Willingness to Pay for Antiretroviral Drugs Covered by Medical Insurance among People Living with HIV in 18 Chinese Cities

Objective Antiretroviral drugs covered by medical insurance have been gradually used by people living with human immunodeficiency virus(PLWH)in recent years in China.This study aimed to analyze their willingness to pay(WTP)for antiretroviral drugs.Methods A mixed-methods study design involving a cross-sectional survey and in-depth interviews was conducted.A cross-sectional survey was performed to collect data on the general characteristics,economic status,antiretroviral therapy(ART)status,and WTP of PLWH in 18 Chinese cities from August 2022 to February 2023.Multivariate logistic regression was used to analyze the factors associated with WTP.Representatives of PLWH were interviewed via in-depth interviews,and the data were thematically analyzed.Results Among the 941 PLWH,271(28.80%)were willing to pay for antiretroviral drugs covered by medical insurance.For basic medical insurance for urban and rural residents,PLWH with the following characteristics were more willing to pay:an educational level of senior high school or technical secondary school,having an undergraduate degree or higher,frequently working away from their hometowns,and homosexual transmission.Off-farm workers and recipients of government medical aid were more unwilling to pay.For basic medical insurance for urban employees,PLWH with the following characteristics were more willing to pay:frequently working away from their hometowns;homosexual transmission;personal annual income≥100,000 CNY;and adverse events of antiretroviral drugs.The main reasons for PLWH’s WTP for antiretroviral drugs covered by medical insurance were that the drugs had fewer adverse events and were easier to administer.The main reasons for PLWH’s unwillingness to pay were financial difficulties and privacy concerns.Conclusion Nearly one-third of PLWH are willing to pay for antiretroviral drugs covered by medical insurance.In the future,PLWH with a high WTP can be guided to use these drugs.

An Assessment of the Level of Knowledge of HIV-Infected Patients about Highly Active Antireteroviral Therapy and Waiting Times and Their Influence on Antiretroviral Therapy Adherence at a Primary Healthcare Centre of South Africa

Objectives： The study assessed if the level of knowledge of HIV-infected about HAART and waiting-times in the PHC （primary healthcare） clinic have an influence on antiretroviral adherence. Methods： A descriptive-cross-sectional study was conducted in South Africa. Data collected uses a standardized-questionnaire and face-to-face-exit interviews. Pill-count technique was performed and a value of≥ 95% acceptable. Data were analysed using SPSS. Univariate-factors associated with poor-adherence to knowledge about HAART and waiting times were assessed using ANOVA and p ≤ 0.05 considered statistically significant. Key findings： Of 86 enrolled, 63（73.3%） were females and 23（26.7%） males, with mean-age （± SD） of 35.6（±9.6） years and on HAART for 35.5（± 31.8） months ranging from 1-137. Of these, 27（31.40%） and 25（29.07%） were on WHO stages 2 and 3 respectively. Adherence-rates computed from 32 patients, 23（71.9%） revealed poor adherence-rates. The level of knowledge about HAART in terms of names of tablets, correct-dose, frequency, adverse-effects had no influence on ARV-adherence （p _〉 0.05）. Of 23 non-compliant, 10 （40%） gave the reason of drugs-unavailability, 7（30%） adverse-effects, 5（20%） drugs＇ complexity, and 1（10%） too busy to take them. Waiting areas associated with poor ARV-adherence were reception （p = 0.028）, doctors （p = 0.027）, while nurse＇s station （p = 0.29） and pharmacy （p = 0.43） revealed acceptable ARV-adherence.

Differential Pulse Voltammetric Studies on Lamivudine:An Antiretroviral Drug

Lamivudine (also known as 3TC) is a dideoxynucleoside analogue, which undergoes intracellular phosphorylation in the putative active metabolite, lamivudine triphosphate. Lamivudine triphosphate prevents HIV replication by competitively inhibiting viral reverse transcriptase. Lamivudine has been extensively used in the treatment of HIV patients owing to its antiretroviral activity. For the determination of lamivudine in pharmaceuticals, an analytical methodology using voltammetry was developed. Lamivudine was reduced at a hanging mercury drop electrode (HMDE) at –1.16 V vs Ag/AgCl at pH 2.0. The influence of electroanalytical parameters such as scan rate (20 mV.s–1), amplitude (50 mV), nature of the support electrolyte (Clark-Lubs), and pH (2.0) on the voltammetric signal was optimized. Under these optimized conditions, the method had been validated using pharmaceutical formulations. The lamivudine peak current varied linearly with its concentration from 1.15 to 10.40 mg.L–1, detection and determination limits of 0.46 and 1.0 mg.L–1, respectively, and recovery of 95.15% with a relative standard deviation of 1.10%.

Antiretroviral Drug Distribution Routing System in Limpopo Province of South Africa

This study was concerned with developing an antiretroviral drug distribution routing system with a goal of improving fleet utilization whilst reducing delivery costs. The system would enhance ARV drug delivery satisfaction of patients staying in the Limpopo province of South Africa. A VRP mathematical programming problem was formulated and the Savings Based as well as the Sequential Insertion algorithm was used to solve the problem. A mini program was then developed in Visual Basic.Net software that speeded up the vehicle route determination heuristics. This computer based vehicle routing system gave a total travelled distance of 1302.94 km and a space utilization of 93% as compared to the pigeonhole system which had a total travelled distance of 2874.2 km and space utilization of 86% for the demand of 5384 ARV drug patients. Therefore, the mathematical programming approach is more cost effective and efficient thereby enhancing delivery satisfaction to ARV drug patients in the province.

