion to PEG-jmdb, ranged from $406,118 (at 10% conversion and PEG-OBI failure of 1%) to $5,674,454 (at 100% conversion and 7% PEG-OBI failure). These savings translated into expanded access to between 118 additional cycles of PEG-jmdb or 62 cycles of R-CHOP (at 10% conversion and 1% PEG-OBI failure) and 1,652 cycles of PEG-jmdb or 861 cycles of R-CHOP (at 100% conversion and 7% PEG-OBI failure). Over a 6-cycle regimen, savings increase to $2,323,394 (at 10% conversion and 1% PEG-OBI failure) to $26,114,789 (at 100% conversion and 7% PEG-OBI failure). These additional savings increased expanded access to PEG-jmdb to between 676 additional cycles of PEG-jmdb or 353 cycles of R-CHOP (at 10% conversion and 1% PEG-OBI failure) and 7,601 cycles of PEG-jmdb or 3,962 cycles of R-CHOP (at 100% conversion and 7% PEG-OBI failure). Conclusions: CIN/FN prophylaxis with biosimilar PEG-jmdb generates substantial cost savings compared to PEG-OBI when considering drug and administration costs. Savings further increase when the costs of FN-HOSP related to PEG-OBI failure are taken into account. Reallocation of savings realized through conversion to biosimilar pegfilgrastim-jmdb provide expanded access to additional CIN/FN prophylaxis and anti-neoplastic treatment on a budget-neutral basis while reducing risk and associated hospitalization costs associated with inadequate prophylaxis due to device failure. Disclosures McBride: Coherus BioSciences: Consultancy, Speakers Bureau; Merck: Speakers Bureau; Pfizer: Consultancy; Sandoz: Consultancy; MorphoSys: Consultancy; Bristol-Myers Squibb: Consultancy. MacDonald:Sandoz: Consultancy; Coherus BioSciences: Research Funding; Mylan: Consultancy; Novartis: Consultancy; Janssen: Consultancy; Rockwell Medical: Consultancy; Terumo: Consultancy; Celgene: Consultancy; MorphoSys: Consultancy. Abraham:Sandoz: Consultancy; Mylan: Consultancy; Janssen: Consultancy; Rockwell Medical: Consultancy; Terumo: Consultancy; Celgene: Consultancy; Coherus BioSciences: Research Funding, Speakers Bureau; MorphoSys: Consultancy.
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Grossman, Katlyn H. "987. Improving Patient Access to HIV Post-Exposure Prophylaxis with Pharmacist Involvement." Open Forum Infectious Diseases 7, Supplement_1 (2020): S522. http://dx.doi.org/10.1093/ofid/ofaa439.1173.
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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
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Haire, Bridget. "National leadership needed on HIV Pre-exposure Prophylaxis (PrEP) access in Australia." Australian and New Zealand Journal of Public Health 40, no. 6 (2016): 504–5. http://dx.doi.org/10.1111/1753-6405.12570.
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Scully, Eileen P., Ethel D. Weld, and Joel N. Blankson. "Challenges in optimizing preexposure prophylaxis development, engagement, and access for HIV prevention." Journal of Clinical Investigation 129, no. 12 (2019): 5071–73. http://dx.doi.org/10.1172/jci134389.
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Scaife, Courtney L., Molly E. Gross, Mary C. Mone, et al. "Antibiotic prophylaxis in the placement of totally implanted central venous access ports." American Journal of Surgery 200, no. 6 (2010): 719–23. http://dx.doi.org/10.1016/j.amjsurg.2010.07.023.
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Tung, Elyse L., Annalisa Thomas, Allyson Eichner, and Peter Shalit. "Implementation of a community pharmacy-based pre-exposure prophylaxis service: a novel model for pre-exposure prophylaxis care." Sexual Health 15, no. 6 (2018): 556. http://dx.doi.org/10.1071/sh18084.
