Injectable Long-Acting Cabotegravir-Rilpivirine Therapy for People Living With HIV/AIDS: Addressing Implementation Barriers From the Start

ABSTRACT

Injectable cabotegravir and rilpivirine (CAB/RPV), administered bimonthly by a medical provider, is convenient and improves privacy and medication management. One year after approval, myriad implementation barriers threaten the access and sustainability of this life-saving innovation: (1) eligibility issues (viral suppression, drug resistance, and failed oral regimens); (2) injection requires medical provider and transportation to facility; (3) strict medication adherence; (4) life challenges-mental health, homelessness, joblessness; and (5) lack of insurance and high cost. Universal implementation of CAB/RPV calls for social, human, and health organizations to partner and provide HIV continuum of care and prevention services to facilitate CAB/RPV access and maintenance and for transparent health insurance billing practices to abate uncertainty concerning CAB/RPV's classification as a pharmaceutical or medical benefit and related cost implications.

Implementation of antimicrobial stewardship weekend coverage within a community hospital with a PGY-2 infectious diseases pharmacy resident

OBJECTIVES

The goal of this study was to describe the impact of expanding inpatient ASP weekend coverage with a newly established infectious diseases postgraduate second-year (ID-PGY-2) pharmacy residency program through quantification of inpatient ASP interventions. Secondary end points included comparing weekend stewardship activities before and after an ID-PGY-2 incorporated staffing model shift based on intervention quantity, type, and impact to weekends.

METHODS

This retrospective cohort study was conducted evaluating weekend Antimicrobial stewardship program (ASP) interventions documented within the electronic health record between July 1, 2021, and December 31, 2022. Groups included a single clinical pharmacist, 2 new postgraduate first-year (PGY-1) pharmacy residents, 2 experienced PGY-1 pharmacy residents, and an ID-PGY-2 responsible only for ASP coverage.

RESULTS

Eight weekends of interventions were collected per group. The median (interquartile range [IQR]) number of ASP interventions per weekend increased during ID-PGY-2 resident weekends (34 [28.75-35]) compared to a clinical pharmacist alone (5 [4-10], P < 0.001), and both new (2.5 [1.25-4], P < 0.001) and experienced (6 [3.5-10.5], P < 0.001) PGY-1 resident groups. The ID-PGY-2 resident initiated statistically significantly more interventions per protocol and interventions requiring communication with providers. The acceptance rate for interventions made via communication was similar between groups (ID-PGY-2 86.3% vs. clinical pharmacist 87.7% vs. new PGY-1 100% vs. experienced PGY-1 90.5%, P = 0.541).

CONCLUSION

Expansion of ASP services to include weekend clinical coverage with an ID-PGY-2 pharmacy resident significantly increased weekend ASP interventions in a community teaching hospital.

Society of pediatric liver transplantation: Current registry status 2011-2018

BACKGROUND

SPLIT was founded in 1995 in order to collect comprehensive prospective data on pediatric liver transplantation, including waiting list data, transplant, and early and late outcomes. Since 2011, data collection of the current registry has been refined to focus on prospective data and outcomes only after transplant to serve as a foundation for the future development of targeted clinical studies.

OBJECTIVE

To report the outcomes of the SPLIT registry from 2011 to 2018.

METHODS

This is a multicenter, cross-sectional analysis characterizing patients transplanted and enrolled in the SPLIT registry between 2011 and 2018. All patients, <18 years of age, received a first liver-only, a combined liver-kidney, or a combined liver-pancreas transplant during this study period.

RESULTS

A total of 1911 recipients from 39 participating centers in North America were registered. Indications included biliary atresia (38.5%), metabolic disease (19.1%), tumors (11.7%), and fulminant liver failure (11.5%). Greater than 50% of recipients were transplanted as either Status 1A/1B or with a MELD/PELD exception score. Incompatible transplants were performed in 4.1%. Kaplan-Meier estimates of 1-year patient and graft survival were 97.3% and 96.6%. First 30 days of surgical complications included reoperation (31.7%), hepatic artery thrombosis (6.3%), and portal vein thrombosis (3.2%). In the first 90 days, biliary tract complications were reported in 13.6%. Acute cellular rejection during first year was 34.7%. At 1 and 2 years of follow-up, 39.2% and 50.6% had normal liver tests on monotherapy (tacrolimus or sirolimus). Further surgical, survival, allograft function, and complications are detailed.

