Health Care Delivery Research Articles

Background: Palliative care in Iraq remains severely underdeveloped, despite growing recognition of its critical role in alleviating the suffering of patients with terminal illnesses. Structural limitations, socio-cultural barriers, and political instability continue to undermine its accessibility and integration into the national health system. Objectives: This paper explores the evolution, current gaps, and future opportunities for palliative care in Iraq, with a focus on institutional readiness, geographic equity, and cultural dimensions. It aims to offer a comprehensive overview of the systemic challenges and to outline a strategic path forward. Methods: This is a narrative review and policy analysis based on published literature, institutional observations, and recent regional developments in palliative care infrastructure, training, and cultural attitudes. Special emphasis is placed on the interaction between family roles, healthcare delivery, and end-of-life decision-making in the Iraqi context. Results: Findings reveal a profound misalignment between the need for palliative care and its current availability. Terminal patients often receive aggressive, non-beneficial treatments in intensive care settings, while community-based services are scarce or absent. Cultural stigma, lack of trained personnel, insufficient funding, and the legacy of conflict further complicate access. Family caregivers carry a disproportionate burden, often without professional or psychosocial support. Conclusion: Integrating palliative care into Iraq’s health system requires both structural reform and cultural transformation. A national policy that prioritizes palliative education, decentralizes services, and respects local values could significantly improve end-of-life care for Iraqi patients and their families. Keywords: Palliative care, end-of-life care, health system challenges, Iraq, cultural barriers

This study examines factors affecting organisational learning during crises by comparing a healthcare organization and a construction service organization. Our goal was to identify differences and similarities between the two organizations in organisational learning for resilience in order to support crisis preparedness in society. Our qualitative study consists of case studies of the Finnish National Blood Establishment, Finnish Red Cross Blood Service (FRCBS), and public enterprise Stara (Stara), a construction service provider for the City of Helsinki. We followed the organisations throughout the COVID-19 pandemic years 2020-2022 through repeat interviews and as participant researchers within management. Differences were observed in the nature of contradictions with the environment, reflecting the tightness of bonds within the organisations respective organisational networks. The experiences with remote work and personal coping were similar for specialist-level employees in the two organisations. Our research was focused on office workers even though many of them had close contact with the floor level. We did not address the employees with mainly operative or physical tasks. The number of interviewed persons was limited, which may restrict the diversity of views in our material. Our results demonstrate the uniformity of organisational learning processes in healthcare and construction service organisations during a prolonged crisis. This supports the idea that, in crisis situations, healthcare leaders should benchmark best practices with other sectors of society.

The landscape of modern healthcare is undergoing a profound transformation, with the proliferation of digital information systems at its core. This rapid evolving landscape of information technologies, individuals and organizations must adapt to the digital age. The Electronic Health Records (EHRs) represent a fundamental shift from paper-based medical records to a digital format, revolutionizing the way patient data is stored, managed, and shared. This digital system has increases efficiency, improves patient safety, and streamlines healthcare delivery by eliminating medical errors and support data-driven healthcare practices by providing easy access to patient information. Conversely, the full implementation of the resources is impeded by human and technical factors. Therefore, the study sought to identify and address influencing factors at the Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria. The study adopted the descriptive survey approach, involving 313 participants. Data were collected through purposive and simple random sampling techniques using a structured questionnaire. The study recorded a youthful workforce (71.9%) that is predominantly female (68.6%). It also recorded that EHRs improved patient care efficiency, secured medical records, reduced duplication of tests, and decreased waiting times. However, poor understanding of EHR systems, inadequate funding, technical issues, workflow disruptions during power or network outages, and insufficient ICT-skilled personnel were factors militating against the use of EHRs. The study also observed a significant relationship between age and gender on influencing factors militating against the use of electronic health records among health workers in the study area. It also recorded positive workers' perception towards the adoption of EHRs, however, addressing the influencing factors is critical for optimizing EHR implementation and achieving sustainable healthcare improvements through sincere government open involvement in infrastructural development, training on gender-sensitivity, resource allocation and introductions of user-friendly interfaces.

