Background: Negative attitudes toward people who use drugs (PWUD) can hinder their engagement in healthcare and contribute to poor clinical outcomes. While harm reduction-informed care may improve healthcare worker attitudes and patient experiences, limited research has examined its acceptability within HIV clinical settings.
Objectives: This study aimed to assess healthcare workers' attitudes toward PWUD and their acceptance of harm reduction principles within HIV care clinics and to examine associated sociodemographic and work-related factors.
Design: Cross-sectional quantitative study.
Design: In 2022, 128 healthcare workers from three HIV care clinics in Birmingham, AL and Pittsburgh, PA, completed a self-administered electronic survey via REDCap. Multivariable linear regression was used to examine associations between attitudes toward PWUD and acceptance of harm reduction practices, adjusting for relevant covariates.
Methods: Overall, healthcare workers reported generally positive attitudes toward PWUD, though variations by location, race, and years of experience were observed. More negative attitudes toward PWUD were associated with lower harm reduction principles acceptance (b = -0.29, p = .001). Independent predictors of lower harm reduction acceptance included working in Birmingham versus Pittsburgh (b = -0.34, p = 0.001) and being identified as Black or African American versus White (b = -0.45, p = 0.001). Healthcare workers with 6-10 years and > 20 years of experience working with people with HIV reported higher harm arm reduction acceptance (b = 0.45, p = 0.003 and b = 0.62, p = 0.02, respectively), compared to those with ⩽5 years of experience.
Results: These findings underscore the need for targeted interventions that improve harm reduction acceptability among HIV care workers, particularly those shaped by location, race, healthcare worker experience, and attitudes toward PWUD, to support the integration of harm reduction into HIV clinical practice.
Background: Simplification of antiretroviral regimens has the potential to improve both patient-reported outcomes (PROs) and therapeutic adherence in people living with HIV (PLWH). Dual therapy with dolutegravir (DTG) plus lamivudine (3TC) demonstrated good safety and efficacy, but its impact on PROs remains to be documented.
Objectives: To evaluate PROs among adult PLWH switching from standard multi-drug therapy to the DTG/3TC combined therapy Dovato®.
Design: A non-comparative, 6-month observational study in 25 French medical centers.
Methods: Sociodemographic and biomedical data were collected from medical records and PROs from self-administered questionnaires at treatment switch (Day, D0) and at months (M) 1 and 6. Primary endpoints included changes between D0 and M6 in perceived toxicity, treatment acceptability, PLWH's preferences, and the score value of the treatment impact dimension of health-related quality of life (HRQL) (PROQOL-HIV) during follow-up. Secondary endpoints encompassed scores in other HRQL dimensions and self-reported symptoms. Multivariable standard and mixed-effects linear regression models were used to identify factors associated with PRO values and changes over time. Additionally, binary logistic regression was used to identify factors associated with the discontinuation of combined DTG/3TC regimen.
Results: In the study population (260 PLWH, 64.6% male, mean ± SD age: 51 ± 12 years, 16 ± 10 years since HIV diagnosis), 20 individuals stopped treatment during follow-up, without resumption. Men, individuals previously receiving abacavir/3TC/DTG, and those with better daily comfort and perceived treatment efficacy were less likely to stop treatment. Treatment impact-related HRQL, acceptability of treatment, and number of self-reported symptoms significantly improved at M1 and M6. Mental and cognitive HRQL improved at M6.
Conclusion: Dolutegravir and lamivudine dual oral therapy improved several dimensions in HRQL and delivered a simplified treatment regimen designed for eligible patients, supporting a patient-centered approach to managing HIV care. Attention should be maintained on the reasons for treatment discontinuation, especially among women.
Trial registration: Patient-Reported Outcomes HV BItherapy (PROBI) was registered as number NCT04788784 on https://clinicaltrials.gov/study/NCT04788784?term=PROBI&rank=2.
Background: Febrile neutropenia (FN) is the most common and serious adverse event of chemotherapy for solid and hematological neoplasms, with infection as a major complication. FN occurs in 10%-50% of patients with solid tumors and over 80% with hematological malignancies, with mortality rates up to 11%.
Objective: To characterize bloodstream pathogens in post-chemotherapy FN through a systematic review and meta-analysis of studies published from 2013 to February 13, 2024.
Design: Systematic review and meta-analysis.
Data sources and methods: PubMed, Web of Science, Scopus, and Embase were searched using MeSH, Emtree, and keywords. Risk of bias was assessed using the JBI checklist. Random-effects proportions meta-analysis was performed.
