Medication Shortages Research Articles

Downstream Effects of Market Changes on Inhalers: Impacts on Individuals With Chronic Lung Disease.

COPD and asthma are two of the most common chronic lung diseases, affecting over 545 million people globally and 34 million in the United States. Annual health care costs related to chronic lung disease are estimated at €380 billion in the European Union, and $24-$50 billion in the United States averaging to $4,000 in out-of-pocket costs per person in the U.S. A full-text literature search was conducted for English publications between January 1, 2005-March 18, 2024. It returned over 5,000 publications that were further narrowed using key search words, resulting in 172 peer-reviewed articles. Using their experience and subject expertise, the authors further narrowed the peer-reviewed articles to 55 that were in their opinion relevant. Also, 38 recently published industry reports and news articles specific to downstream effects of inhaler market changes and the future impact were included. The literature suggests that individuals with chronic lung disease face increased challenges with access to inhaled medication due to rising medication costs, discontinuation of branded medications, introduction of generic medications not covered by insurance, exclusionary preferred drug list tactics that force health care providers into non-medical switching of medication or devices, and ongoing medication shortages. Providers experience ongoing hurdles in prescribing appropriate inhaled medications for individuals with chronic lung disease, including increased time and costs spent on administrative tasks due to inhaler denials, a loss of patient trust, and limits on their ability to prescribe appropriate inhaled medication for individuals with chronic lung disease.

A SWOT ANALYSIS OF THE TÜRKİYE HEALTHCARE SYSTEM: A PHYSICIANS' PERSPECTIVE

The aim of this study is to conduct a SWOT analysis of the Türkiye healthcare system from the viewpoint of physicians. The sample for this study consisted of 22 physicians who voluntarily participated. A qualitative research approach was employed, utilizing semi-structured interview forms for data collection. Data were gathered both face-to-face and online. The obtained data were coded, and similar codes were categorized and themed. This study incorporated both SWOT analysis and content analysis methods. When examining the findings, physicians highlighted easy access and availability as the strong aspects of the Türkiye healthcare system. However, the system's weaknesses were predominantly identified as issues concerning healthcare professionals. On the other hand, medical tourism was pointed out as the most significant opportunity awaiting the health system, whereas the escalating violence towards healthcare workers was perceived as the biggest threat. The Türkiye Healthcare System stands out with strengths such as ease of access and advanced technological infrastructure, as well as opportunities like medical tourism. However, it also harbors pressing challenges, including violence against healthcare workers and medication shortages. It is anticipated that many of these issues will be addressed when the balance between demand and supply is achieved.

Impact of ADA Guidelines and Medication Shortage on GLP-1 Receptor Agonists Prescribing Trends in the UK: A Time-Series Analysis with Country-Specific Insights

Background: Several GLP-1 receptor agonists (GLP-1 RAs) are used to treat type 2 diabetes (T2DM). Their cardio- and renal-protective effects and their association with substantial weight loss have been evident and progressively expanded their role in the American Diabetes Association (ADA) guidelines, which are endorsed by the European Association for the Study of Diabetes (EASD). The increased demand led to a global shortage. Methods: We utilized a repeated cross-sectional design, drawing data from national prescribing databases, to analyze six GLP-1 RAs: Dulaglutide, Exenatide, Liraglutide, Lixisenatide, Semaglutide, and Tirzepatide. AutoRegressive Integrated Moving Average (ARIMA) models with exogenous variables were applied to assess the trends over time and in different regions. Results: The prescription rates significantly differ between regions. Wales shows the highest prescribing rate for most GLP-1 RAs. The ARIMA models indicated a significant increase in their prescribing rates after the release of the 2022 ADA guidelines (e.g., Dulaglutide: Post-ADA effect of 15.22, 95% CI: [12.97, 17.47]). Following the GLP-1 RA shortages in July 2023, the prescribing rates, particularly for Semaglutide, increased (Shortage effect: 74.36, 95% CI: [71.92, 76.80]). Model diagnostics, including the Akaike Information Criterion (AIC) and Durbin–Watson statistics, confirmed the robustness of these trends. Conclusions: Informed decisions should be made by considering the prescribing trends before and after important events such as the issuing of new guidelines or safety alerts.

