scholarly journals Demedicalisation of HIV interventions to end HIV in the Asia–Pacific

Sexual Health ◽  
2021 ◽  
Vol 18 (1) ◽  
pp. 13 ◽  
Author(s):  
Rena Janamnuaysook ◽  
Kimberly Elizabeth Green ◽  
Pich Seekaew ◽  
Bao Ngoc Vu ◽  
Huu Van Ngo ◽  
...  
Keyword(s):  
Real Life ◽  
Hormone Treatment ◽  
Healthcare Services ◽  
Medical Discourse ◽  
Asia Pacific ◽  
People Living With Hiv ◽  
Key Populations ◽  
Hiv Interventions ◽  
Hiv Intervention ◽  
Key Population

Despite the challenges to the HIV response in the Asia–Pacific, a demedicalisation of HIV intervention has been demonstrated to be an important strategy to maximise the uptake of HIV prevention tools among key populations in this region. Demedicalisation of HIV interventions translates medical discourse and shifts the paradigm from a disease-focused to a people-centred approach. It also recognises real-life experiences of key populations in the HIV response by empowering them to voice their needs and be at the forefront of the epidemic control. We further categorise a demedicalisation approach into three frameworks: (1) the demystification of clinical or medical concerns; (2) the destigmatisation of people living with HIV; and (3) the decentralisation of healthcare services. This article reviewed the demedicalisation framework by looking at the HIV intervention examples from countries in the Asia–Pacific, which included: (1) a study on drug–drug interaction between pre-exposure prophylaxis and feminising hormone treatment for transgender women; (2) the roles of key population-led health services; and (3) certification of key population lay providers.

What will it take to end AIDS in Asia and the Pacific region by 2030?

Sexual Health ◽  
2021 ◽  
Vol 18 (1) ◽  
pp. 41 ◽  
Author(s):  
Eamonn Murphy ◽  
Ye Yu Shwe ◽  
Reeta Bhatia ◽  
Taoufik Bakkali ◽  
Ravipa Vannakit
Keyword(s):  
Asia Pacific ◽  
Public Health Approach ◽  
People Living With Hiv ◽  
Full Potential ◽  
Pacific Region ◽  
Key Populations ◽  
Health Coverage ◽  
Fully Integrated ◽  
Aids Epidemic ◽  
The People

The 2016 global commitments towards ending the AIDS epidemic by 2030 require the Asia–Pacific region to reach the Fast-Track targets by 2020. Despite early successes, the region is well short of meeting these targets. The overall stalled progress in the HIV response has been further undermined by rising new infections among young key populations and the unprecedented COVID-19 pandemic. This paper examines the HIV situation, assesses the gaps, and analyses what it would take the region to end AIDS by 2030. Political will and commitments for ending AIDS must be reaffirmed and reinforced. Focused regional strategic direction that answers the specific regional context and guides countries to respond to their specific needs must be put in place. The region must harness the power of innovative tools and technology in both prevention and treatment. Community activism and meaningful community engagement across the spectrum of HIV response must be ensured. Punitive laws, stigma, and discrimination that deter key populations and people living with HIV from accessing health services must be effectively tackled. The people-centred public health approach must be fully integrated into national universal health coverage while ensuring domestic resources are available for community-led service delivery. The region must utilise its full potential and draw upon lessons that have been learnt to address common challenges of the HIV and COVID-19 pandemics and achieve the goal of ending AIDS by 2030, in fulfillment of the United Nations’ Sustainable Development Goals.

scholarly journals An Unsupervised Behavioral Modeling and Alerting System Based on Passive Sensing for Elderly Care

2020 ◽  
Vol 13 (1) ◽  
pp. 6
Author(s):  
Rui Hu ◽  
Bruno Michel ◽  
Dario Russo ◽  
Niccolò Mora ◽  
Guido Matrella ◽  
...  
Keyword(s):  
Health Status ◽  
Healthcare Service ◽  
Behavioral Science ◽  
Elderly Care ◽  
Elderly Person ◽  
Real Life ◽  
Healthcare Services ◽  
Living Condition ◽  
Care Providers ◽  
Remote Healthcare

