Evaluating the Introduction of COVID-19 Oral Antivirals Through a Test and Treat Programme: Implementation Research in Four African Countries
Опубликована: Янв. 1, 2025
Introduction:
Access
to
oral
antivirals
like
nirmatrelvir/ritonavir
treat
COVID-19
remains
largely
unavailable
across
Africa.
Ghana,
Malawi,
Rwanda
and
Zambia,
all
members
of
the
COVID
Treatment
QuickStart
Consortium,
leveraged
existing
infrastructure
rapidly
commence
test-and-treat
programs.
We
describe
individual-level
impact
within
cascade
care.Methods:
A
retrospective
cohort
study
was
conducted
in
36
facilities
four
countries
that
captured
data
on
SARS-CoV-2
positive
individuals
who
were
screened
for
treatment.
criteria
included
being
high-risk
severe
disease
progression,
presenting
five
days
symptom
onset,
having
mild-to-moderate
severity;
treatment
eligibility
ultimately
determined
by
trained
healthcare
workers.Findings:
From
1,941
participants,
50·2%
eligible
while
65·2%
prescribed
nirmatrelvir/ritonavir.
Among
those
prescribed,
1,265
(73·2%)
received
follow-up,
among
whom
99·4%
confirmed
initiation
97·6%
completed
five-day
course.
Two
serious
adverse
events
reported,
but
neither
attributed
nirmatrelvir/ritonavir.Interpretations:
These
are
first
suggest
antiviral
can
be
quickly,
efficiently
safely
deployed
lower-
middle-income
countries,
parallel
with
implementation
research.
Programs
integrated
their
response
into
health
service
infrastructure,
allowing
decentralization
demonstrating
introducing
newly
developed
diagnostics
government
systems
is
feasible
lower-resourced
settings
during
emergencies.
Equitable
timely
access
treatments
crucial
combat
emerging
global
threats
achieve
equity.Funding:
Open
Society
Foundations,
Conrad
N.
Hilton
Foundation,
Pfizer
funded
had
no
role
research.Declaration
Interest:
Christian
Ramers
served
Advisory
Board
consulting
fees
he
has
also
or
honoraria
from
Gilead
Sciences,
Viiv,
AbbVie.
All
other
authors
declare
competing
interests.Ethical
Approval:
This
approved
Duke
University
Institutional
Review
(Pro00111388),
Ghana
Health
Services
Ethics
Committee
(017/11/22),
National
Sciences
Research
Committee,
Malawi
(#23/03/4025),
(105/RNEC/2023),
ERES
Converge
(Zambia)
(23-Jan-023).
Язык: Английский
Association between nirmatrelvir/ritonavir treatment and antibiotic prescribing in the outpatient setting among patients with COVID-19
Microbiology Spectrum,
Год журнала:
2025,
Номер
unknown
Опубликована: Март 5, 2025
Coronavirus
disease
2019
(COVID-19)
has
complicated
the
management
of
acute
respiratory
infections
and
impacted
antibiotic
use.
We
assessed
relationship
between
nirmatrelvir/ritonavir
(NMV/r)
receipt
outpatient
prescribing
among
patients
with
COVID-19
in
a
large
national
health
system.
conducted
retrospective
cohort
study
outpatients
enrolled
Veterans
Affairs
Healthcare
System
who
had
positive
severe
syndrome
coronavirus
2
test
or
diagnosis
were
eligible
for
NMV/r
treatment
1
April
2022
31
March
2024.
NMV/r-treated
compared
those
did
not
receive
considered
unexposed
until
was
dispensed.
being
prescribed
an
30
days
after
using
adjusted
Cox
proportional
hazards
regression.
included
302,600
NMV/r-eligible
COVID-19,
whom
67,649
received
234,951
NMV/r.
less
likely
to
antibiotics
(7.2%
[4,901/67,649]
vs
9.2%
[21,533/234,951],
respectively;
hazard
ratio
[HR]
0.65,
95%
CI:
0.63‒0.68).
After
excluding
prescription
upon
(i.e.,
empiric
therapy),
this
attenuated
(HR:
0.91,
0.87‒0.95).
35%
be
NMV/r,
possibly
driven
by
diminished
perceived
need
therapy.
Treatment
may
reduce
unnecessary
Antibiotics
should
reserved
high
suspicion
bacterial
co-infection.IMPORTANCEAntimicrobial
resistance,
overuse
antibiotics,
is
major
global
threat.
The
pandemic
issue,
often
despite
ineffective
against
viruses.