An assessment of the factors contributing to the unavailability of drugs at outpatient pharmacy of tertiary care hospital: an observational study

Introduction Throughout history and up until the present, there has been a medicine shortage. In the early 1920s, there was a shortage of insulin, which is when drug scarcity first appeared in the records. Drug shortages are now more prevalent globally than they were back then. The goal of this essay is to pinpoint the key components that make up a definition for medication shortages and to pinpoint the circumstances that should be considered when reporting drug shortages in databases. Understanding the factors that led certain organizations to create their own definition of a medicine shortage was crucial for achieving these goals. The pharmaceutical regulatory environment can be connected to several reasons why there are medication shortages, including parallel trading, quality standards, and business choices to halt or reduce manufacturing. The many rules governing medicine shortages have not yet been the subject of a thorough investigation. This protocol’s objective is to analyze the pertinent legislative and regulatory frameworks in the European pharmaceutical system that affect medication shortages. The objectives of the study will be the non–availability of drugs at an outpatient pharmacy and to analyze the reason of non–availability of drugs. Methods An observational study will be adopted in this study. It includes a collection of data from the patient coming to the outpatient pharmacy of AVBRH Sawangi (Meghe) Wardha. Expected result It can lead to delayed treatment for patients seeking alternative medication. It can also lead to increased healthcare costs if patients seek alternative treatments that are more expensive or require additional medical care. The unavailability of drugs can also lead to frustration and anxiety for patients who need medication to manage their health condition. It can also negatively impact the reputation of the hospital.

A review on the impact of the worldwide shortage of glucagon-like peptide-1 medications on control of diabetic patients

Glucagon-like peptide 1 receptor agonists (GLP-1 RA) have shown promising benefits in improving outcomes for patients with type 2 diabetes, particularly those affected by obesity-related complications such as cardiovascular disease, cardiometabolic disorders, and heightened cancer risks, posing significant public health challenges. Notably, GLP-1 RA have been recognized for their potential to achieve up to a 15% weight reduction over a span of two years, making them a preferred choice in specific conditions for diabetic patients with a body mass index (BMI) above 27. However, widespread public interest, particularly amplified through social media, has intensified the demand for GLP-1 RA due to their weight loss properties, thereby straining global supplies and fostering a black market among non-diabetic individuals seeking these effects. This heightened attention has prompted various medical regulatory bodies worldwide to enact strategies and policies aimed at alleviating shortages. Measures include minimizing new prescriptions of GLP-1 RA, exploring alternative medications within the GLP-1 RA category, carefully transitioning patients to other anti-diabetic treatments and managing patient expectations. These efforts appear effective in managing overall outcomes amid ongoing supply challenges. This narrative review provides a focused evaluation of how these GLP-1 RA medication shortages have impacted type 2 diabetic patients around the world and their overall diabetic outcomes.

Microsporum audouinii: Emergence of an etiological agent of tinea capitis in Rio de Janeiro, Brazil (2012-2019).

The etiology of tinea capitis changes over time, mainly due to trends in migration. We report 19 cases of tinea capitis caused by Microsporum audouinii, an uncommon agent in South America, all of them confirmed by molecular methods. All patients were male. The average age was 6.1 years. Fifteen patients were residents of Rio de Janeiro city and four were from neighboring cities. Among the patients submitted to follow-up, griseofulvin was prescribed for eight of them. Due to medication shortages, terbinafine was prescribed for five patients, needing to be switched in three cases, with a bigger total average time until clinical improvement. The study reaffirms the emergence of a new etiological agent in Rio de Janeiro, Brazil.

Pediatric Lead Chelation Managed During Critical Medication Shortages: Case Report and Literature Review.