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Background National guidelines for the provision of HIV pre-exposure prophylaxis (PrEP) to reduce a person’s risk of acquiring HIV were made available in 2014. We created a pharmacist-managed HIV PrEP clinic in a community pharmacy setting at Kelley-Ross Pharmacy in Seattle, WA, USA. Methods: The clinic operates under a collaborative drug therapy agreement based on these guidelines. This allows pharmacists to initiate and manage tenofovir disoproxil fumarate/emtricitabine under the supervision of a physician medical director. Results: Between March 2015 and February 2018, 714 patients were evaluated and 695 (97.3%) initiated PrEP. Five hundred and thirteen (74%) patients began medication the same day as their initial appointment. Of the prescriptions filled in our pharmacy, 90% of patients had a mean proportion of days covered (PDC) greater than 80%, and 98% had a zero-dollar patient responsibility per month, including uninsured individuals. 19% of patients were lost to follow up, with an effective drop-out rate of 25%. Two hundred and seven diagnoses of sexually transmissible infections were made. There were no HIV seroconversions in the service. Conclusion: The pharmacist-managed PrEP clinic proved to be a successful alternative model of PrEP care, with high initiation rates and low drop-out and lost-to-follow-up rates. This may benefit individuals who do not access PrEP in traditional health care settings or where PrEP access is scarce. Financial sustainability of the model was dependent on the ability of pharmacists in the clinic to bill insurance plans for their services in accordance with Washington State legislative changes requiring commercial insurances to recognise pharmacists as providers.
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Clarke-Steffen, Laura, Veenod Chulani, Michael Dobbs, and Janice Piatt. "Barriers Encountered By Youth Aged 13–24 While Accessing Pre-Exposure Prophylaxis to HIV: Phoenix Pre-Exposure Prophylaxis Access Project." AIDS Patient Care and STDs 37, no. 9 (2023): 432–35. http://dx.doi.org/10.1089/apc.2023.0131.
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Ragni, Margaret V., Patrick F. Fogarty, Neil C. Josephson, Anne T. Neff, Leslie Raffini, and Craig M. Kessler. "Survey of Current Prophylaxis Practices and Bleeding Characteristics of Children with Severe Hemophilia A In U.S. Hemophilia Treatment Centers." Blood 116, no. 21 (2010): 3653. http://dx.doi.org/10.1182/blood.v116.21.3653.3653.
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Abstract Abstract 3653 Introduction: Every other day (qod) factor VIII prophylaxis prevents joint bleeds in children with severe hemophilia A. Although three times weekly or qod prophylaxis is recommended by the National Hemophilia Foundation (NHF), how widely these practices have been adopted is not known. Aim: We sought to define current prophylaxis practices at U.S. Hemophilic Treatment Centers (HTCs). Method: An email survey was distributed to U.S. HTCs, utilizing web-based membership rosters of the Centers for Disease Control (CDC) and the Hemophilia Thrombosis Research Society (HTRS). Results: Of 62 HTCs responding, prophylaxis is initiated on a three times weekly schedule in 29 (46.8%), twice weekly in 13 HTCs (21.0%), and once weekly in 20 HTCs (32.2%). Central venous catheters are used to infuse factor prophylactically at 55 HTCs (88.7%), including in 100% of children initiating prophylaxis at 19 HTCs (30.6%) and in 50% of those at 41 HTCs (66.1%), but avoided altogether at seven HTCs (11.3%). Prophylaxis is initiated after one or more bleeds in 56 HTCs (90.3%), but after the first bleed in only 28 HTCs (25.2%). Among 226 newborns with severe hemophilia A in 62 HTCs, 1.82 births/HTC/year, the median age at first bleed, excluding circumcision, is 7 months. Of the 113 (53.5%) who underwent circumcision, 62 (54.9%), bled. Conclusion: Despite a recommended standard of three times weekly prophylaxis, over half of surveyed HTCs do not follow these guidelines, and nearly one third begin prophylaxis on a once weekly schedule to delay or avoid the need for central venous access. Disclosures: Kessler: Grifols S.A.: Research Funding.
