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Introduction High childhood vaccine adherence is critical for disease prevention, and poverty is a key barrier to vaccine uptake. Interventions like microfinance programs that aim to lift individuals out of poverty could thus improve vaccine adherence of the children in the household. BIGPIC Family Program in rural Western Kenya provides group-based microfinance services while working to improve access to healthcare and health screenings for the local community. The aim of the present paper is to evaluate the association between household participation in BIGPIC's microfinance program and vaccine adherence among children in the household. We hypothesize that microfinance group participation will have a positive impact on vaccine adherence among children in the household. Methods From 2018 to 2019, we surveyed a sample of 300 participants from two rural communities in Western Kenya, some of whom were participants in the BIGPIC Family's microfinance program. The primary outcome of interest was vaccine adherence of children in the household. Log-binomial models were used to estimate the relationship between microfinance group participation and vaccine adherence, adjusted for key covariates. We also assessed whether the relationship differed by gender of the adult respondent. Results Microfinance group members were more likely to have all children in their households fully vaccinated [aPR (95% CI): 1.68 (1.20,2.35)] compared to non-microfinance group members. Further, the association was stronger when women were the microfinance members [PR (95% CI): 1.87 (1.27,2.76)] compared to men [PR (95% CI): 1.24 (0.81,1.90)]. Conclusions Microfinance participation was associated with higher childhood vaccine adherence in rural Western Kenya. Microfinance interventions should be further explored as strategies to improve child health and well-being in low- and middle-income countries., Author(s): Jessica E. Deyoe [sup.1] , James Akiruga Amisi [sup.2] [sup.9] , Daria Szkwarko [sup.2] [sup.3] [sup.4] , Dan N. Tran [sup.2] [sup.5] , Maya Luetke [sup.1] , Sina Kianersi [...]

Problem The coronavirus disease 2019 (COVID-19) pandemic has disrupted health systems worldwide and threatened the supply of essential medicines. Especially affected are vulnerable patients in low- and middle-income countries who can only afford access to public health systems. Approach Soon after physical distancing and curfew orders began on 15 March 2020 in Kenya, we rapidly implemented three supply-chain strategies to ensure a continuous supply of essential medicines while minimizing patients' COVID-19 exposure risks. We redistributed central stocks of medicines to peripheral health facilities to ensure local availability for several months. We equipped smaller, remote health facilities with medicine tackle boxes. We also made deliveries of medicines to patients with difficulty reaching facilities. Local setting To implement these strategies we leveraged our 30-year partnership with local health authorities in rural western Kenya and the existing revolving fund pharmacy scheme serving 85 peripheral health centres. Relevant changes In April 2020, stocks of essential chronic and non-chronic disease medicines redistributed to peripheral health facilities increased to 835 140 units, as compared with 316 330 units in April 2019. We provided medicine tackle boxes to an additional 46 health facilities. Our team successfully delivered medications to 264 out of 311 patients (84.9%) with noncommunicable diseases whom we were able to reach. Lessons learnt Our revolving fund pharmacy model has ensured that patients' access to essential medicines has not been interrupted during the pandemic. Success was built on a community approach to extend pharmaceutical services, adapting our current supply-chain infrastructure and working quickly in partnership with local health authorities. Probleme La pandemie de maladie a Coronavirus 2019 (COVID-19) a bouleverse les systemes de sante du monde entier et menace l'approvisionnement en medicaments essentiels. Dans les pays a faible et moyen revenu, les patients vulnerables ayant uniquement acces aux soins de sante publics ont ete particulierement affectes. Approche Peu apres l'instauration de la distanciation physique et du couvre-feu le 15 mars 2020 au Kenya, nous avons rapidement mis en oeuvre trois strategies visant a assurer un approvisionnement continu en medicaments essentiels, tout en limitant les risques d'exposition des patients au coronavirus. Nous avons redistribue les principaux stocks de medicaments aux etablissements sanitaires peripheriques afin de garantir leur disponibilite pendant plusieurs mois. Nous avons fourni des boites de materiel medical aux petits centres de soins implantes dans des regions reculees. Nous avons egalement livre des medicaments aux patients incapables de se rendre dans un etablissement. Environnement local Pour deployer ces strategies, nous avons profite de nos trente annees de partenariat avec