These
practices,
typically
aimed
at
preventing
empirically
treating
rare
co-infections,
have
raised
concerns
about
accelerating
resistance.
antiviral
(NMV/r),
widely
used
high-risk
prevent
illness,
offers
opportunity
reassess
use
infections.
Our
over
300,000
healthcare
system
found
that
treated
than
antiviral.
Lower
reflect
reduction
findings
highlight
potential
role
antivirals
supporting
stewardship
addressing
critical
public
challenge.
Язык: Английский
Predictors of nirmatrelvir–ritonavir receipt among COVID-19 patients in a large US health system
Scientific Reports,
Год журнала:
2024,
Номер
14(1)
Опубликована: Март 29, 2024
Abstract
A
clear
understanding
of
real-world
uptake
nirmatrelvir–ritonavir
for
treatment
SARS-CoV-2
can
inform
allocation
strategies
and
improve
interpretation
effectiveness
studies.
We
used
data
from
a
large
US
healthcare
system
to
describe
dispenses
among
all
positive
patients
aged
≥
12
years
meeting
recommended
National
Institutes
Health
eligibility
criteria
the
study
period
between
1
January
31
December,
2022.
Overall,
10.9%
(N
=
34,791/319,900)
eligible
with
infections
received
over
period.
Although
increased
time,
by
end
2022,
less
than
quarter
had
nirmatrelvir–ritonavir.
Across
patient
demographics,
was
generally
consistent
tiered
guidelines,
concentrated
65
(14,706/63,921;
23.0%),
multiple
comorbidities
(10,989/54,431;
20.1%).
However,
neighborhoods
lower
socioeconomic
status
(upper
third
neighborhood
deprivation
index
[NDI])
12%
(95%
CI:
7–18%)
28%
(25–32%)
odds
dispense
time
periods
studied
compared
NDI
distribution,
even
after
accounting
demographic
clinical
characteristics.
limited
chart
review
40)
confirmed
that
in
some
cases
decision
not
treat
appropriate
aligned
national
guidelines
use
judgement
on
case-by-case
basis.
There
is
need
enhance
provider
awareness
availability
benefits
COVID-19
illness.
Язык: Английский
Severe Acute Respiratory Syndrome Coronavirus 2 Plasma Antibody and Nucleocapsid Antigen Status Predict Outcomes in Outpatients With Coronavirus Disease 2019
Clinical Infectious Diseases,
Год журнала:
2024,
Номер
79(4), С. 920 - 927
Опубликована: Июль 17, 2024
Reliable
biomarkers
of
coronavirus
disease
2019
(COVID-19)
outcomes
are
critically
needed.
We
evaluated
associations
spike
antibody
(Ab)
and
plasma
nucleocapsid
antigen
(N
Ag)
with
clinical
in
nonhospitalized
persons
mild-to-moderate
COVID-19.
Язык: Английский
Coronavirus Disease 2019 Rebound in Nirmatrelvir Plus Ritonavir Treatment and Control Groups: A Prospective Cohort Study
Research Square (Research Square),
Год журнала:
2024,
Номер
unknown
Опубликована: Ноя. 6, 2024
Abstract
Observation
of
COVID-19
rebound
after
Nirmatrelvir
Plus
Ritonavir
(NPR)
has
driven
important
questions
surrounding
one
the
only
direct
acting
antiviral
treatments
for
COVID-19.
This
prospective
cohort
study
to
investigate
incidence
enrolled
917
positive
outpatients
via
a
digital
proctored
test-to-treat
solution.
Among
669
included
in
evaluation
493
intended
take
NPR
and
176
did
not.
Participants
were
provided
frequent
tests
symptom
surveys
15
days.
Time
initial
viral
or
clearance
was
not
different
between
groups.
Overall,
15-day
three-fold
higher
group
(15.2%
vs
5.4%,
p
<0.001)
double
(16.4%
8.4%,
<0.01).
those
experiencing
resolution,
resolution
notably
(43.8%
17.5%).
demonstrates
that
while
occurs
both
treated
untreated
outpatients,
is
group.
Язык: Английский
A Majority Of Americans Have No Or Low Awareness Of Paxlovid, The At-Home COVID-19 Treatment
Health Affairs,
Год журнала:
2024,
Номер
43(10), С. 1428 - 1437
Опубликована: Сен. 25, 2024
Oral
Paxlovid
(nirmatrelvir-ritonavir)
is
highly
effective
at
preventing
hospitalization
and
death
from
COVID-19,
yet
it
has
been
remarkably
underused,
even
by
patients
highest
risk
since
its
December
2021
introduction
in
the
US.
The
reasons
behind
this
underuse
are
still
unclear.