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Fasola, Gianpiero, Chiara Savignano, Maria Gloria Revignas, Luigi Virgolini, and Michele Baccarani. "Infections in Patients with Acute Non-Lymphocytic Leukemia Nursed with Central or Peripheral Venous Access." Tumori Journal 79, no. 2 (1993): 112–15. http://dx.doi.org/10.1177/030089169307900206.
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Aims and Background Infections are a major problem in patients undergoing induction chemotherapy for acute leukemia. Granulocytopenia is the single most imporant risk factor, but the pattern of infecting organisms can change according to nursing facilities or bacterial and fungal prophylaxis. Methods We reviewed the patterns and types of infections in 30 patients with acute non-lymphocytic leukemia. Eighty-nine periods of neutropenia following chemotherapy were evaluated: in 60 courses patients had central and in 29 had peripheral venous access. Results Almost all patients (97 %) became febrile after the 1st course of therapy, but one-third remained apyretic after the fourth course (P = 0.002). In this series, the incidence of gram-positive, gram-negative and mycotic isolations were respectively 76 %, 18 % and 6 %. The need for antimicrobic treatment varied in relation to the course of chemotherapy. Conclusions We conclude that in acute non-lymphocytic leukemia the first neutropenic period following the onset of disease is the most critical regarding infectious problems. Both quinolonic prophylaxis and central venous access could be responsible for the microbiologic findings.
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Cultrera, Dorina, Raimondo De Cristofaro, Paola Giordano, et al. "Identification of the Profile of the Patients with Hemophilia B Eligible for Treatment with Nonacog Alfa Once-Weekly." Reports — Medical Cases, Images, and Videos 3, no. 1 (2020): 3. http://dx.doi.org/10.3390/reports3010003.
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This study aimed to identify the characteristics of patients with hemophilia B eligible for once-weekly treatment with Nonacog alfa. Methods: A survey was conducted in 14 Hemophilia (HCs) of Italy. These centers were given a questionnaire consisting of ten closed multiple-choice questions. The centers were asked: (a) the percentages of their hemophilia B (HB) patients undergoing replacement therapy, “On-demand”, or weekly prophylaxis, (b) the criteria guiding the monitoring of patients, the advantages according to the age of patients, and (c) the obstacles to prophylaxis. The percentage of patients receiving “On-demand” (OD) treatment or continuous prophylaxis (prophy) differed depending on patient age and the severity of the disease. Only 57% of HCs provided “On-demand” therapy to the mild HB patients, about 93% to moderate ones, of whom 43% on prophylaxis. About 78% of patients <6 years old, were on treatment in 9 out of 14 HCs, by prophylaxis 66.7% and 33.3% by On-demand. In the 6–18 age group, 90.1% of HCs treated HB patients with prophylaxis, 42.8% in the 18–30 age range. On-demand treatment was the therapy of choice in 61.5% of HCs for patients aged 30–65 years. In total, 64% of the HCs assigned the maximum score to bleeding frequency, especially in the <6 and 6–18 age groups. Bleeding severity was also taken into significant consideration, particularly in subjects up to 30 years old. The scores regarding venous access were distributed relatively evenly throughout all age groups. The majority of the centers attributed a medium-high score to treatment compliance, especially in the 6–65 age range. In actuality, 55% of HCs attributed pro-thrombotic comorbidity a low score in the 18–30 age group, whereas 81% gave pro-hemorrhagic comorbidity a high rating in patients aged >65 years old. Many centers assigned a medium-high score to the baseline concentration of FIX level at diagnosis in all age groups. Most HCs attributed a medium-high score to type of genetic mutation in the younger age groups. As for socio-cultural barriers and quality of life, the majority of respondents gave a medium-high score in all age groups. For periodic monitoring of patients receiving continuous prophylaxis, 59% of the centers reported using clinical assessment. With regard to prophylaxis administration method, the majority of hemophiliacs were given infusions twice weekly, while as regards to the dose of FIX concentrate delivered, 50% of the centers reported administering prophylaxis once-weekly at a dose ranging from 5–100 IU/kg in 10–50% of HB patients. Thus, 93% of the centers reported using a dose of 25–50 IU/kg for twice-weekly prophylaxis in 6–100% of the patients. The majority of centers (86%) believe that, in a program of early primary prevention, once-weekly treatment with nonacog alfa may represent an alternative strategy to dose escalation. The results show that patients with mild hemophilia, with functional musculoskeletal status and difficulties with venous access, are candidates for once-weekly prophylaxis with nonacog alfa. For such patients, this regimen can improve treatment compliance and quality of life.
