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Gait disorders in neurological diseases are frequently associated with spasticity. Intramuscular injection of Botulinum Toxin Type A (BTX-A) can be used to treat spasticity. Providing optimal treatment with the highest possible benefit–risk ratio is a crucial consideration. This paper presents a novel approach for predicting knee and ankle kinematics after BTX-A treatment based on pre-treatment kinematics and treatment information. The proposed method is based on a Bidirectional Long Short-Term Memory (Bi-LSTM) deep learning architecture. Our study's objective is to investigate this approach's effectiveness in accurately predicting the kinematics of each phase of the gait cycle separately after BTX-A treatment. Two deep learning models are designed to incorporate categorical medical treatment data corresponding to the injected muscles: (1) within the hidden layers of the Bi-LSTM network, (2) through a gating mechanism. Since several muscles can be injected during the same session, the proposed architectures aim to model the interactions between the different treatment combinations. In this study, we conduct a comparative analysis of our prediction results with the current state of the art. The best results are obtained with the incorporation of the gating mechanism. The average prediction root mean squared error is 2.99° ( R 2 = 0.85) and 2.21° ( R 2 = 0.84) for the knee and the ankle kinematics, respectively. Our findings indicate that our approach outperforms the existing methods, yielding a significantly improved prediction accuracy. [ABSTRACT FROM AUTHOR]

HIV pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention for HIV infections. PrEP persistence is critical to achieving optimal protection against HIV infection. However, little is known about PrEP persistence in the United States. This study utilized the Connecticut All-Payer Claims Database (APCD) to identify PrEP persistence among patients who filled their PrEP prescriptions in the state. The authors identified 1,576 PrEP patients who picked up PrEP prescriptions and extracted medical and pharmacy claims to evaluate a longitudinal cohort during 2012–2018 based on the Connecticut APCD. Patients who did not pick up medication for one consecutive month (ie, 30 days) were defined as discontinuing PrEP. Kaplan–Meier Survival Curve and proportional hazard regression were used to describe PrEP persistence. Of the 1,576 patients who picked up PrEP prescriptions, the median age was 32.0 (interquartile range [IQR]: 22.0–44.0). The majority were male individuals (93%). Of 1,040 patients who discontinued PrEP, 702 (67.5%) restarted PrEP at least once. The median time of PrEP persistence was 3 months (IQR: 1–6 months) for initial PrEP use. The median time on PrEP was also around 3 months in the following episodes of PrEP use. Being female, being on parent's insurance, and having high co-pays were associated with shorter periods of PrEP persistence. PrEP persistence was low among patients who picked up PrEP prescriptions. Although many patients restarted PrEP, persistence remained low during follow-up PrEP use and possibly led to periods of increased HIV risk. Effective interventions are needed to improve PrEP persistence and reduce HIV incidence. [ABSTRACT FROM AUTHOR]

Introduction: Like many countries in sub-Saharan Africa, Kenya is experiencing a rapid rise in the burden of non-communicable diseases (NCDs): NCDs now contribute to over 50% of inpatient admissions and 40% of hospital deaths in the country. The Academic Model Providing Access to Healthcare (AMPATH) Chronic Disease Management (CDM) programme builds on lessons and capacity of HIV care to deliver chronic NCD care layered into both HIV and primary care platforms to over 24,000 patients across 69 health facilities in western Kenya. We conducted a cost and budget impact analysis of scaling up the AMPATH CDM programme in western Kenya using the International Society for Pharmacoeconomics and Outcomes Research guidelines. Methods: Costs of the CDM programme for the health system were measured retrospectively for 69 AMPATH clinics from 2014 to 2018 using programmatic records and clinic schedules to assign per clinic monthly costs. We quantified the additiona costs to provide NCD care above those associated with existing HIV or acute care services, including clinician, staff, training, travel and equipment costs, but do not include drugs or consumables as they would be paid by the patient. We projected the budget impact of increasing CDM coverage to 50% of the eligible population from 2021 to 2025, and compared it with the county budgets from 2019. Results: The per visit cost of providing CDM care was $10.42 (SD $2.26), with costs at facilities added to HIV clinics $1.00 (95% CI: -$2:11 to $0.11) lower than at primary care facilities. The budget impact of adding 26,765 patients from 2021 to 2025 to the CDM programme was 3,088,928 under constant percent growth, and 3,451,732 under steady-state enrolment. Scaling up under the constant percent growth scenario resulted in 12% cost savings in the budget impact. The county programmatic CDM cost in 2025 was Conclusions: The budget impact of scaling up AMPATH's CDM programme will be driven by annual growth scenarios, and facility/provider mix. By leveraging task shifting, referral systems and partnering with public and non-profit clinics without NCD services, AMPATH's CDM programme can provide critical NCD care to new, rural populations with minimal financia impact. Keywords: budget impact; chronic care; costing; modelling; integrated; non-communicable disease; HIV, 1 | INTRODUCTION In low- and middle-income countries (LMICs), the burden of non-communicable diseases (NCD) is rapidly increasing due to ageing populations, lifestyle and dietary changes, rapid urbanization, and improved [...]