Artificial Intelligence in combination with the Internet of Medical Things enables remote healthcare services through networks of environmental and/or personal sensors. We present a remote healthcare service system which collects real-life data through an environmental sensor package, including binary motion, contact, pressure, and proximity sensors, installed at households of elderly people. Its aim is to keep the caregivers informed of subjects’ health-status progressive trajectory, and alert them of health-related anomalies to enable objective on-demand healthcare service delivery at scale. The system was deployed in 19 households inhabited by an elderly person with post-stroke condition in the Emilia–Romagna region in Italy, with maximal and median observation durations of 98 and 55 weeks. Among these households, 17 were multi-occupancy residences, while the other 2 housed elderly patients living alone. Subjects’ daily behavioral diaries were extracted and registered from raw sensor signals, using rule-based data pre-processing and unsupervised algorithms. Personal behavioral habits were identified and compared to typical patterns reported in behavioral science, as a quality-of-life indicator. We consider the activity patterns extracted across all users as a dictionary, and represent each patient’s behavior as a ‘Bag of Words’, based on which patients can be categorized into sub-groups for precision cohort treatment. Longitudinal trends of the behavioral progressive trajectory and sudden abnormalities of a patient were detected and reported to care providers. Due to the sparse sensor setting and the multi-occupancy living condition, the sleep profile was used as the main indicator in our system. Experimental results demonstrate the ability to report on subjects’ daily activity pattern in terms of sleep, outing, visiting, and health-status trajectories, as well as predicting/detecting 75% hospitalization sessions up to 11 days in advance. 65% of the alerts were confirmed to be semantically meaningful by the users. Furthermore, reduced social interaction (outing and visiting), and lower sleep quality could be observed during the COVID-19 lockdown period across the cohort.

scholarly journals Long-acting antiretrovirals: a new era for the management and prevention of HIV infection

2021 ◽  
Author(s):  
Paul Thoueille ◽  
Eva Choong ◽  
Matthias Cavassini ◽  
Thierry Buclin ◽  
Laurent A Decosterd
Keyword(s):  
Hiv Infection ◽  
Drug Exposure ◽  
Real Life ◽  
Effective Vaccine ◽  
Therapeutic Drug ◽  
People Living With Hiv ◽  
Medical Procedure ◽  
Clinical Pharmacokinetics ◽  
Long Acting ◽  
Prevention Of Hiv

Abstract The long-acting antiretroviral cabotegravir and rilpivirine combination has just received FDA, EMA and Health Canada approval. This novel drug delivery approach is about to revolutionize the therapy of people living with HIV, decreasing the 365 daily pill burden to only six intramuscular injections per year. In addition, islatravir, a first-in-class nucleoside reverse transcriptase translocation inhibitor, is intended to be formulated as an implant with a dosing interval of 1 year or more. At present, long-acting antiretroviral therapies (LA-ARTs) are given at fixed standard doses, irrespectively of the patient’s weight and BMI, and without consideration for host genetic and non-genetic factors likely influencing their systemic disposition. Despite a few remaining challenges related to administration (e.g. pain, dedicated medical procedure), the development and implementation of LA-ARTs can overcome long-term adherence issues by improving patients’ privacy and reducing social stigma associated with the daily oral intake of anti-HIV treatments. Yet, the current ‘one-size-fits-all’ approach does not account for the recognized significant inter-individual variability in LA-ART pharmacokinetics. Therapeutic drug monitoring (TDM), an important tool for precision medicine, may provide physicians with valuable information on actual drug exposure in patients, contributing to improve their management in real life. The present review aims to update the current state of knowledge on these novel promising LA-ARTs and discusses their implications, particularly from a clinical pharmacokinetics perspective, for the future management and prevention of HIV infection, issues of ongoing importance in the absence of curative treatment or an effective vaccine.

Dolutegravir-based regimen for maintenance of viral suppression in people living with HIV: 48‐week results in real life setting.

