This article discusses the evolving real-world practice using nitazoxanide,nonsteroidal anti-inflammatory drugs(NSAIDs)and/or azithromycin(Kelleni’s protocol)to manage the evolving manifestations of severe acute resp...This article discusses the evolving real-world practice using nitazoxanide,nonsteroidal anti-inflammatory drugs(NSAIDs)and/or azithromycin(Kelleni’s protocol)to manage the evolving manifestations of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron EG.5.1,its descendant HV.1 as well as BA.2.86 and its descendant JN.1 subvariants in Egypt in 2024.These subvariants are well-known for their highly evolved immune-evasive properties and the manifestations include some peculiar manifestations as persistent cough besides high fever in young children as well as high fever,persistent severe cough,change of voice,loss of taste and smell,epigastric pain,nausea,vomiting,diarrhea,generalized malaise and marked bone aches in adults including the high-risk groups.It’s suggested that the ongoing SARS-CoV-2 evolution is continuing to mostly affect the high-risk groups of patients,to some of whom we’ve also successfully prescribed nitazoxanide and/or NSAIDs for post-exposure prophylaxis of all household contacts.We also continue to recommend starting the immune-modulatory antiviral Kelleni’s protocol as soon as possible in the course of infection and adjusting it in a personalized manner to be more aggressive from the beginning for the high risk patients,at least until the currently encountered surge of infections subsides.展开更多
Background: World Health Organization recommends the implementation of contact tracing and Leprosy Post Exposure prophylaxis (LPEP) to interrupt the chain of transmission. To accelerate the uptake of this recommendati...Background: World Health Organization recommends the implementation of contact tracing and Leprosy Post Exposure prophylaxis (LPEP) to interrupt the chain of transmission. To accelerate the uptake of this recommendation, a cross-sectional study among contacts of leprosy patients was conducted to investigate the feasibility of integrating leprosy systematic contact tracing and post-exposure prophylaxis (PEP) into the routine leprosy control program. Methods: This was a mixed methods cross-sectional study. The study was implemented in Kumi, Ngora, Serere, Soroti, Budaka and Kibuku Districts. Results: The 45 enrolled index patients (97.8% of the registered) identified a total of 135 contacts, of which 134 (99·2%) consented and were screened. Among them, one new leprosy patient was identified and started on treatment with multidrug therapy (MDT). All the eligible contacts, received the prophylactic treatment with Single Dose Rifampicin (SDR). Overall, SDR was administered to 133(98.5% of the listed contacts) with no adverse event reported. Factors associated with successful contact investigation and management included: Involvement of index patients, health care workers during the contact screening and SDR A administration, counselling of the index patients and contacts by the health care works, LPEP being administered as Directly observed Therapy (DOT) among others. Results Interpretation: The integration of leprosy post-exposure prophylaxis with administration of SDR and contact tracing is feasible, generally accepted by the patient, their contacts and health workers and can be integrated into the National Leprosy control programmes with minimal additional efforts once contact tracing has been established. Therefore, we recommend integration of administration of SDR in to the routine leprosy control program.展开更多
Introduction:Human Immunodeficiency Virus(HIV)nonoccupational post-exposure prophylaxis(nPEP)clinics are specialized healthcare facilities that provide urgent medical interventions to individuals with potential high-r...Introduction:Human Immunodeficiency Virus(HIV)nonoccupational post-exposure prophylaxis(nPEP)clinics are specialized healthcare facilities that provide urgent medical interventions to individuals with potential high-risk HIV exposures.This study analyzed utilization patterns of HIV nPEP services in China and examined factors associated with medication adherence among consultees,providing evidence to inform further implementation and optimization of HIV nPEP interventions.Methods:We analyzed nPEP case data collected from the national nPEP data information system between November 1,2022,and November 1,2024,using SPSS 29.0 software.Chi-square tests were applied to