Objective To analyse the effect of enrolment in the public health insurance scheme known as Seguro Popular [People's Insurance] on access to health resources, treatment and blood glucose control among poor adults with diabetes in Mexico. Methods We analysed cross-sectional data from the 2006 National Health and Nutrition Survey and compared health care access and biological health outcomes, specifically glycosylated haemoglobin (HbA1c) levels, among adults with diabetes who were enrolled in the Seguro Popular (treatment group) and those who had no health insurance (control group). Standard propensity score matching was used to create a highly comparable control group. Findings Adults with diabetes who were enrolled in the Seguro Popular had significantly more access than comparable uninsured adults to some type of blood glucose control test (by a difference of 9.5 percentage points; 95% confidence interval, CI: 2.4-16.6) and to insulin injections (3.13 more per week; 95% CI: 0.04-6.22). Those with insurance were also significantly more likely to have appropriately-controlled blood glucose levels (HbA1c [less than or equal to] 7%) than their uninsured counterparts (by a difference of 5.6 percentage points; 95% CI: 0.9-10.3). Very poor glucose control (HbA1c > 12%) was found in a significantly Smaller proportion of adults in the insured group than in the uninsured group (by a difference of 17.5 percentage points; 95% CI: 6.5-28.5). Conclusion The Seguro Popular appears to have improved access to health care and blood glucose control among poor adults with diabetes in Mexico, and it may have had a positive effect on the management of other chronic health conditions, but its long-term effects are yet to be demonstrated. Although the findings are most relevant to Mexico, they may also be applicable to other developing countries seeking to improve health-care coverage for the poor by expanding their public health insurance programmes. Objectif Analyser l'effet de la couverture par le schema d'assurance sante publique appele Seguro Popular (Assurance du peuple) sur racces aux ressources de sante, au traitement et au controle de la glycemie pour les adultes pauvres et diabetiques du Mexique. Methodes Nous avons analyse des donnees transversales provenant de l'Enquete nationale sur la sante et la nutrition de 2006 et compare l'acces aux soins de sante et les resultats biologiques, notamment les taux d'hemoglobine glyquee (HbA1c), chez des adultes diabetiques beneficiant de Seguro Popular (groupe traite) et chez des adultes diabetiques depourvus d'assurance sante (groupe temoin), On a fait appel a l'appariement par scores de propension standard pour constituer un groupe temoin hautement comparable. Resultats Les adultes diabetiques beneficiant de Seguro Popular disposaient d'un acces significativement plus important que les adultes comparables non assures a certains types de controles de la glycemie (difference de 9,5 points de pourcentage ; intervalle de confiance a 95 %, IC : 2,4-16,6) et aux injections d'insuline (3,13 de plus par semaine ;IC a 95 % : 0,04-6,22). Les individus assures avaient une probabilite significativement plus elevee de presenter une glycemie correctement controlee (HbA1c [less than or equal to] 7 %) que leurs homologues non assures (difference de 5,6 points de pourcentage ;IC a 95 % : 0,9-10,3). On a releve une proportion significativement plus faible d'adultes presentant un controle de la glycemie tres insatisfaisant (HbA1c > 12 %) dans le groupe assure que dans le groupe non assure (difference de 17,5 points de pourcentage ;IC a 95 % : 6,5-28,5). Conclusion l'assurance Seguro Popular semble avoir ameliore l'acces aux soins de sante et au controle de la glycemie pour les adultes pauvres et diabetiques du Mexique et pourrait avoir eu un effet positif sur la prise en charge d'autres maladies chroniques. Neanmoins, ses effets a long terme restent a demontrer. Si ces resultats concernent principalement le Mexique, ils peuvent aussi etre applicables a d'autres pays en developpement desireux d'ameliorer la couverture des plus demunis par les soins de sante a travers l'elargissement de leurs programmes d'assurance sante publique. Objetivo Analizar los efectos de la cobertura por el plan de seguro medico publico conocido como Seguro Popular en el acceso a los recursos de salud y el tratamiento y control de la glucemia entre los adultos pobres con diabetes en Mexico. Metodos Analizamos datos transversales de la Encuesta Nacional de Salud y Nutricion de 2006 a fin de comparar el acceso a la atencion de salud y el valor de variables biologicas, concretamente de los niveles de glucohemoglobina (HbA1c), en adultos con diabetes beneficiarios del Seguro Popular (grupo de tratamiento) y en una poblacion similar que carecia de seguro de enfermedad (grupo control). Se utilizo el metodo estandar de apareamiento segun propension para crear un grupo control altamente comparable. Resultados Los adultos con diabetes beneficiarios del Seguro Popular disfrutaron de un acceso significativamente mayor que los adultos no asegurados comparables a algun tipo de prueba de control de la glucemia (diferencia de 9,5 puntos porcentuales, con un intervalode confianza, IC, del 95% de 2,4-16,6) y a inyecciones e insulina (3,13 mas por semana; IC95%: 0,04-6,22). Los acogidos al seguro tenian tambien una mayor probabilidad de presentar una glucemia bien controlada (HbA1c [menor que o igual a] 7%) que sus homologos no asegurados (diferencia de 5,6 puntos porcentuales; IC95%: 0,9-10,3). En el grupo asegurado se observo que la proporcion de adultos con un control muy deficiente de la glucosa (HbA1c > 12%) era significativamente inferior a la hallada en el grupo no asegurado (diferencia de 17,5 puntos porcentuales; IC95%: 6,5-28,5). Conclusion El Seguro Popular parece haber mejorado el acceso a la atencion de salud y el control de la glucemia entre los adultos pobres con diabetes de Mexico, y puede haber tenido un efecto positivo en el tratamiento de otras dolencias cronicas, pero quedan por demostrar sus efectos a largo plazo. Aunque los resultados son de especial interes para Mexico, posiblemente pueden aplicarse tambien a otros paises en desarrollo que aspiran a mejorar la cobertura de atencion sanitaria de la poblacion pobre ampliando sus programas de seguro medico publico., Introduction Lack of health insurance can deprive the poor of access to services or put them at risk of financial hardship. To protect the poor against excessive health expenditures, many [...]