Lead poisoning in children has the potential for devastating neurodevelopmental consequences. There is significant socioeconomic disparity in children with lead poisoning. Specific lead chelation regimens have been approved for children by the US Food and Drug Administration, however in the United States, there has been a recent national shortage of the primary therapy, edetate calcium disodium (CaNa2 EDTA). This case report presents a 23-month-old child with severe symptomatic lead poisoning during a national shortage of CaNa2 EDTA to highlight the need for advocacy regarding critical medication shortages, especially for antidote therapy. The infant's initial blood lead level was 364 mcg/dL and he received a continuous infusion of CaNa2 EDTA (1000 mg/m2/day), as well as dimercaprol (4 mg/kg intramuscularly every 4 hours). The supply of CaNa2 EDTA was exhausted on day 3 of therapy so he was transitioned to enteral succimer monotherapy. Initial parenteral therapy of 72 hours achieved a lead level of 72 mcg/dL; he then completed his enteral course of succimer along with environmental mitigation. However, elevated blood lead levels persisted and he subsequently required 3 more courses of enteral succimer, and he continues to have detectable blood lead levels 2 years after initial presentation. In the face of medication shortages including CaNa2 EDTA, and now also dimercaprol, clinicians must create and study alternative chelation therapy regimens for pediatric lead toxicity. Furthermore, public policy initiatives, including the development of a national supply stockpile of chelation agents, must be created in order to minimize supply chain disruption and ensure adequate and equitable antidote therapy for lead poisoning outbreaks.

Risk management and insurance failures: the case of Ghana’s National Health Insurance Scheme

Since its inception, Ghana’s National Health Insurance Scheme (NHIS) has brought about notable improvements in healthcare access and health outcomes. However, challenges have arisen, threatening its intended function. This study aims to investigate the challenges encountered by NHIS participants and their risk management practices in response to insurance failures. Convenience and purposeful sampling techniques were employed to gather data from 45 Quality Insurance Company (QIC) employees residing in the Greater Accra area of Ghana who are NHIS members. A quantitative approach was utilized, and a questionnaire was administered to collect data. The study employed Cronbach’s alpha to assess the reliability and validity of the data. Additionally, Regression analysis, correlation, and descriptive statistics were utilized to achieve the study's objectives. The study revealed several challenges facing the NHIS, including a shortage of medical specialists, medications, and hospital beds, as well as high patient out-of-pocket expenses. Despite these challenges, the NHIS has not yet failed. However, the majority of NHIS cardholders (62.20%) would be adversely affected in the event of system failure, as they primarily rely on NHIS for risk management. Conversely, a minority of participants (37.80%) are less likely to experience the effects of failure due to alternative insurance plans and personal savings. Therefore, understanding these dynamics is crucial for policymakers and stakeholders to strengthen the NHIS and ensure sustainable healthcare access for all Ghanaians.

Enhanced Pharmacy Service Delivery Through a Pharmacy Information System at a Medical Center: A Case Study.

A pharmacy information system (PIS) is a crucial tool for preventing errors and enhancing patient safety. This study aims to assess the influence of a PIS on workflow and medication errors (MEs) within the pharmacy department of a medical city in Saudi Arabia. The analysis encompasses an evaluation of the current workflow within pharmacy modules (in-patient, out-patient, and clinical pharmacy modules) and an exploration of associated challenges and inefficiencies. The study employed both qualitative and quantitative methodologies, incorporating structured interview techniques and the review of system records, such as logs, incident reports, and ME databases. Respondents recognized the benefits of the PIS, including the management of high-quality real-time data (26%), reduction of MEs (25%), acceleration of healthcare practices (23%), and absence of space-time constraints (14%). The study highlighted the role of PIS in addressing medication stock control and shortage issues, thereby improving overall medication availability. Furthermore, PIS significantly enhanced safety (93.3%), efficiency (80%), reliability, accuracy, ease of use (56.7%, 56.7%), and cost-effectiveness (53.7%). Following the implementation of the PIS, there was an increase in ME reporting, indicating improved error detection and management. The research revealed an increase in ME reporting rates in hospitals after PIS installation, attributed to improved medication management processes resulting in higher detection rates. As healthcare facilities increasingly embrace electronic medical records, the understanding of patient care quality will be significantly impacted. Consequently, further research is warranted to explore the role of PIS in reporting, detecting, analyzing, and mitigating MEs, as well as their influence on the work environment to promote a secure and efficient patient journey.

Evaluation of indications and efficacy of doxycycline for surgical antibiotic prophylaxis.