Results: Twenty-two studies (n = 23,319) reported 8665 positive blood cultures: 59% Gram-negative (95% CI: 46.8-67.5), 39.7% Gram-positive (95% CI: 31.3-48.2), and 2.5% fungi (95% CI: 0.9-4.1). Random-effects meta-analysis showed high heterogeneity (I 2 = 98.92%, p < 0.01). Meta-regression by sample size, economic development, and risk of bias did not explain this variability.
Conclusion: Gram-negative pathogens slightly predominate over Gram-positives in bloodstream infections among post-chemotherapy FN patients.
Trial registration: PROSPERO (CRD42023472191).
The resurgence of monkeypox (mpox), driven by Clade IIb of the monkeypox virus (MPXV), has intensified global concerns about its transmission, treatment, and prevention. Mpox, a zoonotic orthopoxvirus and is primarily transmitted through close contact with infected individuals, contaminated surfaces, or respiratory droplets. Historically, the virus has been divided into two clades: Clade I, endemic to Central Africa and characterized by higher fatality rates, and Clade II, linked to milder disease in West Africa. The unprecedented global spread of Clade IIb Mpox in 2022, affecting over 99,000 individuals across 118 countries, underscored the potential for widespread transmission beyond endemic regions. This review provides a detailed examination of the transmission dynamics of mpox, current treatments, innovations, and global health challenges. Current treatment strategies primarily involve supportive care, with advanced therapeutics such as tecovirimat, cidofovir, and brincidofovir reserved for severe cases. While these antivirals show promise, their clinical efficacy and safety remain inadequately substantiated, creating a pressing need for rigorous trials. Preventive measures, including vaccination and postexposure prophylaxis, remain pivotal in mitigating disease spread, yet face barriers such as limited supply, accessibility, and vaccine hesitancy. Emerging therapeutic innovations, such as monoclonal antibodies, gene-editing technologies, and RNA-based therapies, offer hope for addressing these gaps. These novel approaches aim to enhance treatment specificity, minimize off-target effects, and reduce the risk of resistance. However, their successful integration into clinical practice demands robust validation through preclinical and clinical research. In addressing the challenges ahead, this review underscores the critical importance of global collaboration to strengthen epidemiological surveillance, accelerate drug development, and optimize prevention strategies. The emergence of drug-resistant strains, the persistence of mpox in vulnerable populations, and the potential for future outbreaks necessitate sustained investment in research and public health infrastructure. By integrating innovative therapeutic approaches, effective preventive measures, and comprehensive outbreak management strategies, the global health community can better address the ongoing threat of mpox and prepare for future public health challenges.
Background: Infection prevention and control (IPC) measures during the coronavirus disease 2019 (COVID-19) pandemic have led to a reduction in respiratory viral infections. However, these infections showed a resurgence in the post-COVID-19 era. Respiratory viral infections often exacerbate respiratory diseases.
Objectives: This study aimed to determine how the relaxation of IPC measures affects the incidence of virus-related acute exacerbations in various respiratory diseases.
Design: A retrospective study conducted at a tertiary care facility.
Methods: This study retrospectively assessed data from adult patients aged 18 years and older who visited the emergency department (ED) of a tertiary medical centre in Kobe, Japan, from 1 October 2020 to 12 March 2024. We identified patients who visited because of chronic obstructive pulmonary disease (COPD) exacerbation, asthma exacerbation or acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) and classified them into two groups based on the pre-relaxation and post-relaxation of IPC measures. The detection rates and respiratory viruses identified using multiplex polymerase chain reaction were compared between the groups.
Results: The total number of ED visits was 84,183 involving 129 cases of COPD exacerbation, 156 cases of asthma exacerbation and 68 cases of AE-IPF. Virus-related COPD exacerbations were significantly more frequent after the relaxation of IPC measures than before (7.7% vs 52.5%, p < 0.001). Similarly, virus-related asthma exacerbations occurred significantly more frequently after relaxation than before (39.7% vs 66.7%, p = 0.009). In contrast, no significant difference in the virus-associated AE-IPF was observed before and after relaxation (2.5% vs 5.0%, p = 0.61).
Conclusion: Relaxation of IPC measures may increase virus-related exacerbations in COPD and asthma.