2021 ◽  
Author(s):  
Daniele Di Carlo ◽  
Francesca Falasca ◽  
Enrico Palermo ◽  
Ivano Mezzaroma ◽  
Caterina Fimiani ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Real Life ◽  
People Living With Hiv ◽  
Real Life Setting ◽  
Living With Hiv

Linking Cost Control to Cost Management in Healthcare Services

2018 ◽  
pp. 185-219
Author(s):  
Michele Bertoni ◽  
Bruno De Rosa ◽  
Guido Grisi ◽  
Alessio Rebelli
Keyword(s):  
Cost Control ◽  
Cost Management ◽  
Process Analysis ◽  
Real Life ◽  
Medical Personnel ◽  
Healthcare Services ◽  
Activity Based Costing ◽  
Healthcare Settings ◽  
Cost Measurement ◽  
Technical Solutions

The issue of healthcare costs has become increasingly problematic over the years. This chapter summarizes the problems faced by hospitals when measuring the costs of healthcare treatments, explaining how an Activity-Based Costing (ABC) framework can be successfully adopted in healthcare settings. After describing the theoretical foundations of cost control and cost management, the chapter continues with the analysis of three real-life applications of ABC in a hospital, drawn from the process analysis and activity-based costing experience developed at the Azienda Ospedaliero-Universitaria “Ospedali Riuniti” (Joint Hospitals) of Trieste, Italy. In particular, the cases are about cost measurement in cardiology, odontostomatology, and radiology, and describe the technical solutions applied for computing the costs of selected therapeutic and diagnostic treatments. A particular emphasis is placed on how these measures have been subsequently used by hospital managers and medical personnel in order to gain insights and to improve the efficiency of the processes developed within the organization.

Integrating Telehealth into the Organization’s Work System

2011 ◽  
pp. 161-194
Author(s):  
Joachim Jean-Jules ◽  
Alain O. Villeneuve
Keyword(s):  
Information Systems ◽  
Organizational Learning ◽  
Multilevel Model ◽  
Real Life ◽  
Healthcare Services ◽  
Learning Theories ◽  
Clinical Practices ◽  
Past Work ◽  
Work System

With increased use of telehealth to provide healthcare services, bringing telehealth technology out of experimental settings into real life settings, it is imperative to gain a deeper understanding of mechanisms underlying the assimilation of teleheath systems. Yet, there is little understanding of how information systems are assimilated by organizations, more work is then warranted to understand how telehealth can be integrated into administrative and clinical practices and to identify factors that may impinge onto telehealth integration. Borrowing from institutional, structural and organizational learning theories, the authors develop a multilevel model for understanding assimilation of telehealth systems. Their study addresses limitations of past work and will be helpful for guiding research and managerial actions while integrating telehealth in the workplace.

Wearable Systems for Monitoring Mobility Related Activities

2011 ◽  
pp. 801-824 ◽  
Author(s):  
Wiebren Zijlstra ◽  
Clemens Becker ◽  
Klaus Pfeiffer
Keyword(s):  
Real Life ◽  
Healthcare Services ◽  
Sensing Technology ◽  
Mobility Assessment ◽  
Wearable Systems ◽  
Assessment And Monitoring ◽  
Single Sensor ◽  
Wearable Monitoring Systems ◽  
Older Populations ◽  
User Perspectives

Monitoring the performance of daily life mobility related activities, such as rising from a chair, standing and walking may be used to support healthcare services. This chapter identifies available wearable motion-sensing technology; its (potential) clinical application for mobility assessment and monitoring; and it addresses the need to assess user perspectives on wearable monitoring systems. Given the basic requirements for application under real-life conditions, this chapter emphasizes methods based on single sensor locations. A number of relevant clinical applications in specific older populations are discussed; i.e. (risk-) assessment, evaluation of changes in functioning, and monitoring as an essential part of exercise-based interventions. Since the application of mobility monitoring as part of existing healthcare services for older populations is rather limited, this chapter ends with issues that need to be addressed to effectively implement techniques for mobility monitoring in healthcare.

