Objective: Multipurpose prevention technologies (MPTs) are an innovative class of products that deliver varied combinations of human immunodeficiency virus (HIV) prevention, other sexually transmitted infection (STI) prevention, and contraception. Combining separate strategies for different indications into singular prevention products can reduce the stigma around HIV and STI prevention, improve acceptability of and adherence to more convenient products, and be more cost-effective by addressing overlapping risks. Methods: This article outlines a strategic action framework developed as an outcome of a series of expert meetings held between 2014 and 2016. The meetings focused on identifying opportunities and challenges for MPTs that combine hormonal contraception (HC) with antiretroviral drugs into single products. The framework aims to present an actionable strategy, by addressing key research gaps and outlining the key areas for progress, to guide current and future HC MPT development. Results: We identified eight primary action areas for the development of impactful HC MPTs, and includes aspects from epidemiology, pharmacology, clinical trial design, regulatory requirements, manufacturing and commercialisation, behavioural science, and investment needs for research and development. Conclusion: Overall, the challenges involved with reconciling the critical social-behavioural context that will drive MPT product use and uptake with the complexities of research and development and regulatory approval are of paramount importance. To realise the potential of MPTs given their complexity and finite resources, researchers in the MPT field must be strategic about the way forward; increased support among policy-makers, advocates, funders and the pharmaceutical industry is critical.
Background Pediatric bronchiolitis and upper respiratory infections (URI) are almost always of viral origin and thus managed without antibiotics. Inappropriate antibiotic use for such diagnoses can contribute to antimicrobial resistance. We assessed the appropriateness of pediatric bronchiolitis and URI treatment in primary, tertiary, and urgent care settings within a large private health system in Upstate New York and compared treatment appropriateness between the three settings. Method We conducted a retrospective, observational chart review of patient visits in pediatric primary, pediatric tertiary, and urgent care settings where there was a presumptive diagnosis of bronchiolitis or URI between January 1 and December 31, 2019 using ICD-10 diagnostic codes. We assessed patient treatment for each visit as “appropriate,” “possibly appropriate,” or “inappropriate” based on extracted chart data. We performed simple proportion calculations for each treatment category in each care setting, and then compared proportions for each treatment category between settings using chi-square and logistic regression models. Results Of the 450 patient visits reviewed in each care setting, 354 primary care, 375 tertiary care, and 442 urgent care visits met the inclusion criteria. Table 1 shows the proportion of appropriate, possibly appropriate, and inappropriate visits in the primary, tertiary, and urgent care settings. The tertiary care and urgent care settings had a statistically significant proportion of possibly appropriate or inappropriate encounters at 2.4% and 4.8% respectively. In comparing odds ratios for possibly appropriate or inappropriate treatment of pediatric bronchiolitis and URIs between care settings, urgent care setting treatments were 5.77 times more likely to be inappropriate or possibly appropriate than in pediatric primary care settings (95% CI [1.71, 19.5]). Differences in treatment between primary and tertiary care settings and tertiary and urgent care settings were not statistically significant. Conclusion In 2019, nearly all reviewed encounters in the pediatric primary, pediatric tertiary, and urgent care settings within a large private health system in Upstate New York adhered to clinical guidelines for bronchiolitis and URI treatment. However, the urgent care setting had a significantly greater odds of possibly appropriate or inappropriate treatment of these pediatric infections, highlighting an opportunity for further education and intervention to improve guideline adherence for bronchiolitis and URI management in that setting.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.