Introduction: Successful population-level antiretroviral therapy (ART) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale-up and, ultimately, the end of AIDS. Although many people living with HIV are adhering well, others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy. Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource-limited settings. Methods: In July 2015, the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in resource-limited settings. This article summarizes that discussion with recent updates. It is not a systematic review, but rather provides practical considerations for programme implementation based on evidence from individual studies, systematic reviews, meta-analyses, and the World Health Organization Consolidated Guidelines for HIV, which include evidence from randomized controlled trials in low- and middle-income countries. Interventions are categorized broadly as education and counselling; information and communication technology-enhanced solutions; healthcare delivery restructuring; and economic incentives and social protection interventions. Each category is discussed, including descriptions of interventions, current evidence for effectiveness, and what appears promising for the near future. Approaches to intervention implementation and impact assessment are then described. Results and discussion: The evidence base is promising for currently available, effective, and scalable ART adherence interventions for resource-limited settings. Numerous interventions build on existing health care infrastructure and leverage available resources. Those most widely studied and implemented to date involve peer counselling, adherence clubs, and short message service (SMS). Many additional interventions could have an important impact on ART adherence with further development, including standardized counselling through multi-media technology, electronic dose monitoring, decentralized and differentiated models of care, and livelihood interventions. Optimal targeting and tailoring of interventions will require improved adherence measurement. Conclusions: The opportunity exists today to address and resolve many of the challenges to effective ART adherence, so that they do not limit the potential of ART to help bring about the end of AIDS. Keywords: HIV; antiretroviral therapy adherence; interventions; resource-limited settings, Introduction Antiretroviral therapy (ART) has transformed HIV infection from a terminal disease into a manageable chronic illness [1]. ART can also reduce viral load (i.e. HIV RNA levels) and the [...]

Introduction In 2012 alone, there were 2.3 million new HIV infections globally, of which 1.9 million were in countries marked by poverty [1]. Even in the affluent United States, approximately [...]

Introduction: The objective of this article is to present the rationale and baseline results for a randomized controlled pilot trial using economic incentives to reduce HIV and sexually transmitted infection (STI) risk among male sex workers (MSWs) in Mexico City. Methods: Participants (n =267) were tested and treated for STIs (chlamydia, gonorrhoea, syphilis and HIV) and viral hepatitis (hepatitis B and C), received HIV and STI prevention education and were randomized into four groups: (1) control, (2) medium conditional incentive ($50/six months), (3) high conditional incentive ($75/six months) and (4) unconditional incentive ($50/six months). In the conditional arms, incentives were contingent upon testing free of new curable STIs (chlamydia, gonorrhoea and syphilis) at follow-up assessments. Results: Participants' mean age was 25 years; 8% were homeless or lived in a shelter, 16% were unemployed and 21% lived in Mexico City less than 5 years. At baseline, 38% were living with HIV, and 32% tested positive for viral hepatitis or at least one STI (other than HIV). Participants had a mean of five male clients in the previous week; 18% reported condomless sex with their last client. For 37%, sex work was their main occupation and was conducted mainly on the streets (51%) or in bars/discotheques (24%) and hotels (24%). The average price for a sex transaction was $25 with a 35% higher payment for condomless sex. Conclusions: The findings suggest that economic incentives are a relevant approach for HIV prevention among MSWs, given the market-based inducements for unprotected sex. This type of targeted intervention seems to be justified and should continue to be explored in the context of combination prevention efforts. Keywords: male sex workers; men who have sex with men; conditional cash transfer; conditional economic incentives; HIV/STI prevention; risk premium; compensating differential; Mexico., Introduction Mexico, a country of 112 million people, has a concentrated HIV epidemic [1] with an HIV prevalence of 0.3% in the adult population (15-49 years), 16.9% among men who [...]