Given medical advancements in global healthcare systems over the past decade, it may be reasonable to assume that the incidence of surgical site infections would have decreased; however, surveillance data indicate that these rates have held constant. Surgical prophylaxis guidelines from the United States and United Kingdom recommend cefazolin, vancomycin and clindamycin in most surgeries for no longer than 24 hours. As a result of medication shortages impacting the global supply chain, surgeons have needed to evaluate alternative perioperative antibiotics, such as doxycycline; however, research into using doxycycline for preventing surgical site infections is limited. The goal of this study is to retrospectively assess doxycycline's efficacy, safety and role in preventing surgical site infections.

Health system barriers to hypertension care in Peru: Rapid assessment to inform organizational-level change.

Traditional patient- and provider-level hypertension interventions have proven insufficient to halt hypertension as the leading cause of morbidity and mortality globally. Systems-level interventions are required to address factors challenging hypertension control across a social ecological framework, an under-studied topic particularly salient in low- and middle-income countries (LMICs) such as Peru. To inform such interventions, we sought to identify key health systems barriers to hypertension care in Puno, Peru. A participatory stakeholder workshop (October 2021) and 21 in-depth interviews (October 2021-March 2022) were conducted with 55 healthcare professionals (i.e., doctors, nurses, midwives, dentists, nutritionists), followed by a deductive qualitative analysis of transcripts and notes. Participating healthcare providers indicated that low prioritization and lack of national policies for hypertension care have resulted in limited funding and lack of societal-level prevention efforts. Additionally, limited cultural consideration, both in national guidelines as well as by some providers in Puno, results in inadequate care that may not align with local traditions. Providers highlighted that patient care is also hampered by inadequate distribution and occasional shortages of medications and equipment, as well as a lack of personnel and limited opportunities for training in hypertension. Multiple incompatible health information systems, complicated referral systems, and geographic barriers additionally hinder continuity of care and care seeking. Insights gained from health providers on the healthcare system in Puno provide essential contextual information to inform development of organizational-level strategies necessary to improve provider and patient behaviors to achieve better hypertension care outcomes.

Shortage of essential pediatric medications puts children's health at risk. Results from a European Confederation of Primary Care Paediatricians (ECPCP) Survey 2023

Unparalleled drug shortages during the winter of 2022/2023 had a profound impact on paediatric primary care across Europe. A survey conducted by the European Confederation of Primary Care Paediatricians (ECPCP) evaluated the availability of essential pediatric drugs and the resulting challenges. The survey was conducted between January and March 2023 and included responses from 640 paediatricians from 18 countries. The results of the survey indicated that there were substantial shortages, particularly of child friendly formulations of commonly prescribed medicines. Paediatricians in the survey feared that the use of less appropriate alternatives could potentially compromise the efficacy and safety of treatment. The survey findings highlight the urgent need for coordinated actions at multiple levels to ensure the availability of essential pediatric medications and safeguard children's health in future crises.

Exploring healthcare professionals' perspectives on neglected tropical diseases in Eastern Uganda: a qualitative study with a focus on schistosomiasis and soil-transmitted helminths.

Neglected tropical diseases (NTDs), including soil-transmitted helminths (STHs) and schistosomiasis, continue to impose a heavy burden, especially in sub-Saharan Africa and Uganda, despite being preventable. Integration of NTD management into primary healthcare has been inadequate. While researchers have explored community perspectives, there is a notable gap in understanding the viewpoints of healthcare workers (HCW), which is crucial for effective NTD control strategies. This study explores HCW' perspectives in Eastern Uganda, highlighting challenges in schistosomiasis and STH prevention and management. In this qualitative descriptive study, we conducted semistructured interviews with 10 key informants who were HCW in Eastern Uganda with experience in managing STHs and schistosomiasis. Participants were selected purposively and interviewed through Zoom guided by a comprehensive interview guide. The data were transcribed, coded and analyzed thematically. We identified five key themes regarding the impact and management of NTDs: (i) the burden of NTDs, where schistosomiasis and STHs were notably prevalent among children and communities adjacent to water bodies; (ii) transmission of NTDs, emphasizing water bodies and poor sanitation as primary routes of disease spread; (iii) clinical manifestations of NTDs, detailing the symptomatic presentations that complicate diagnosis and management; (iv) challenges in managing and diagnosing NTDs, highlighting the shortages of essential medications and diagnostic tools, along with the under-prioritization of NTDs within healthcare systems; and (v) fatalities and complications arising from NTDs, reporting on the severe outcomes and under-reporting of deaths associated with NTDs due to misdiagnosis, delayed treatment and traditional healing preferences. The interviewed Ugandan HCW demonstrated sufficient knowledge of schistosomiasis and STHs, but faced challenges due to inadequate diagnostic tools and medication shortages. The study underscores the need for NTD prioritization with direct funding and government involvement, alongside strategies that integrate continuous medical training, effective community outreach and an enhanced healthcare system response to reduce the burden of NTDs.