Frailty is a prevalent and clinically significant condition affecting up to 45% of adults with heart failure (HF). Frailty reflects a state of reduced physiologic reserve and vulnerability to stressors, which profoundly influences health outcomes including health care utilization and survival. Frailty and HF interact through multiple overlapping pathophysiologic mechanisms, including chronic inflammation, neurohormonal abnormalities, and multiorgan dysfunction. This synergy, for the patient leads to poor physical performance, reduced independence, and a greater susceptibility to complications. Evidence from recent clinical trials focused on frailty in HF underscores the potential benefits of multicomponent interventions combined with medication optimisation target physical dysfunction, poor nutrition, psychological disorders, and social isolation. Multidisciplinary care teams - including cardiologists, nurses, physical therapists, dieticians, occupational therapists, and social workers - can implement tailored strategies to reverse or slow the progression of frailty to improve health outcomes of patients with HF. Interventions such as resistance and balance training, individualised nutritional supplementation, medication review, cognitive and psychological support, and caregiver education have demonstrated a range of benefits in HF, from enhanced physical capacity and reduced hospital readmissions to improved health-related quality of life. Managing frailty in patients with HF requires a personalised, holistic and multicomponent approach. Successful intervention involves addressing not only physical dysfunction but also psychological, nutritional, and social factors that collectively undermine health and independence. Integrating multicomponent care into routine practice has the potential to improve clinical outcomes, reduce health care utilisation, and enhance the overall well-being of patients. Future research should aim to identify the most effective combinations of interventions, clarify mechanisms of action, and determine cost-efficiency in health care delivery.

This study aims to analyze the implementation of health policies in the modern era by highlighting the sustainability dynamics of traditional health services amidst the dominance of modern healthcare systems. Using a bibliometric approach, this study explores scientific publications indexed in the Scopus database over the period 2019–2024. The analysis focuses on publication trends, dominant keywords, institutional collaborations, and country contributions related to the integration of traditional health services into national health policies. The findings reveal a significant increase in publications discussing integrative approaches, particularly concerning the formal recognition and potential of traditional services in supporting sustainable healthcare systems. Nevertheless, challenges such as regulatory inconsistencies, limited funding, and scientific validation continue to pose major barriers. This study recommends the formulation of more inclusive and adaptive health policies that accommodate diverse medical systems while prioritizing the effectiveness, safety, and accountability of healthcare delivery.

Surgical success following robotic upper urinary tract reconstruction, results from a global network of healthcare organizations.

Swedish public healthcare is increasingly characterised by a growing administrative layer and complex governance structures. While administrative personnel have grown in numbers, their coordination and integration with core clinical operations appears to remain underdeveloped, leading to tensions, conflicts and perceived power vacuums. Despite the growing complexity, little research has focused on how healthcare managers, including those outside the clinical line, navigate these tensions. This study addresses this gap by exploring how managers understand and respond to conflicts between administrative and clinical domains, and how these dynamics affect their ability to act as public professionals with 'holistic viewpoints' within public healthcare. The study employed qualitative methods, including semi-structured interviews with 24 healthcare managers across three Swedish regions. Participants represented both clinical line organisations and administrative units across hierarchical levels. Thematic reflexive analysis was used to identify patterns in how managers perceive and navigate tensions and conflicts, with a focus on power, conflict resolution, and perception of where one's loyalties lie. The results show how managers often distanced themselves from responsibility for resolving conflicts and managing tensions, delegating integrative tasks to roles with limited mandates. First-line clinical managers aligned with their staff, reinforcing divisions between administration and core operations, and were shown to have much power in practice, yet did not recognise this. Administrative managers lacked legitimacy and formal authority, something which complicated collaboration. Education was proposed as a solution to tensions and conflicts, but often in vague terms. Power was perceived as always residing elsewhere, either with top management, politicians or core operative personnel. While some managers experienced a shift in understanding when moving up the hierarchy, this did not consistently translate into integrative practices. Overall, the findings reveal a gap between the recognition of tensions and conflicts and the capacity or willingness to address them constructively in line with how current research frames 'public professionals'. Managers' actions often reinforced rather than bridged divides, reflecting a lack of holistic perspective amongst healthcare managers. Healthcare managers struggle to act as public professionals in a fragmented system marked by conflicting logics and unclear mandates. Rather than bridging divides, many reinforce them through alignment with their groups or delegation. Addressing these challenges requires rethinking managerial roles and fostering strategic, integrative leadership across organisational boundaries for healthcare organisations.