les autorites sanitaires locales dans les regions rurales du Kenya occidental et compte sur le modele existant de financement pharmaceutique renouvelable, qui dessert 85 centres de soins peripheriques. Changements significatifs Les stocks de medicaments essentiels servant au traitement de maladies chroniques et non chroniques redistribues aux centres de soins peripheriques sont passes de 316 330 unites en avril 2019 a 835 140 unites en avril 2020. Nous avons procure des boites de materiel medical a 46 centres de soins supplementaires. Notre equipe a reussi a livrer des medicaments a 264 des 311 patients (84,9%) souffrant de maladies non transmissibles que nous sommes parvenus a contacter. Lecons tirees Grace a notre modele de financement pharmaceutique renouvelable, les patients ont pu acceder aux medicaments essentiels sans interruption durant la pandemie. Ce succes repose sur une approche communautaire destinee a etendre les services pharmaceutiques en adaptant l'infrastructure de notre chaine d'approvisionnement actuelle, et en avancant rapidement par le biais de partenariats avec les autorites sanitaires locales. Situacion La pandemia de la enfermedad por Coronavirus 2019 (COVID-19)ha perturbado los sistemas sanitarios de todo el mundo y ha amenazado el suministro de medicamentos esenciales. Se ven especialmente afectados los pacientes vulnerables de los paises de ingresos bajos y medios que solo pueden acceder a los sistemas sanitarios publicos. Enfoque Poco despues de que comenzaran el distanciamiento fisico y las ordenes de toque de queda el 15 de marzo de 2020 en Kenia, pusimos en marcha rapidamente tres estrategias para garantizar un suministro continuo de medicamentos esenciales y minimizar al mismo tiempo los riesgos de exposicion de los pacientes al COVID-19. Redistribuimos las existencias centrales de medicamentos a los centros de salud perifericos para garantizar la disponibilidad local durante varios meses. Equipamos a los centros de salud mas pequenos y remotos con cajas de botiquin. Tambien hicimos entregas de medicamentos a pacientes con dificultades para llegar a los centros. Marco regional Para poner en practica estas estrategias, hemos aprovechado nuestra asociacion de 30 anos con las autoridades sanitarias locales de las zonas rurales del oeste de Kenia y nos hemos apoyado en el modelo existente de financiacion farmaceutica rotatoria, que atiende a 85 centros de salud perifericos. Cambios importantes Las existencias de medicamentos esenciales para el tratamiento de enfermedades cronicas y no cronicas redistribuidas a los centros de atencion periferica pasaron de 316.330 unidades en abril de 2019 a 835.140 unidades en abril de 2020. Hemos adquirido cajas de material medico para otros 46 centros de salud. Nuestro equipo pudo entregar medicamentos a 264 de los 311 pacientes (84,9%) con enfermedades no transmisibles con los que logramos contactar. Lecciones aprendidas Gracias a nuestro modelo de financiacion farmaceutica rotatoria, los pacientes pudieron acceder a los medicamentos esenciales sin interrupcion durante la pandemia. Este exito se basa en un enfoque comunitario para ampliar los servicios farmaceuticos adaptando nuestra infraestructura de cadena de suministro existente y avanzando rapidamente mediante asociaciones con las autoridades sanitarias locales., Introduction The Coronavirus disease 2019 (COVID-19) pandemic has challenged health systems worldwide as they cope with the demands of infection control and management of the disease while maintaining the delivery [...]

Anthracimycin is a recently discovered novel marine-derived compound with activity against Bacillus anthracis. We tested anthracimycin against an expanded panel of Staphylococcus aureus strains in vitro and in vivo. All strains of S. aureus tested, including methicillin-susceptible, methicillin-resistant (MRSA) and vancomycin-resistant strains of S. aureus, were susceptible to anthracimycin at MIC values of ⩽0.25 mg l(-1). Although its postantibiotic effects were minimal, anthracimycin exhibited potent and rapid bactericidal activity, with a >4-log kill of USA300 MRSA within 3 h at five times its MIC. At concentrations significantly below the MIC, anthracimycin slowed MRSA growth and potentiated the bactericidal activity of the human cathelicidin, LL-37. The bactericidal activity of anthracimycin was somewhat mitigated in the presence of 20% human serum, and the compound was minimally toxic to human cells, with an IC50 (inhibitory concentration 50)=70 mg l(-1) against human carcinoma cells. At concentrations near the MIC, anthracimycin inhibited S. aureus nucleic acid synthesis as determined by optimized macromolecular synthesis methodology, with inhibition of DNA and RNA synthesis occurring in the absence of DNA intercalation. Anthracimycin at a single dose of 1 or 10 mg kg(-1) was able to protect mice from MRSA-induced mortality in a murine peritonitis model of infection. Anthracimycin provides an interesting new scaffold for future development of a novel MRSA antibiotic.