Natural Products from Brazilian Biodiversity Explored as Anti-EBV Drug Candidates: In-Silico Database Mining, Docking Computations, Molecular Dynamics and DFT Calculations

A DNA tumor virus called Epstein–Barr virus (EBV) is the cause of 1–2% of human cancers. EBV-associated carcinogenesis is caused by a persistent latent infection. The shortage of antiviral medications or vaccinations to control the virus led to a significant percentage of critically sickness individuals needing to be hospitalized. In the absence of an effective vaccine and approved drug, there is an immediate need for treatments that can combat EBV infection. Epstein–Barr nuclear antigen 1 (EBNA1) is continually expressed in all malignancies linked to EBV; it is a desirable target for curative interference. Herein, natural product compounds from the Nuclei of Bioassays, Ecophysiology and Biosynthesis of Natural Products (NuBBE) database were mined to identify potent EBNA1 inhibitors. The performance of the molecular docking technique was initially assessed in expecting the ligand-target binding pose according to the available experimental data. On the basis of the estimated docking protocol, the NuBBE database was virtually screened toward the EBNA1 protein, and the natural compounds with binding scores less than KWG (calc. -7.8 kcal/mol) were subjected to molecular dynamics (MD) simulations followed by binding energy ([Formula: see text] calculation using MM/GBSA approach. Based on binding energy computations, NuBBE1460 revealed superior [Formula: see text] with a value of −36.2 kcal/mol, compared to KWG (calc. -32.4 kcal/mol). Post-MD analyses displayed a high steadiness of NuBBE1460 within the EBNA1 protein binding pocket. Furthermore, the physicochemical, pharmacokinetic and toxicity features of the identified compound were predicted, demonstrating high degrees of its oral bioavailability. The energetical and geometrical properties of NuBBE1460 were calculated using the DFT method. Conclusively, this study offers NuBBE1460 obtained from natural sources as a lead EBNA1 inhibitor for future investigation and development as a therapeutic for EBV.

Burn pain management in a female patient with severe burn injuries in Nepal: a case study and review.

Burn injuries in low-resource settings like Nepal present significant public health challenges, leading to substantial morbidity, mortality and severe pain. This paper assesses burn pain management in Nepal, emphasizing the need for enhanced strategies. A case study of a female patient with severe burn injuries from a rural village in Western Nepal illustrates current challenges. Reviewing studies on burn pain management in Nepal shows limited access to specialized facilities, inadequate palliative care, medication shortages and insufficient healthcare professionals. Pharmacological interventions are impacted by financial constraints and a lack of protocols, while nonpharmacological approaches have not been explored and contextualized for the Nepalese context due to similar financial issues. Comprehensive burn pain management requires addressing resource constraints through collaborative health-aid partnerships.

Evaluation of Mental Health and Well-Being Among Kansas Pharmacists Post-COVID-19 Pandemic.