New human immunodeficiency virus (HIV) cases related to injection drug use (IDU) in the United States increased between 2016 and 2022. The uptake of preexposure prophylaxis (PrEP) is exceedingly low in persons who inject drugs (PWID) despite its efficacy to prevent HIV. There are multilevel barriers in the PrEP care cascade for PWID. We need a combination of effective HIV prevention strategies, including PrEP, treatment for substance use disorder, and syringe services programs (SSP) to reverse the trend. A major challenge is the lack of knowledge and skills in harm reduction practices and addiction care in the infectious disease (ID) workforce. ID clinicians could benefit from education in harm reduction and addiction, including taking on the responsibility of prescribing buprenorphine or navigating the resources for it. Addiction clinicians could benefit from education on PrEP and related program implementation knowledge. Both specialties need to comprehensively evaluate and address the risks for HIV acquisition in PWID. We should create integrated clinical programs between ID and addiction. We should improve HIV screening for hospitalized PWID. We should expand low-barrier integrated clinics with flexible hours, walk-in appointments, same-day PrEP starts, and collocated laboratory and pharmacy services. Other entities that could provide integrated care include substance detoxification and rehabilitation programs, SSPs, opioid treatment programs (OTP), community pharmacies, and mobile health clinics. Long-acting injectable PrEP for PWID is an attractive option for HIV prevention, but robust implementation programs are necessary for roll-out. We still need to address upstream barriers to care for PWID, including stigma and health disparities. We need to continue to advocate for policy changes and funding for SSPs and OTPs to provide comprehensive HIV prevention.
Background: People who use drugs (PWUD) are at increased risk for severe infections and face many barriers when completing conventional, typically parenteral antimicrobial treatments. Despite evidence supporting various antibiotic options, such as oral antibiotic therapy, there has been limited uptake of these strategies by many clinicians.
Objectives: Create a training for hospital-based clinicians detailing harm reduction and various antimicrobial treatment options for the care of PWUD with severe infections. Examine current hospital-based clinician practices regarding the care of PWUD. Compare pre- and post-training clinician knowledge and comfort around various antibiotic treatment options, harm reduction, and substance use stigma.
Design: The study design was a pre- and post-intervention descriptive survey. The intervention was the training session. Surveys were completed by participants before and after the training. Surveys were completed by participants before and after the training and asked about participants' practices and attitudes regarding PWUD and treatment options.
Methods: The training was provided to hospital-based clinicians across eight different sites in four different states from November 2022 to November 2023. We examined knowledge, attitudes, and practices around treating injection drug use-associated infections, patients with substance use disorders, and comfort with antimicrobial treatment options using pre-and post-training surveys. We also used a modified version of a validated substance use stigma instrument to measure stigma pre- and post-training. For paired pre-post survey data, we used McNemar's test to compare Likert scale responses.
Results: Of 167 study participants, 126 (75%) completed the pretraining survey, and 42 (25%) provided paired pre-post survey responses. Among the 126 pre-survey respondents, 64 (51%) were trainees, 75 (60%) frequently treated patients with injection drug use-associated infections, and 61 (50%) reported consistently applying harm reduction strategies to these patients in the hospital. Post-training, participants with paired data were significantly more likely to agree with applying harm reduction principles to the care of PWUD (pre, 23 (55%); post, 39 (95); p < 0.001) and discussing safer drug use practices (pre, 16 (38%); post, 29 (69%); p = 0.004).
Conclusion: Our study shows that an interactive training for hospital-based clinicians can significantly improve clinician knowledge and comfort with applying harm reduction strategies and with offering various antibiotic treatment options to PWUD with severe infections.
Background: Carbapenem-resistant Enterobacterales (CRE) are a significant public health threat affecting human health globally. Unfortunately, the incidence of CRE has increased globally, raising the red flag for the need for an urgent plan for this serious and worrisome problem.
Objectives: We aimed to identify the prevalence and genetic characterization of CRE in addition to determining antibiotic resistance profiles and the effect of independent variables on carbapenemase gene types.
Design: The study is a retrospective cross-sectional study conducted at a tertiary care hospital in East Jerusalem.
Methods: Data were collected from microbiology, molecular, and infectious diseases units from May 2019 till November 2023. Non-repetitive isolates that tested positive for CRE according to the CLSI (M100, S29, 2023) and American Society for Microbiology Diagnostic Microbiology Proceedings manual were included with no age exclusion.
Results: A total of 599 CRE non-repetitive isolates were included, carbapenemase detected (C-CRE detected) genes were seen in 421 isolates, while the remaining 178 isolates were carbapenemase not detected (C-CRE not detected). The most common carbapenemase gene was bla NDM (347 isolates, 82.4%), followed by bla OXA-48 (55 isolates, 13.1%). The prevalence of CRE from total cultures (gram-negative, gram-positive, and no growth) during the study period was 2.4%, while the prevalence of CRE from Enterobacterales was 20.6%. The prevalence of CRE increased over the study years with a notable increase between 2020 and 2021, Klebsiella species were the most common carbapenem-resistant bacterial genera, while surveillance anal swab culture was the most dominant culture site from where CRE isolates were isolated. Antibiotic resistance varied according to carbapenemase gene type and bacterial genera.
Conclusion: CRE is a growing problematic health issue that spotlights the urgent need for integrated, complete, and appropriate national antimicrobial stewardship and infection prevention and control programs.
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