To
examine
public
awareness
perceptions
of
that
might
help
explain
underuse,
we
conducted
a
nationally
representative
survey
1,430
US
adults
July
2023.
A
majority
respondents
(85
percent)
had
no
or
low
Paxlovid,
including
31
percent
who
never
heard
it.
Even
among
those
were
aware
drug,
many
held
misperceptions
about
effectiveness
(39
percent),
adverse
effects
(86
requisite
timing
(61
could
lead
to
underuse.
Lower
more
common
medically
vulnerable
disadvantaged
populations
benefit
most
access,
unvaccinated
against
with
lower
levels
education,
Black
Hispanic
Latino
adults.
Results
suggest
may
be
partly
driven
lack
communication
generate
knowledge
leading
demand.
As
loses
full
government
subsidies,
further
outreach
needed
ensure
accesses
when
needed.
Язык: Английский
A Retrospective Claims Data Analysis on the Burden of COVID-19-Related Hospitalization in Adults at High Risk for Severe Disease Progression in Germany
T Stremel,
S Schnaidt,
Nicole Bihrer
и другие.
Infectious Diseases and Therapy,
Год журнала:
2024,
Номер
unknown
Опубликована: Дек. 8, 2024
Individuals
at
increased
risk
of
severe
coronavirus
disease
2019
(COVID-19)
progression
have
a
higher
probability
being
hospitalized.
Nirmatrelvir/ritonavir
(NMV/r)
is
an
antiviral
drug
aiming
to
prevent
courses.
Our
study
aimed
assess
the
resource
utilization
and
costs
adults
hospitalized
for
COVID-19
high
progression.
A
retrospective
was
conducted
using
German
claims
data.
The
presence
high-risk
criteria
determined
through
recorded
diagnoses,
operations,
procedures,
prescriptions.
progression,
primarily
COVID-19,
required
diagnosis
additionally
sepsis,
pulmonary
embolism,
acute
respiratory
failure,
pneumonia,
or
remdesivir
prescription.
Patients
were
grouped
by
eligibility
NMV/r
treatment
(eligible,
eligible
with
restrictions,
not
eligible).
outcomes
interest
reported
timeframe
last
dominant
virus
variant
available
in
database,
i.e.,
Delta
(June
21,
2021
December
31,
2021).
Of
approximately
3.7
million
individuals
continuously
observable
about
60%
identified
as
Among
individuals,
2938
patients
between
June
2021,
two-thirds
which
suitable
(half
without
restrictions).
Advanced
age
(86.3%)
cardiovascular
conditions
(83.9%)
most
prevalent
predefined
factors.
Identified
stayed,
on
average,
11.3
days
hospital,
inpatient
mortality
18.9%.
These
COVID-19-related
hospitalizations
resulted
mean
healthcare
€8728.
This
reflects
economic
burden
adult
from
payer's
perspective
Germany.
findings
highlight
need
courses
associated
relieve
systems
regarding
allocation.
Язык: Английский
Coronavirus Disease 2019 Antiviral Medication Use Among Pregnant and Recently Pregnant US Outpatients
Clinical Infectious Diseases,
Год журнала:
2024,
Номер
unknown
Опубликована: Ноя. 25, 2024
Pregnant
people
are
at
risk
of
severe
coronavirus
disease
2019
(COVID-19)
and
associated
complications.
While
withholding
treatment
from
pregnant
patients
is
not
recommended,
little
known
about
the
frequency
antiviral
medication
use
during
pregnancy.
Using
Medicaid
commercial
insurance
databases,
we
constructed
a
national
claims-based
cohort
study
pregnant,
recently
nonpregnant
female
18-49
years
old
with
an
outpatient
diagnosis
COVID-19
between
21
December
2021
30
September
2022.
Outpatient
recommended
was
identified
within
5
days
diagnosis,
using
drug
codes
in
prescription
claims.
Propensity
score-matched
prevalence
ratios
(PRs)
were
used
to
compare
by
pregnancy
status.
A
total
412
755
publicly
privately
insured
identified,
including
33
855
currently
2460
376
440
patients;
6.8%
had
record
use,
1.3%
5.4%
7.3%
women.
Most
commonly
ritonavir-boosted
nirmatrelvir
administered.
The
67%
lower
among
compared
(PR,
0.33
[95%
confidence
interval,
.30-.36]),
even
≥1
high-risk
medical
condition
(0.29
[.25-.33]).
Antiviral
slightly
women
than
similar
conditions
0.57;
.44-.72]).
Despite
US
clinical
guidelines,
observed
low
rates
for
patients,
indicating
possible
missed
opportunities
treat
illness
lactation.
Язык: Английский