Background COVID-19 has profoundly affected pharmacists, causing burnout from heavier workloads, personal stressors, and disrupted healthcare delivery. Research on pharmacists' mental health during the pandemic, especially in rural areas like Kansas, remains limited. Objectives This study aimed to understand perceptions, experiences, and impacts on the mental, emotional, and psychological well-being of active Kansas pharmacists during the COVID-19 pandemic, includingevaluatingworkplace modifications on mental health. Methods Kansas licensed pharmacists were recruited via email distributions through five Kansas pharmacy organizations and informal referrals among colleagues. After consenting, respondents completed a 15-minute, 28-question survey via Qualtrics. The survey included 11 questions concerning demographics and employment characteristics, along with 17 questions designed to assess the impact of COVID-19 on mental health, structured according to existing literature. Participation was uncompensated, and incomplete surveys were omitted from the analysis. Results One hundred and seven respondents (83.59% completion) represented 3.25% of Kansas's 3,290 pharmacists. They were aged 26-66 (M=38.7), the majority female (72.57%) and white (84.84%), with 14.24 years average practice duration (SD=10.94). Data covered 12 rural and 11 urban counties, with 50.91% staff pharmacists and 22.73% pharmacy managers. Many worked over 40 hours weekly in 13 settings. Findings showed increased workload (24.68%), medication shortages (24.03%), and burnout (24.32%) affecting job considerations. Workplace changes impacted personal mental health, with the main stressors being work-related factors (19.21%), social distancing (18.95%), and health concerns (12.63%). Conclusion This study underscores the pandemic's profound toll on Kansas pharmacists' mental, emotional, and physical health, leading to burnout, job dissatisfaction, and decreased effectiveness. It emphasizes the urgency of organizational interventions.

Global Strategies for Postoperative Care and Bowel Management in Patients With Anorectal Malformations: Varied Practices and Barriers

BackgroundAnorectal malformations (ARMs) commonly result in constipation and fecal incontinence following primary surgical reconstruction. This study investigates global variations in postoperative care and resources. MethodsA survey was distributed via the International Pediatric Endosurgery Group (IPEG) and snowball sampling. Geographically, respondents were categorized into high-income countries (HICs) and low—or middle-income countries (LMICs). Results233 surveys were received, 64% from LMICs and 36% from HICs. Of these, 51% reported monitoring ARM patients for over a year, while 23% utilized digital technologies. Access to anesthesia for anorectal exams was available to 70% of respondents. Only 29% had established a one-week Bowel Management Program (BMP). Collaboration with urologists and gynecologists was more prevalent in HICs (59%) compared to LMICs (37%, p < 0.01). In HICs, nurses and advanced practice providers were significantly more involved in BMP (71% vs. 39% in LMICs; p < 0.01), and abdominal radiographs for regimen adjustments were used more frequently (80% vs. 69% in LMICs; p = 0.03). Treatment regimens were more varied in HICs, and quality of life tracking was more consistent (19% vs. 9% in LMICs; p = 0.02). LMICs reported significant shortages of medications and equipment (75% vs. 58% in HICs; p = 0.01), inadequate sanitation (48% vs. 24%; p < 0.01), and insufficient insurance coverage (58% vs. 44%; p = 0.04). ConclusionsThere are notable global disparities in the postoperative care of ARM patients, particularly in BMP protocols and treatment regimens, with LMICs facing severe socioeconomic challenges. This emphasizes the urgent need for targeted strategies and resources to enhance outcomes for ARM patients across different regions. Level of EvidenceLevel III.

Nursing leadership in disaster preparedness and response lessons learned and future directions

Nursing leadership is integral to effective disaster preparedness and response, demanding agility, strategic planning, and robust resource management. Disasters, both natural and man-made, present unique challenges that require nursing leaders to be adept in rapid decision-making and efficient coordination. The unpredictability of disasters necessitates comprehensive and regularly updated preparedness plans, ensuring nursing teams are well-versed in their roles through continuous training and simulations. Interprofessional collaboration and strong community partnerships are essential, fostering a unified response and efficient resource distribution. Communication remains a cornerstone of disaster management, with clear, timely information dissemination being crucial for coordinating efforts and maintaining public trust. Resource scarcity during disasters, such as shortages of medications and personal protective equipment (PPE), poses significant challenges. Effective resource management strategies are essential to maintain patient care standards and protect healthcare workers. The psychological toll on healthcare providers is another critical issue, with nursing leaders needing to implement support systems that address mental health and promote resilience. Integrating advanced technologies like telehealth and data analytics can enhance disaster response, providing remote care options and enabling predictive modeling for better resource allocation. Innovative approaches in nursing leadership include the use of telehealth for remote consultations and monitoring, data analytics for predictive modeling, and interprofessional education to improve teamwork and coordination. Strengthening community partnerships enhances overall disaster response capacity, ensuring that community-specific needs are addressed. Mental health support for healthcare providers, both immediate and long-term, is vital for maintaining a resilient workforce. Policy advocacy by nursing leaders is crucial to developing robust disaster preparedness frameworks and securing adequate funding. In summary, nursing leadership is pivotal in disaster preparedness and response, with a focus on strategic planning, interprofessional collaboration, effective communication, resource management, mental health support, and the integration of advanced technologies. Emphasizing these areas will enhance the resilience and responsiveness of healthcare systems, ultimately improving outcomes for patients and healthcare providers during disasters.