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Rujumba, Joseph, Ruth Namazzi, Deogratias Munube, et al. "Caregivers and Healthcare Workers Experiences and Preferences with Use of Penicillin Prophylaxis in Young Children with Sickle Cell Anemia in Uganda." Blood 144, Supplement 1 (2024): 3629. https://doi.org/10.1182/blood-2024-208912.
Full textAbstract:
Introduction: Bacterial infections are a major cause of sickle cell anemia related morbidity and mortality in young children with sickle cell anemia (SCA) in Sub-Saharan Africa. Penicillin prophylaxis is therefore recommended as a standard of care for all SCA children who are less than five years of age. Despite the proven benefit, compliance to penicillin prophylaxis remains poor among SCA children in sub-Saharan Africa. There is therefore, a need to investigate reasons for the poor compliance to penicillin prophylaxis in order to inform interventions to improve adherence. We explored the experiences and preferences of caregivers and healthcare providers regarding penicillin prophylaxis for young children with SCA in Uganda. Methods: We conducted a cross-sectional qualitative study in Sickle Cell clinics at Atutur General, Jinja Regional Referral, and Mulago National Referral hospitals in Uganda. Data was collected through seven Focus Group Discussions (FGDs) each with 6-8 caregivers of SCA children less than five years. In addition, 10 Key Informant Interviews (KII) were held with healthcare workers including, Pediatricians, Medical Officers, clinical medical officers, nurses, and dispensers, involved in providing care to SCA children at the clinics. All FGDs and KIIs were audio recorded and later transcribed verbatim. Data was analyzed using content thematic approach guided by the Consolidated Framework for Implementation Research (CFIR). Results: The caregivers who frequently used the medicine reported improvements in their children's health. The major improvements mentioned across all the three study sites were, a reduction in the frequency of sickness and a reduction in the number of hospitalizations. However, most caregivers struggled to maintain their SCA children on penicillin prophylaxis. The main reasons for poor adherence were difficulty in giving the medicine, the bitter taste and an undesirable smell, all of which made it unattractive to most children. Other reasons for poor adherence to the medicine included distant health facilities, frequent stock-outs of the drug, limited health education for caregivers, and long waiting times at SCD clinics which hindered optimal use of penicillin prophylaxis. On the other hand, facilitators of penicillin prophylaxis mentioned were the availability of the medicine at the hospitals, financial support to buy the medicines when not available at SCD clinics, and reminders to give the medicines. Regarding preference, most caregivers and health care workers preferred oral formulations rather than parenteral forms of the penicillin. Oral forms were considered to be easy to pack, store and are relatively cheap whereas injectables were thought to exacerbate the pain in SCA children and would require skilled health care workers to administer. A few voices noted that injectable penicillin prophylaxis could reduce visits to hospitals, thus saving time for caregivers, and would reduce the pill burden among the SCA children. Conclusions: Penicillin prophylaxis is perceived to still be effective in reducing SCA related morbidity in young children in this population. Adherence to the prophylaxis was however low due to unfavorable palatability of the medicine in its present form and access issues. Overall, most caregivers and health care workers preferred oral to injectable formulations of the medicine. Increasing access to penicillin prophylaxis for SCA children in Uganda requires providing more child friendly formulations of the medicine and strengthening the health system to ensure adequate availability of the drug.