Video consultations enable guideline-based and continuous medical care under the structurally challenging conditions of correctional facilities. This article presents the model of team-based telemedicine using concrete fields of application such as tele-general medicine, telepsychiatry, tele-substitution therapy, and teledermatology. Special attention is given to technical requirements, quality assurance measures, and the challenges and opportunities in correctional healthcare delivery. The approaches described are based on the experiences of the "Videoclinic" in more than 120 correctional institutions. In addition, the results of an initial empirical analysis of telemedicine routine care data (January 2023 to March 2025) and asatisfaction survey of medical and nursing staff (March 12 to 9 April 2024) are presented, which provide insights into the realities of healthcare delivery, the disease spectrum of inmates, and indications regarding the effectiveness and acceptance of telemedicine care in correctional settings.

Impact of vaccination on shingles-related hospitalisations in 70-79-year-olds in Scotland between 2000 and 2023: A retrospective cohort study.

Chronic insomnia is a prevalent but under-recognised sleep disorder in the UK, affecting 6.8%-14.9% of adults. It is associated with significant health and economic burdens, yet remains under-diagnosed and poorly managed in primary care. This study aimed to address key gaps in the understanding, diagnosis and management of chronic insomnia and to develop consensus-based recommendations to optimise care pathways across the National Health Service. A modified Delphi consensus study. UK primary care, involving general practitioners, pharmacists and sleep specialists. A multidisciplinary steering group of seven UK healthcare professionals (HCPs) with expertise in chronic insomnia developed 39 statements. These were tested in a two-round Delphi survey distributed to a panel of 201 HCPs. Consensus was defined as ≥75% agreement on a 4-point Likert scale. Consensus was reached for 37 of the 39 statements. Key findings included the recognition of chronic insomnia as a distinct chronic condition, the recommendation to include routine sleep-related screening in primary care and the need for increased HCP training in cognitive behavioural therapy for insomnia and pharmacological treatment. Respondents highlighted the necessity for greater awareness and public engagement regarding insomnia and its treatment options. In spite of mitigating biases, responses may have been subject to acquiescence bias. The study identifies systemic barriers to effective insomnia care and calls for chronic insomnia to be prioritised in UK primary care. The resulting consensus recommendations aim to reduce the burden of untreated insomnia, improve patient outcomes, enhance healthcare delivery and increase economic productivity.

Meaningful engagement of patients in the research process is a growing component of learning health systems; however, few studies have examined efforts to facilitate or foster patient-engaged research among large healthcare organizations. To describe patient engagement activities and infrastructure among the seven national research networks funded by US Veterans Affairs (VA) Health Systems Research (HSR). We conducted an environmental scan comprised of (1) structured searches of peer-reviewed publications and other publicly available documents and (2) qualitative, semi-structured group interviews with VA HSR research network representatives. Staff and leaders with knowledge of their research network's engagement-related activities. We used principles of thematic analysis and content analysis to code and categorize networks' engagement activities and key considerations identified through the environmental scan. We identified 129 discrete engagement-related activities across the seven VA HSR research networks in three domains of (1) facilitating patient-engaged research, (2) network engagement infrastructure, and (3) building and maintaining relationships with partners. The number and types of reported activities varied across the networks. All five networks with a current or planned patient engagement group budgeted for staff effort and patient compensation, and offered patient engagement services that spanned research and care implementation projects. We identified five themes essential to engagement infrastructure (supportive network environment; team environment and relationship building; patient engagement group characteristics; flexibility and adaptability; and efficiency). This work documents patient engagement activities and infrastructure among seven VA-funded national research networks within VA's integrated learning health system. Network representatives' experiences highlight important considerations for developing and sustaining patient engagement infrastructure. Future research is needed to examine quality, outcomes, and costs of patient engagement services within different contexts, and how this infrastructure could best be deployed to meaningfully incorporate patient perspectives across learning health system improvement cycles.