Lawsuits against the Brazilian Unified Health System regarding Bladder/Ureteral Cancer

Abstract Objective To evaluate the technical notes (TNs) issued by the Center for Technical Support of the Judiciary (Núcleo de Apoio Técnico do Poder Judiciário, NAT-Jus, in Portuguese) of the Brazilian Ministry of Justice regarding lawsuits against the Brazilian Unified Health System (Sistema Único de Saúde, SUS, in Portuguese) concerning bladder/ureteral cancer, in order to better advise the formulation of public policies regarding oncologic care. Materials and Methods A cross-sectional study on the TNs issued by NAT-Jus regarding lawsuits from patients against SUS from 2019 to 2023 concerning bladder or ureteral cancer. Results A total of 137 TNs were issued. Most plaintiffs were male patients (70.8%), with a mean age of 69.1 ± 17.6 years. The lawsuits were filed in an attempt to obtain medications (67%), medical care or procedures (26%), or other health products (7%).The most common medications requested were immuno-oncology (IO) therapeutic agents, in 66 cases (pembrolizumab, avelumab, nivolumab, and atezolizumab), followed by the Bacillus Calmette-Guerin (BCG) vaccine (n = 13), chemotherapeutic agents in 5 cases, erdafitinib in 2 cases, and enfortumab vedotin in 1 case.Pembrolizumab was the medication most frequently requested by patients undergoing treatment for bladder or ureteral cancer. Out of more than 50 thousand TNs, there were 1,349 requests for this medication. Bladder or ureteral cancer was responsible for 3.4% of all the demands for pembrolizumab.It is also notable that lawsuits were more common in the Southern (n = 47), followed by the Southeastern (n = 26), Northeastern (n = 20), and Midwestern (n = 6) regions. The lawsuits in the South were more often related to expensive medications. In the Northeast and Midwest, there were proportionally more lawsuits demanding medical procedures. The Brazilian Federal Government lost the lawsuits, representing expenses of BRL 42.1 million with these novel medications within the period evaluated. Conclusion Bladder cancer treatment within SUS faces obstacles and shortages of essential medications. Moreover, advanced and costly therapies are not widely available, straining the public healthcare system and resulting in increasing legal costs. Collaboration among the government, the scientific community, and patient advocacy organizations is crucial to ensure the sustainability of SUS in the face of these challenges.

Lived experience, social support, and challenges to health service use during the COVID-19 pandemic among HIV key populations in Indonesia

The COVID-19 pandemic has greatly affected the lives, health, and social well-being of people globally including presenting special challenges in low to middle income countries for people living with HIV. This study investigates the pandemic experiences of the four key HIV-positive populations in Indonesia: men who have sex with men, transgender women, female sex workers, and people who use drugs. In-depth interviews were conducted with a convenience sample of 22 key population members recruited through 9 nongovernment HIV agencies in Jakarta and Bali, Indonesia. Indonesia’s Large-scale Social Restrictions Policy mandating physical distancing and stay-at-home orders had been in effect for 7–10 months at the time of the interviews. The interviews were audio-recorded, transcribed, and coded using NVivo™ (R1.7) software. A grounded theory approach identified key concepts along with similarities, differences, and reoccurring patterns of COVID-19 lived experience among participants. Participants recounted the impact of both the pandemic and the Restriction Policy on their interpersonal, financial, medical, and psychosocial well-being. When in need, they turned to formal and informal sources of financial and social support plus their own resourcefulness. Along with other factors, HIV medication shortages, HIV and COVID-19 related stigma, and fear of acquiring COVID-19 negatively impacted their antiretroviral adherence and the use of health services. The results point to the latent consequences of government attempts to curb a pandemic through public health lockdowns and enforced policies of physical separation. Its findings reveal the importance of ensuring that public safety nets for HIV key populations are available to supplement more informal personal sources of needed support.