analyze characteristics of nPEP consultees,and logistic regression models were used to identify factors influencing medication adherence and followup compliance among those who initiated treatment.Results:As of November 1,2024,924 nPEP clinics nationwide received 54,108 consultees,with 53,405(98.70%)initiating medication.Most individuals seeking services were male(88.63%),classified as high-risk(83.11%),and heterosexual with multiple partners(67.66%).The“BIC/FTC/TAF”regimen was selected by 63.07%of recipients.Nearly all users(99.03%)completed medication evaluation within 72 hours post-exposure.Among medication users,60.34%(30,650)adhered to the full 28-day regimen,and 60.10%(30,509)completed either onemonth or three-month follow-ups.Multivariate logistic regression analysis identified gender,exposure risk assessment results,exposure population classification,individual preferences,and medication regimen as significant factors influencing both 28-day medication adherence and follow-up compliance(P<0.05).Conclusions:nPEP clinic consultees in China are predominantly young male heterosexual individuals with multiple sexual partners,with most selecting the Biktarvy regimen.However,both current 28-day medication adherence and follow-up compliance rates remain suboptimal.High-risk men and those receiving the Biktarvy regimen demonstrate superior medication adherence and follow-up compliance compared to other groups.Further research is needed to develop targeted interventions to improve medication adherence and follow-up rates among nPEP recipients.Enhancing adherence and follow-up should be prioritized in future interventions,supported by continuous monitoring to inform timely intervention strategy adjustments.展开更多
Introduction:Pre-exposure prophylaxis(PrEP)and post-exposure prophylaxis(PEP)are promising interventions to curb HIV transmission among men who have sex with men(MSM).However,incorrect use may elevate HIV risk.This st...Introduction:Pre-exposure prophylaxis(PrEP)and post-exposure prophylaxis(PEP)are promising interventions to curb HIV transmission among men who have sex with men(MSM).However,incorrect use may elevate HIV risk.This study investigated the impact of improper PrEP/PEP use on HIV infection among MSM.Methods:A cross-sectional survey was conducted in Shenzhen(2021-2023)using time-location sampling and respondent-driven sampling.χ^(2)tests and Poisson regression with robust error variance were employed for univariate and multivariate analyses.Results:Compared to PrEP/PEP non-users,MSM who incorrectly used PrEP[adjusted odds ratio(aOR)=2.17,95%confidence interval(CI):1.05,4.49]and PEP(aOR=3.76,95%CI:1.40,10.15)were more likely to be HIV-positive.No HIV-positive cases were reported among MSM who correctly used PrEP.Correct PEP users showed no significant difference in HIV prevalence compared to non-users.Conclusions:Correct PrEP/PEP use is an effective HIV prevention strategy for MSM,but incorrect use may increase infection risk.Public health efforts must prioritize interventions promoting adherence to PrEP/PEP guidelines,emphasizing that PrEP/PEP should complement—not replace—consistent condom use.展开更多
文摘This article discusses the evolving real-world practice using nitazoxanide,nonsteroidal anti-inflammatory drugs(NSAIDs)and/or azithromycin(Kelleni’s protocol)to manage the evolving manifestations of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron EG.5.1,its descendant HV.1 as well as BA.2.86 and its descendant JN.1 subvariants in Egypt in 2024.These subvariants are well-known for their highly evolved immune-evasive properties and the manifestations include some peculiar manifestations as persistent cough besides high fever in young children as well as high fever,persistent severe cough,change of voice,loss of taste and smell,epigastric pain,nausea,vomiting,diarrhea,generalized malaise and marked bone aches in adults including the high-risk groups.It’s suggested that the ongoing SARS-CoV-2 evolution is continuing to mostly affect the high-risk groups of patients,to some of whom we’ve also successfully prescribed nitazoxanide and/or NSAIDs for post-exposure prophylaxis of all household contacts.We also continue to recommend starting the immune-modulatory antiviral Kelleni’s protocol as soon as possible in the course of infection and adjusting it in a personalized manner to be more aggressive from the beginning for the high risk patients,at least until the currently encountered surge of infections subsides.