scholarly journals Performance of the Lateral Flow Assay and the Latex Agglutination Serum Cryptococcal Antigen Test in Cryptococcal Disease in Patients with and without HIV

2020 ◽  
Vol 58 (11) ◽  
Author(s):  
Matthew A. Hevey ◽  
Ige A. George ◽  
Adriana M. Rauseo ◽  
Lindsey Larson ◽  
William Powderly ◽  
...  
Keyword(s):  
Pulmonary Disease ◽  
Real Life ◽  
Latex Agglutination ◽  
Lateral Flow ◽  
Lateral Flow Assay ◽  
People Living With Hiv ◽  
Cryptococcal Antigen ◽  
Cryptococcal Disease ◽  
Disseminated Disease ◽  
Hiv Negative

ABSTRACT Cryptococcal epidemiology is shifting toward HIV-negative populations who have diverse presentations. Cryptococcal antigen (CrAg) testing is also changing, with development of the lateral flow assay (LFA) having reported increased sensitivity and specificity, but with minimal knowledge in the HIV-negative population. In this study, we evaluate the real-life performance of CrAg testing in patients with cryptococcal disease. We conducted a retrospective review of patients with cryptococcosis from 2002 to 2019 at Barnes-Jewish Hospital. Latex agglutination (LA) was used exclusively until April 2016, at which point LFA was used exclusively. Demographics, presentations, and testing outcomes were evaluated. Serum CrAg testing was completed in 227 patients with cryptococcosis. Of 141 HIV-negative patients, 107 had LA testing and 34 had LFA testing. In patients with disseminated disease, serum CrAg sensitivity by LA was 78.1% compared to 82.6% for LFA. In patients with localized pulmonary disease, serum CrAg sensitivity was 23.5% compared to 90.9% for LFA. Of 86 people living with HIV (PLWH), 76 had LA testing, and 10 had LFA testing. Serum CrAg sensitivity for LA was 94.7% compared to 100% for LFA in patients with disseminated disease. We noted a significant improvement in sensitivity from LA testing to LFA testing, predominantly in those with localized pulmonary disease. However, both LFA and LA appear to be less sensitive in HIV-negative patients than previously described in PLWH.

scholarly journals An Observational, Prospective Survey Assessing the Control of Atrial Fibrillation in Asia Pacific: Rationale and Design of the RecordAF-AP Registry

2011 ◽  
Vol 5 ◽  
pp. CMC.S6289 ◽  
Author(s):  
John Amerena ◽  
Shih-Ann Chen ◽  
Charn Sriratanasathavorn ◽  
Jeong-Gwan Cho ◽  
Huang Dejia ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Control Strategies ◽  
Real Life ◽  
Public Health Problem ◽  
Asia Pacific ◽  
Prospective Survey ◽  
Significant Public Health Problem ◽  
Significant Public Health

Background The literature suggests that the prevalence of atrial fibrillation (AF) may be lower in Asian countries than in Western countries. Nevertheless, AF remains a significant public health problem in the region. The burden of AF, the experiences of previous trials and the lack of data on AF and its management in Asia Pacific highlight the need for a comprehensive prospective study of AF management. Methods The REgistry on Cardiac rhythm disORDers assessing the control of Atrial Fibrillation Asia Pacific (RecordAF-AP) is a prospective, observational survey of the management of recently diagnosed AF patients with 1-year follow-up in 8 countries across Asia Pacific. Eligible patients presenting with AF, treated or not, will be included in the registry and data will be recorded prospectively during follow-up visits at 6 and 12 months. Results RecordAF-AP will recruit more than 3000 patients. Study recruitment commenced in April 2009 and the final results anticipated at the end of 2011. Conclusions RecordAF-AP will assess the real-life management of AF patients in Asia Pacific, including a comparison of clinical outcomes in rhythm versus rate control strategies, providing much needed insight into the costs, treatment choices and clinical outcomes of AF patients in this region.

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