Background: Adequate knowledge among healthcare professionals is essential for early diagnosis and effective management of headache disorders. However, training on headache disorders during medical and nursing education is often insufficient. Methods: The Studio Emicrania Maugeri (SEM) is an observational study designed to assess knowledge, awareness, prevalence, and characteristics of migraine among healthcare workers. Maugeri is a healthcare organization in Italy with 25 clinical sites distributed nationwide. All 4050 employees, including a range of healthcare professionals, were invited to participate via a web questionnaire exploring: a) exposure to formal education on headaches during academic training; b) basic knowledge of headache disorders and migraine; c) prevalence, clinical features and migraine-related burden. Participation was voluntary and anonymous. Results: A total of 1518 responses were collected. Training gaps:46% of physicians and 81% of nurses reported not receiving formal education on headache disorders during their studies. Knowledge distribution:Physicians generally achieved higher scores on 23 knowledge questions, with most scoring 18–22 correct answers. Nurses showed a broader distribution, mainly between 13–19 correct answers. Correct Answers (out of 23) Nurses (%) Physicians (%) 8–13 6.95 0.53 14–17 43.96 18.25 18–19 35.74 34.76 20–23 13.35 46.46 Key misconceptions among physicians: 33% believed instrumental tests are always needed for migraine diagnosis. 66% considered cervical spine disorders (“la cervicale”) one of the most frequent causes of headache. 14% did not know specific migraine medications. 66% incorrectly defined chronic migraine as lasting over one year. 33% were unaware that frequent analgesic use can worsen migraine. Conclusion: These preliminary results highlight significant knowledge gaps and misconceptions about headache disorders among healthcare workers, especially nurses. The lack of formal education during academic training is notable. These findings emphasize the need to strengthen headache education in medical and nursing curricula to improve patient care.

The use of telemedicine has soared in recent years. In this study, the authors explored perspectives of Israeli mental health professionals on the use of telemedicine for mental health services. Semistructured interviews were conducted with 10 mental health professionals recruited from a health maintenance organization (HMO) in Israel's public health system. The interviews were transcribed and analyzed in an iterative method to code and identify themes and categories. Most of the participants viewed telemedicine positively, as a way to enable care when in-person visits were not possible, and favored its implementation alongside in-person visits. The providers agreed that video appointments were superior to telephone appointments. Difficulties raised included technical and privacy issues; benefits included the ability to see patients in their home environments. The therapists who set minimal guidelines for video appointments found the process to be effective; those who did not set guidelines found that their patients were less focused. The participants felt that they could effectively connect with their patients via video, particularly once a relationship had been established in person. Whereas some of the providers had received training specific to telemedicine, others had learned on the job. The results highlighted the growing acceptance and effectiveness of telemedicine in facilitating continuity of mental health care, particularly when combined with in-person appointments. HMOs may consider a hybrid model, offering telemedicine to patients who may benefit from it. Continued training and support for providers is crucial to optimize delivery of mental health care via telemedicine.

3D printing is a cost-effective manufacturing approach that offers several advantages for health care delivery, including rapid prototyping, precise customization to patient anatomy and user specifications, and the capability to produce implants directly at the point of care. The purpose of this study was to test whether 3D-printed carbon fiber-reinforced polyetheretherketone (CF-PEEK) one-third tubular plates are statistically equivalent, within prespecified margins, to stainless steel plates in simulated early weightbearing and torsion. Carbon fiber-reinforced polyetheretherketone one-third tubular plates were designed and printed using Fused Deposition Modeling printers by study authors. These were compared to traditionally manufactured plates using 4-point bend tests. A cadaveric biomechanical comparison between fractures stabilized using 3D-printed plates and traditional manufactured plates was performed. Matched-pairs specimens underwent axial cyclic loading and torsional load to failure. Ten matched paired specimens underwent mechanical testing. All specimens survived 100 000 cycles loaded to 875 N. Torque at failure did not significantly differ between groups (P = .14). During torsional load to failure, all 10 specimens (100%) with the traditional plate failed because of screw pullout. Five specimens (50%) with the 3D plate failed because of screw pullout and 5 (50%) failed because of plate fracture. Fifteen plates (five 3D, five 3D post autoclave, 5 traditional) underwent 4-point bending test. Stiffness was significantly lower in the 3D plates (P < .0001). The coefficient of variation was 0.06 for the 3D-printed plates and 0.01 for the traditional manufactured plates, demonstrating high consistency within groups. In conclusion, this cadaveric study found that nonsterilized CF-PEEK plates demonstrated statistically equivalent displacement and torque at failure to stainless steel plates. However, they exhibited reduced stiffness and a higher incidence of plate fracture. Additionally, autoclave sterilization had a significant impact on the mechanical properties of the CF-PEEK plates. These findings underscore the need for additional biomechanical and clinical studies to assess the performance of 3D-printed implants and to refine sterilization protocols. These results suggest that constructs using 3D-printed CF-PEEK plates can perform statistically equivalently (within prespecified margins) to stainless steel constructs in simulated early weightbearing and torsion, despite different material properties. The impact of sterilization, however, must be considered, and alternatives to autoclaving are recommended.