文摘Background: World Health Organization recommends the implementation of contact tracing and Leprosy Post Exposure prophylaxis (LPEP) to interrupt the chain of transmission. To accelerate the uptake of this recommendation, a cross-sectional study among contacts of leprosy patients was conducted to investigate the feasibility of integrating leprosy systematic contact tracing and post-exposure prophylaxis (PEP) into the routine leprosy control program. Methods: This was a mixed methods cross-sectional study. The study was implemented in Kumi, Ngora, Serere, Soroti, Budaka and Kibuku Districts. Results: The 45 enrolled index patients (97.8% of the registered) identified a total of 135 contacts, of which 134 (99·2%) consented and were screened. Among them, one new leprosy patient was identified and started on treatment with multidrug therapy (MDT). All the eligible contacts, received the prophylactic treatment with Single Dose Rifampicin (SDR). Overall, SDR was administered to 133(98.5% of the listed contacts) with no adverse event reported. Factors associated with successful contact investigation and management included: Involvement of index patients, health care workers during the contact screening and SDR A administration, counselling of the index patients and contacts by the health care works, LPEP being administered as Directly observed Therapy (DOT) among others. Results Interpretation: The integration of leprosy post-exposure prophylaxis with administration of SDR and contact tracing is feasible, generally accepted by the patient, their contacts and health workers and can be integrated into the National Leprosy control programmes with minimal additional efforts once contact tracing has been established. Therefore, we recommend integration of administration of SDR in to the routine leprosy control program.
文摘Introduction:Human Immunodeficiency Virus(HIV)nonoccupational post-exposure prophylaxis(nPEP)clinics are specialized healthcare facilities that provide urgent medical interventions to individuals with potential high-risk HIV exposures.This study analyzed utilization patterns of HIV nPEP services in China and examined factors associated with medication adherence among consultees,providing evidence to inform further implementation and optimization of HIV nPEP interventions.Methods:We analyzed nPEP case data collected from the national nPEP data information system between November 1,2022,and November 1,2024,using SPSS 29.0 software.Chi-square tests were applied to analyze characteristics of nPEP consultees,and logistic regression models were used to identify factors influencing medication adherence and followup compliance among those who initiated treatment.Results:As of November 1,2024,924 nPEP clinics nationwide received 54,108 consultees,with 53,405(98.70%)initiating medication.Most individuals seeking services were male(88.63%),classified as high-risk(83.11%),and heterosexual with multiple partners(67.66%).The“BIC/FTC/TAF”regimen was selected by 63.07%of recipients.Nearly all users(99.03%)completed medication evaluation within 72 hours post-exposure.Among medication users,60.34%(30,650)adhered to the full 28-day regimen,and 60.10%(30,509)completed either onemonth or three-month follow-ups.Multivariate logistic regression analysis identified gender,exposure risk assessment results,exposure population classification,individual preferences,and medication regimen as significant factors influencing both 28-day medication adherence and follow-up compliance(P<0.05).Conclusions:nPEP clinic consultees in China are predominantly young male heterosexual individuals with multiple sexual partners,with most selecting the Biktarvy regimen.However,both current 28-day medication adherence and follow-up compliance rates remain suboptimal.High-risk men and those receiving the Biktarvy regimen demonstrate superior medication adherence and follow-up compliance compared to other groups.Further research is needed to develop targeted interventions to improve medication adherence and follow-up rates among nPEP recipients.Enhancing adherence and follow-up should be prioritized in future interventions,supported by continuous monitoring to inform timely intervention strategy adjustments.
基金Supported by grants from the National Natural Science Foundation of China(82373651)the Shenzhen San-Ming Project of Medicine in Shenzhen(SZSM202311015)the Shenzhen Key Medical Discipline Construction Fund(SZXK064).
文摘Introduction:Pre-exposure prophylaxis(PrEP)and post-exposure prophylaxis(PEP)are promising interventions to curb HIV transmission among men who have sex with men(MSM).However,incorrect use may elevate HIV risk.This study investigated the impact of improper PrEP/PEP use on HIV infection among MSM.Methods:A cross-sectional survey was conducted in Shenzhen(2021-2023)using time-location sampling and respondent-driven sampling.χ^(2)tests and Poisson regression with robust error variance were employed for univariate and multivariate analyses.Results:Compared to PrEP/PEP non-users,MSM who incorrectly used PrEP[adjusted odds ratio(aOR)=2.17,95%confidence interval(CI):1.05,4.49]and PEP(aOR=3.76,95%CI:1.40,10.15)were more likely to be HIV-positive.No HIV-positive cases were reported among MSM who correctly used PrEP.Correct PEP users showed no significant difference in HIV prevalence compared to non-users.Conclusions:Correct PrEP/PEP use is an effective HIV prevention strategy for MSM,but incorrect use may increase infection risk.Public health efforts must prioritize interventions promoting adherence to PrEP/PEP guidelines,emphasizing that PrEP/PEP should complement—not replace—consistent condom use.