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Tolani. "Clinical Audit of Low Dose Prophylaxis Programme for Nigerian Children with Haemophilia." West Africa Journal of Medicine 39, no. 1 (2022): 11–15. http://dx.doi.org/10.55891/wajm.v39i1.86.
Full textAbstract:
Introduction: The evidence of benefits for prophylaxis especially low dose prophylaxis is incontestable yet most children in developing countries as Nigeria do not have access to this treatment protocol.
 Aim: The aim was to audit the low dose prophylaxis treatment in Nigerian children with haemophilia.
 Methodology: A multicentre clinical audit of five haemophilia treatment centres; University of Nigeria Teaching Hospital Enugu, Lagos University Teaching Hospital, National Hospital Abuja, University of Port Harcourt Teaching Hospital Port Harcourt, and Federal Teaching Hospital Gombe. Eighteen children with mild-severe haemophilia were enrolled into low-dose prophylaxis treatment programme. The reduction of joint bleeding, improvement of joint function and Quality of Life (QoL) during prophylaxis were analysed.
 Results: In total 18 children - 17males and 1 female (median age 8 years) were enrolled. The median duration of observation was 7 months (range 3-15months). Seven of the children were on primary prophylaxis (41%) while 10 of the children (59%) were on secondary prophylaxis. The number of joint bleeds decreased from a total of 162 (individual range 5-20, mean 10.3) to 42 (range 0-7, mean 3.0) during the observation period with an overall reduction of 74%. Joint function improved in 94.1% of disease joints, while only 5.6% reported no improvement (due to poor compliance). School attendance improved in all subjects, sports participation and daily activity improved moderately.
 Conclusion: Low dose prophylaxis was beneficial in reduction of joint bleeds, improvement of joint function and improvement of QoL of Children with haemophilia in Nigeria.
 
 Authors
 T U Nwagha 1, H C Okoye 1, C E Udo 2, S Yuguda 3, K I Korubo 4, T A Adeyemo 5
 
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Malloy, Giovanni S. P., Margaret L. Brandeau, and Jeremy D. Goldhaber-Fiebert. "Modeling the Cost-Effectiveness of Interventions to Prevent Plague in Madagascar." Tropical Medicine and Infectious Disease 6, no. 2 (2021): 101. http://dx.doi.org/10.3390/tropicalmed6020101.
Full textAbstract:
Plague (Yersinia pestis) remains endemic in certain parts of the world. We assessed the cost-effectiveness of plague control interventions recommended by the World Health Organization with particular consideration to intervention coverage and timing. We developed a dynamic model of the spread of plague between interacting populations of humans, rats, and fleas and performed a cost-effectiveness analysis calibrated to a 2017 Madagascar outbreak. We assessed three interventions alone and in combination: expanded access to antibiotic treatment with doxycycline, mass distribution of doxycycline prophylaxis, and mass distribution of malathion. We varied intervention timing and coverage levels. We calculated costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios from a healthcare perspective. The preferred intervention, using a cost-effectiveness threshold of $1350/QALY (GDP per capita in Madagascar), was expanded access to antibiotic treatment with doxycycline with 100% coverage starting immediately after the first reported case, gaining 543 QALYs at an incremental cost of $1023/QALY gained. Sensitivity analyses support expanded access to antibiotic treatment and leave open the possibility that mass distribution of doxycycline prophylaxis or mass distribution of malathion could be cost-effective. Our analysis highlights the potential for rapid expansion of access to doxycycline upon recognition of plague outbreaks to cost-effectively prevent future large-scale plague outbreaks and highlights the importance of intervention timing.