Patient journeys highlight evolving processes of care seeking from patient perspectives over the course of time and disease progression. Patient journeys for neglected tropical diseases (NTDs) in rural sub-Saharan Africa (SSA) are poorly understood. This review aims to identify studies including patient journeys for NTDs in rural SSA. Systematic search of six scientific databases from inception to 18 November 2024. All studies were required to include patient journeys for NTDs, defined as the continuous arc of the patient care seeking experience at multiple time points while navigating increasingly debilitating disease. All patient journeys were depicted explicitly using flow diagrams, lists of ordered journey components, or patient narratives. Variables extracted included the use and rationale of referrals, types of healthcare delivery providers engaged in the patient journey, and barriers and facilitators of care continuity. Journeys were analysed using framework synthesis. Searches returned 2605 studies where after de-duplication and eligibility screening, 22 studies were identified for inclusion Included studies represented eight NTDs, which were categorised into four groups: severe and stigmatising skin NTDs (SSSDs) (13/22) including Buruli ulcer, lymphatic filariasis, onchocerciasis, and yaws; human African trypanosomiasis (HAT) (3/22); snakebite and rabies (4/22); and schistosomiasis (intestinal and female genital) (2/22). NTD patient journeys revealed health system constraints relating to limited medical resources and ineffective referral pathways, social dimensions of gender and stigma hindering access to care, and logistical concerns related to distance to health facilities, and lack of transport. Patient journeys for different NTDs highlighted specific dimensions of this local context, including challenges with mental health distress for individuals living with SSSDs, difficulties obtaining diagnoses for HAT as an NTD with non-specific symptoms, and inaccessibility of treatment for schistosomiasis in the context of missed mass drug administration. NTD patient journeys show varied care seeking experiences within the broader context of neglect and health inequity that characterises settings where NTDs are endemic. For NTDs resulting in long-term or chronic conditions, these journeys highlight inaccessible care and a lack of integrated approaches for prevention, treatment, and management within health systems. By understanding patient journeys, NTD researchers and practitioners can determine how best to support NTD patients in navigating access to care.

The onset of the COVID-19 pandemic disrupted healthcare delivery including malaria healthcare services in sub-Saharan Africa. There is limited research exploring impact of COVID-19 on malaria healthcare utilization. This study explores the trends in disruption of malaria service utilization across 20 sub-Saharan African countries before, at the initial onset, and 1 year into the COVID-19 pandemic. Longitudinal study was conducted using secondary data from the 'Premise Malaria COVID-19 Health Services Disruption Survey 2020 and 2021 from 20 malaria endemic African countries'. The study population consisted of individuals aged 16years and above from the general population across 20 malaria-endemic African countries. The outcome variable for this study was malaria healthcare service utilization, comprising three specific measures: being tested for malaria, visiting a healthcare provider for malaria symptoms and receiving treatment for malaria symptoms at three distinct time periods. Data was extract and analysed using STATA version 18. A Generalized Estimating Equation (GEE) approach was used in the statistical analysis. A total of 4726 participants were included in this study. Before to, during, and 1 year into the COVID-19 pandemic, 71.77%, 72.26%, and 59.12% of participants were tested for malaria, respectively. Also, 80.61%, 79.71%, and 1.25% of participants visited healthcare providers for malaria symptoms before, at the initial onset, and 1 year into the COVID-19 pandemic, respectively. Additionally, 97.97%, 96.30%, and 15.23% of participants received treatment for malaria symptoms before, at the initial onset, and 1 year into the COVID-19 pandemic, respectively. 1 year after the onset of the COVID-19 pandemic, people were 45% less likely to be tested for malaria, (AOR = 0.55, 95% CI 0.48, 0.63), 99.7% less likely to visit healthcare providers for malaria symptoms (AOR = 0.003, 95% CI 0.002, 0.005), 99.6% less likely to receive treatment for malaria symptoms (AOR = 0.004, 95% CI 0.002, 0.006). This study demonstrates a significant decline in malaria healthcare service utilization 1 year into the COVID-19 pandemic across 20 sub-Saharan African countries. Individuals were markedly less likely to be tested, visit healthcare providers, or receive treatment for malaria symptoms compared to pre-pandemic levels. These findings emphasize the urgent need for resilient health systems and sustained malaria services during global health emergencies to prevent setbacks in malaria control and elimination efforts.