Eculizumab Therapy for Chronic Antibody-Mediated Injury in Kidney Transplant Recipients: A Pilot Randomized Controlled Trial

We hypothesized that de novo donor-specific antibody (DSA) causes complement-dependent endothelial cell injury in kidney transplants, as assessed by expression of endothelial cell-associated transcripts (ENDATs), that may be attenuated through complement inhibition. In total, 15 participants (five control, 10 treatment) with DSA and deteriorating renal function were enrolled. The treatment group received 6 mo of eculizumab followed by 6 mo of observation, whereas controls were observed. The primary end point was percentage change in estimated GFR (eGFR) trajectory over the treatment period. The treatment group had an improved eGFR trajectory versus control, based on our predetermined two-sided 0.10 significance level (p = 0.09). Within-subject analysis of treated participants at 6-mo intervals did not show significant change (p = 0.60). Modeling C1q status showed that C1q-positive patients had significantly higher mean eGFR than patients with negative C1q (p = 0.04). Biopsies revealed elevated renal ENDATs in most participants, but ENDATs were not reduced with complement inhibition. Our data suggest that eculizumab treatment may stabilize kidney function in patients with chronic persistent DSA based on our pilot a priori significance threshold. ENDAT expression predicative of acute humoral injury is not reduced with complement inhibition in this chronic setting. Further studies will be necessary to determine which patients may benefit from eculizumab.

Symptoms of depression among patients attending a diabetes care clinic in rural western Kenya

Objective

The prevalence of diabetes in sub-Saharan Africa is rising, but its relationship to depression is not well-characterized. This report describes depressive symptom prevalence and associations with adherence and outcomes among patients with diabetes in a rural, resource-constrained setting.

Methods

In the Webuye, Kenya diabetes clinic, we conducted a chart review, analyzing data including medication adherence, hemoglobin A1c (HbA1c), clinic attendance, and PHQ-2 depression screening results.

Results

Among 253 patients, 20.9% screened positive for depression. Prevalence in females was higher than in males; 27% vs 15% (p = 0.023). Glycemic control trends were better in those screening negative; at 24 months post-enrollment mean HbA1c was 7.5 for those screening negative and 9.5 for those screening positive (p = 0.0025). There was a nonsignificant (p = 0.269) trend toward loss to follow-up among those screening positive.

Conclusions

These findings suggest that depression is common among people with diabetes in rural western Kenya, which may profoundly impact diabetes control and treatment adherence.

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Patients attending a rural diabetes clinic were screened for depression.

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Screen negative patients had better glycemic control trends.

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Screen positive patients showed higher trends of loss to follow-up.

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There is need for psychological care among patients with diabetes.

Laboratory constraints on chameleon dark energy and power-law fields

We report results from a search for chameleon particles created via photon-chameleon oscillations within a magnetic field. This experiment is sensitive to a wide class of unexplored chameleon power-law and dark energy models. These results exclude 5 orders of magnitude in the coupling of chameleons to photons covering a range of 4 orders of magnitude in chameleon effective mass and, for individual models, exclude between 4 and 12 orders of magnitude in chameleon couplings to matter.

Search for chameleon particles using a photon-regeneration technique

We report the first results from the GammeV search for chameleon particles, which may be created via photon-photon interactions within a strong magnetic field. Chameleons are hypothesized scalar fields that could explain the dark energy problem. We implement a novel technique to create and trap the reflective particles within a jar and to detect them later via their afterglow as they slowly convert back into photons. These measurements provide the first experimental constraints on the couplings of chameleons to photons.

Search for axionlike particles using a variable-baseline photon-regeneration technique

We report the first results of the GammeV experiment, a search for milli-eV mass particles with axionlike couplings to two photons. The search is performed using a "light shining through a wall" technique where incident photons oscillate into new weakly interacting particles that are able to pass through the wall and subsequently regenerate back into detectable photons. The oscillation baseline of the apparatus is variable, thus allowing probes of different values of particle mass. We find no excess of events above background and are able to constrain the two-photon couplings of possible new scalar (pseudoscalar) particles to be less than 3.1x10;(-7) GeV-1 (3.5x10;(-7) GeV-1) in the limit of massless particles.

Video narration as a language sampling context

Video narration is a context for sampling spontaneous expressive language in which the subject produces an on-line description of the events he or she observes on videotape. Video narration offers a means of reducing the variability among language samples from different speakers, or from the same speaker over time, because the number and complexity of events to be coded linguistically is known and constant. This increased consistency facilitates comparisons among samples, as well as enabling certain analyses requiring a transparent relationship between utterances and events. Advantages and limitations of video narration as an adjunct to conversational sampling are described, and comparisons between longitudinal video narration and conversational samples obtained from brain-injured children and their matched normal controls are presented.