Prevalence of Metabolic Syndrome in HIV-Infected Cameroonian Patients

Aims: Metabolic complications related to antiretroviral therapy are rarely investigated among HIV-infected patients in Cameroon. The study reports the prevalence of metabolic syndrome and its individual components among HIV-infected Cameroonians. Materials and Methods: We conducted a prospective, cross-sectional study of the prevalence of metabolic syndrome among 492 patients (338 women, 117 men;age range 20 years) recruited at a reference centre, the day hospital, Central Hospital in Yaounde between September 2009 and September 2010. Metabolic syndrome was defined according to IDF (International Diabetes Federation) and NCEP ATP III (National Cholesterol Education Program Adult Treatment Panel III) criteria relative to obesity, glycemic, lipid, arterial blood pressure parameters. Results: The prevalence of metabolic syndrome was 32.8% according to IDF and 30.7% by NCEP (p = 0.0001). The prevalences of individual components according to IDF and NCEP were as follows: abdominal obesity (40.5%;26.9% respectively), hypertriglyceridemia (55.5%), low HDL cholesterol (42.5%), systolic hypertension (38.2%) diastolic hypertension (28.5%), hyperglycemia (31.2%;1.3% p = 0.0001). The prevalence of metabolic syndrome was 36% in patients under HAART, 23.4% in naive, (p = 0.0001). Conclusion: The prevalence of metabolic syndrome depends on the presence and the type of HAART used, the definition and the gender.

Anti-retroviral drugs: current state and development in the next decade

The pace of discovery of new antiretroviral(ARV) drugs has slowed, although the efficacy and safety of once-daily fixed dose combinations have been extensively investigated. Several traditional ARV drugs remain in phase Ⅲ clinical trials. This review summarizes current information on ARV drugs in phase Ⅲ clinical trials and focuses on the development of ARV drugs in the next decade.

Optimal control of combined antiretroviral therapies in an HIV infection model with cure rate and fusion effect

This paper mainly targets to deduce an optimal treatment strategy for combined antiretroviral drugs,which can maximize healthy CD4^(+)T cells level with minimum side effects and cost.For this purpose,we consider a within-host treatment model for the HIV infection with two controls incorporating full logistic proliferation of healthy CD4^(+)T cells,cure rate and fusion effect.These two controls represent the effects of reverse transcriptase inhibitors(RTIs)and protease inhibitors(PIs),respectively.The model analysis begins with proving different basic properties like non-negativity,boundedness of the model solutions and calculation of the basic reproduction number of the model under consideration.Then,stability results are obtained for HIV infection-free equilibrium point and also,a critical efficacy for the combined therapies is calculated.After that,the optimal control problem is proposed and solved numerically using a forwardbackward iterative method.Finally,we obtain an optimal treatment strategy that can maximize healthy CD4^(+)T cells count and control the viral load,and HIV-infected CD4^(+)T cells count to an undetectable level resulting in improved health conditions of infected individuals.

The impact of a Wastewater Treatment Works in Southern Gauteng, South Africa on efavirenz and nevirapine discharges into the aquatic environment

There has been growing concern regarding the pollution of the aquatic environment with synthetic organic chemicals.Antiretroviral drugs,such as efavirenz and nevirapine,are pharmaceutical drugs and are referred to as emerging contaminants.Such drugs can be environmentally persistent and may be expected to pose potential risks to drinking water supplies.Sources of pharmaceutical drugs include effluents from Wastewater Treatment Works(WWTPs),hospital and pharmaceutical production facilities and the incorrect disposal of unused and expired medicines.Currently there are no monitoring programs and legislative guidelines for their regulations in South Africa.The aims of this study were firstly to develop a semi-quantitative method to extract and analyse efavirenz and nevirapine in the primary settling tank sludge.Secondly to use that method,and an existing method for liquid wastewater samples,to monitor the concentrations of efavirenz and nevirapine as the wastewater passes through the different stages of purification(anoxic;aerobic;pre and post chlorination)in the WWTP.This was repeated weekly over a period of 4 weeks.Thirdly,to determine if binding of efavirenz and nevirapine to the solids in the WWTP played a role in the removal of these compounds from the WWTP liquid phase.No references to the analysis of ARVDs in WWTP sludge were found in the literature.Grab samples of wastewater and sludge samples were collected from a WWTP(activated sludge treatment process)weekly for 4 weeks.Liquid samples were extracted solid phase extraction,solid samples were extracted using sonication followed by a QuEChERs clean-up.Sample extracts were then subjected to gas chromatography-time of flight mass spectrometry for analyte determination.Efavirenz concentrations entering the WWTP ranged between 5500 to almost 14000 ng/L.The removal of efavirenz by the WWTP ranged between 27 and 71%.The largest removal occurred in the anoxic zone,smaller amounts were removed in the aerators.Slight increases in efavirenz concentrations were found after chlorination and the final effluent into the river post maturation ponds again were slightly lower.Solids were found to contain efavirenz at concentrations between 17 and 43 mg/kg dried primary settling tank sludge and it is proposed that this binding to the solids is the main mechanism of removal of efavirenz from the wastewater stream as it passes through the WWTP.Although an order of magnitude lower nevirapine concentrations displayed the opposite behaviour and gradually increased through the various stages of purification in the WWTP.Minor fluctuations occurred but the concentrations of nevirapine were higher at the effluent(between 92 and 473 ng/L)than those entering the WWTP.No nevirapine was detected in the PST sludge.The increase in nevirapine concentrations are likely to be the result of the de-conjugation of the hydroxylated metabolites of nevirapine in the WWTP,its resistance to degradation and the lack of binding of the nevirapine to the PST sludge.