Objectives This narrative review evaluates the role of artificial intelligence (AI) in healthcare, summarizing its historical evolution, current applications across medical and surgical specialties, and implications for allied health professions and biomedical research. Methods We conducted a structured literature search in Ovid MEDLINE (2018–2025) using terms related to AI, machine learning, deep learning, large language models, generative AI, and healthcare applications. Priority was given to peer-reviewed articles providing novel insights, multidisciplinary perspectives, and coverage of underrepresented domains. Key findings AI is increasingly applied to diagnostics, surgical navigation, risk prediction, and personalized medicine. It also holds promise in allied health, drug discovery, genomics, and clinical trial optimization. However, adoption remains limited by challenges including bias, interpretability, legal frameworks, and uneven global access. Contributions This review highlights underexplored areas such as generative AI and allied health professions, providing an integrated multidisciplinary perspective. Conclusions With careful regulation, clinician-led design, and global equity considerations, AI can augment healthcare delivery and research. Future work must focus on robust validation, responsible implementation, and expanding education in digital medicine.

Background: Healthcare systems worldwide face growing challenges in anticipating and managing patient surges, particularly in times of public health crises, natural disasters, or seasonal peaks. The ability of healthcare organisations to forecast and respond to such demand fluctuations—referred to as organisational readiness for patient capacity surge—has become a critical determinant of service continuity and patient outcomes. Despite the urgency, there remains a lack of consolidated evidence on how healthcare authorities measure, evaluate, and operationalise this readiness. This systematic review aims to identify and synthesise existing literature that presents case studies, methodologies, and strategic frameworks used to evaluate organisational preparedness for patient surge capacity. It also explores resource allocation mechanisms, hospital capacity planning algorithms, and temporary facility strategies documented in healthcare settings. Methods: The review was conducted across two major scientific repositories, i.e., PubMed and Web of Science (WoS). A set of four structured search queries were formulated to capture the breadth of the topic, focusing on demand forecasting, hospital capacity planning, workforce models, and resource management within the context of healthcare surge demand. The search was limited to publications from the last 10 years (2014–2024) to ensure the inclusion of contemporary practices and technologies. Resutls: A total of 142 articles were selected for detailed analysis. The articles were categorised into six thematic groups: (i) empirical case studies on healthcare surge management; (ii) hospital resources and capacity scaling; (iii) ethical frameworks guiding surge response; (iv) IT-driven algorithms and forecasting tools; (v) policy evaluations and actionable lessons learned; and (vi) existing systematic reviews in related domains. Notably, several articles provided evidence-based frameworks and simulation models supporting predictive planning, while others highlighted real-world implementation of temporary care facilities and staff redeployment protocols. Conclusions: The review underscores the fragmented yet growing body of literature addressing the multidimensional nature of surge preparedness in healthcare. While algorithmic forecasting and capacity modelling are advancing, gaps remain in standardising metrics for organisational readiness and incorporating ethical considerations in surge planning. Limitations of this review include potential selection bias and the subjective categorisation of articles. Future research should aim to develop integrative frameworks that couple technical, operational, and ethical readiness for patient surge scenarios.

Retention in pre-exposure prophylaxis (PrEP) care—defined as receiving a fourth PrEP prescription within 12 months of initiation—remains a major challenge for young adults and individuals minoritized by race and ethnicity in the United States (U.S.), particularly after disruptions in care from the Coronavirus Disease 2019 (COVID-19) pandemic. This study examined changes in PrEP retention before and after COVID-19 among clients ages 18–29 years at AIDS Healthcare Foundation (AHF) Wellness Center clinics across the U.S. We conducted a retrospective analysis of electronic health record (EHR) data from 6047 clients who initiated PrEP between 1 January 2018 and 15 March 2023. Retention was defined as receiving a fourth PrEP prescription within 12 months of initiation. Overall, PrEP initiation increased threefold post-COVID-19, but retention by the fourth prescription declined from 86.2% pre-COVID-19 to 62.6% post-COVID-19 (p &lt; 0.001). Clients initiating PrEP post-COVID-19 had significantly lower odds of retention (odds ratio [OR] = 0.13; p &lt; 0.001), suggesting these systemic disruptions reduced continuity of care. Additionally, clients who identify as non-White had lower retention odds compared to clients who identify as White post-COVID-19 (OR = 0.80; p = 0.003), indicating that racial/ethnic disparities in PrEP care persist beyond the pandemic’s impact. These findings highlight the need for targeted interventions to strengthen retention in PrEP care post-COVID-19.

Architecting Cloud-Based CPQ Solutions for Healthcare Enterprise Transformation: A Framework for Medical Device Sales and Compliance