Purpose. Two BRAFV600E targeted therapies, dabrafenib and vemurafenib, have received US approval for treatment of metastatic melanoma in BRAFV600E patients, a mutation that affects ~50% of patients. We evaluated the cost-effectiveness of BRAF inhibitors and traditional chemotherapy for treatment of metastatic melanoma. Methods. A Markov model was developed using a societal perspective. Transition probabilities were derived from two Phase III registration trials comparing each BRAF inhibitor against dacarbazine. Costs were obtained from literature, national databases, and Medicare fee schedules. Utilities were obtained from published literature. Deterministic and probabilistic sensitivity analyses were run to test the impact of uncertainties. Results. The incremental cost-effectiveness ratio of dabrafenib was $149,035/QALY compared to dacarbazine. Vemurafenib was dominated by dabrafenib. Probabilistic sensitivity analysis showed that, at a willingness-to-pay (WTP) threshold of ≤$100,000/QALY, dacarbazine was the optimal treatment in ~85% of simulations. At a WTP threshold of ≥$150,000/QALY, dabrafenib was the optimal treatment. Conclusion. Compared with dacarbazine, dabrafenib and vemurafenib were not cost-effective at a willingness-to-pay threshold of $100,000/QALY. Dabrafenib is more efficient compared to vemurafenib. With few treatment options, dabrafenib is an option for qualifying patients if the overall cost of dabrafenib is reduced to $30,000–$31,000 or a WTP threshold of ≥$150,000/QALY is considered. More comparative data is needed. [ABSTRACT FROM AUTHOR]

Introduction: The relationship between food insecurity and access to healthcare in low-resource settings remains unclear. Some studies find that food insecurity is a barrier to accessing care, while others report that food insecurity is associated with a greater need for care, leading to more care utilisation. We use data from the Harambee study in western Kenya to assess the association between food insecurity and difficulty accessing care among people living with HIV (PLWH) with or without comorbid non-communicable diseases (NCDs)., Methods: The Harambee study is a cluster randomised trial that tested the effectiveness of delivering integrated HIV and NCD care for PLWH. In this cross-sectional analysis, we examined baseline data from Harambee participants to investigate the relationship between household food insecurity and difficulty accessing care, using multivariable logistic regression models, controlling for sociodemographic factors and care satisfaction. We tested for effect measure modification by gender and household wealth and stratified analyses by NCD status., Results: Among 1039 participants, 11.1% reported difficulty accessing care, and 18.9% and 51.9% of participants had moderate and severe food insecurity, respectively. Among those with difficulty accessing care, 73.9% cited transportation issues as the major barrier. Difficulty accessing care was greater with higher levels of food insecurity: among participants with low, moderate and severe food insecurity, 5.9%, 9.7% and 14.4% reported difficulty accessing care, respectively. After adjusting for confounders, severe food insecurity was independently associated with difficulty accessing care (adjusted OR=2.5, 95% CI 1.4 to 4.4). There was no statistical evidence for effect measure modification by gender or wealth., Conclusions: We found that greater food insecurity was associated with greater difficulty accessing care among PLWH with or without NCDs in rural western Kenya. These findings suggest that addressing social determinants of health may be necessary when implementing integrated HIV and NCD care programmes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose. Two BRAF(V600E) targeted therapies, dabrafenib and vemurafenib, have received US approval for treatment of metastatic melanoma in BRAF(V600E) patients, a mutation that affects ~50% of patients. We evaluated the cost-effectiveness of BRAF inhibitors and traditional chemotherapy for treatment of metastatic melanoma. Methods. A Markov model was developed using a societal perspective. Transition probabilities were derived from two Phase III registration trials comparing each BRAF inhibitor against dacarbazine. Costs were obtained from literature, national databases, and Medicare fee schedules. Utilities were obtained from published literature. Deterministic and probabilistic sensitivity analyses were run to test the impact of uncertainties. Results. The incremental cost-effectiveness ratio of dabrafenib was $149,035/QALY compared to dacarbazine. Vemurafenib was dominated by dabrafenib. Probabilistic sensitivity analysis showed that, at a willingness-to-pay (WTP) threshold of ≤$100,000/QALY, dacarbazine was the optimal treatment in ~85% of simulations. At a WTP threshold of ≥$150,000/QALY, dabrafenib was the optimal treatment. Conclusion. Compared with dacarbazine, dabrafenib and vemurafenib were not cost-effective at a willingness-to-pay threshold of $100,000/QALY. Dabrafenib is more efficient compared to vemurafenib. With few treatment options, dabrafenib is an option for qualifying patients if the overall cost of dabrafenib is reduced to $30,000-$31,000 or a WTP threshold of ≥$150,000/QALY is considered. More comparative data is needed.