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Background Potentially inappropriate medications (PIM) are associated with adverse health outcomes. The use of PIM among persons living with HIV (PLHIV) could be more problematic due to peculiarities such as antiretroviral toxicity and drug-disease interactions. However, PIM among PLHIV continues to receive little attention. Therefore, we aimed to systematically review and estimate the prevalence of PIM among PLHIV. Methods We searched the PubMed, Scopus, and Web of Science databases to identify relevant studies from 1 January 2014 to 30 June 2024. Studies included were peer-reviewed articles that determined PIM prevalence using validated explicit or implicit tools and provided statistical information on the measured outcomes. Systematic, narrative, and literature reviews as well as case studies, commentaries, and editorials were excluded. Risk of bias was assessed using the Joanna Briggs Institute Prevalence Critical Appraisal Tool. Subgroup analysis was performed for the different geographic regions, PIM criteria, age, study period, and median numbers of medicines. Statistical heterogeneity was assessed using the I2 statistic. Sensitivity analyses, publication bias, and cumulative meta-analysis were conducted. Results A total of 13 articles, including 3200 PLHIV, were included for the systematic review, while meta-analysis was conducted using 8 studies comprising 2546 PLHIV. Most of the studies (46%) employed a cross-sectional study design. 11 out of the 13 studies were conducted in Europe. Most studies reported benzodiazepines as the most common PIM among PLHIV, while hypertension and dyslipidaemia were identified as the most frequent comorbidities. Overall, the pooled prevalence of PIM was 44.8% (95% CI, 32%-58%) using a random-effect model. PIM prevalence among PLHIV was higher among those exposed to polypharmacy (59.3%; CI: 48.9% – 68.9%), those aged > 70 years (44.6%; CI: 24.1–67.1), and post-COVID (48.9%; CI: 39%-59%). Conclusion This study suggests that PIM exposure among PLHIV is a budding issue. Findings from this review advocate for mitigating measures against PIM use. Also, this review contributes data on the use of PIM across different cohorts, creating awareness for policymakers and health managers. Review registration PROSPERO – CRD42024529411.

Healthcare access remains a challenge in developing countries and could be a drawback to the attainment of Objective 3 of the Sustainable Development Goals. Digital interventions such as telemedicine have been identified as an effective tool to improve healthcare access. However, evidence suggests that the impact of telemedicine is not uniform globally due to variances in barriers and facilitators. Thus, we conducted a systematic review to identify the barriers and facilitators of telemedicine in Nigeria. The systematic review was pre-registered on PROSPERO (Identification Number: CRD42024609405). Search was conducted on PubMed, Scopus, and the Cumulative Index of Nursing and Allied Health Literature databases. We included studies that reported on the estimates of barriers and facilitators of telemedicine in Nigeria as well as the factors associated with telemedicine implementation, provision, or operation in Nigeria. The outcome was the reportage of barriers and facilitators of telemedicine in Nigeria. A total of 384 studies were identified from the search. After the application of eligibility criteria and deletion of duplicates, 29 studies were included in the review. The most reported barriers were technical and institutional-related while the most reported facilitators were human-resource-related. Technical barriers frequently reported were power outages, poor internet connectivity, and paucity of health professionals with technical expertise while institutional barriers were lack of regulation and poor organizational policies. Formal telemedicine training and education were the most reported human resource facilitators while the use of low-tech educational networks and internet accessibility were the most reported technical facilitators. Findings from this review suggest that technical barriers are a challenge to adopting telemedicine in Nigeria. Evidence shows that education and training are critical in addressing these technical challenges. Thus, this review provides a background for interventions towards the effective implementation of telemedicine in Nigeria.

Healthcare access remains a challenge in developing countries and could be a drawback to the attainment of Objective 3 of the Sustainable Development Goals. Digital interventions such as telemedicine have been identified as an effective tool to improve healthcare access. However, evidence suggests that the impact of telemedicine is not uniform globally due to variances in barriers and facilitators. Thus, we conducted a systematic review to identify the barriers and facilitators of telemedicine in Nigeria. The systematic review was pre-registered on PROSPERO (Identification Number: CRD42024609405). Search was conducted on PubMed, Scopus, and the Cumulative Index of Nursing and Allied Health Literature databases. We included studies that reported on the estimates of barriers and facilitators of telemedicine in Nigeria as well as the factors associated with telemedicine implementation, provision, or operation in Nigeria. The outcome was the reportage of barriers and facilitators of telemedicine in Nigeria. A total of 384 studies were identified from the search. After the application of eligibility criteria and deletion of duplicates, 29 studies were included in the review. The most reported barriers were technical and institutional-related while the most reported facilitators were human-resource-related. Technical barriers frequently reported were power outages, poor internet connectivity, and paucity of health professionals with technical expertise while institutional barriers were lack of regulation and poor organizational policies. Formal telemedicine training and education were the most reported human resource facilitators while the use of low-tech educational networks and internet accessibility were the most reported technical facilitators. Findings from this review suggest that technical barriers are a challenge to adopting telemedicine in Nigeria. Evidence shows that education and training are critical in addressing these technical challenges. Thus, this review provides a background for interventions towards the effective implementation of telemedicine in Nigeria.

COVID-19 is a multisystem disease and patients who survive might have in-hospital complications. These complications are likely to have important short-term and long-term consequences for patients, health-care utilisation, health-care system preparedness, and society amidst the ongoing COVID-19 pandemic. Our aim was to characterise the extent and effect of COVID-19 complications, particularly in those who survive, using the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK. We did a prospective, multicentre cohort study in 302 UK health-care facilities. Adult patients aged 19 years or older, with confirmed or highly suspected SARS-CoV-2 infection leading to COVID-19 were included in the study. The primary outcome of this study was the incidence of in-hospital complications, defined as organ-specific diagnoses occurring alone or in addition to any hallmarks of COVID-19 illness. We used multilevel logistic regression and survival models to explore associations between these outcomes and in-hospital complications, age, and pre-existing comorbidities. Between Jan 17 and Aug 4, 2020, 80 388 patients were included in the study. Of the patients admitted to hospital for management of COVID-19, 49·7% (36 367 of 73 197) had at least one complication. The mean age of our cohort was 71·1 years (SD 18·7), with 56·0% (41 025 of 73 197) being male and 81·0% (59 289 of 73 197) having at least one comorbidity. Males and those aged older than 60 years were most likely to have a complication (aged ≥60 years: 54·5% [16 579 of 30 416] in males and 48·2% [11 707 of 24 288] in females; aged <60 years: 48·8% [5179 of 10 609] in males and 36·6% [2814 of 7689] in females). Renal (24·3%, 17 752 of 73 197), complex respiratory (18·4%, 13 486 of 73 197), and systemic (16·3%, 11 895 of 73 197) complications were the most frequent. Cardiovascular (12·3%, 8973 of 73 197), neurological (4·3%, 3115 of 73 197), and gastrointestinal or liver (10·8%, 7901 of 73 197) complications were also reported. Complications and worse functional outcomes in patients admitted to hospital with COVID-19 are high, even in young, previously healthy individuals. Acute complications are associated with reduced ability to self-care at discharge, with neurological complications being associated with the worst functional outcomes. COVID-19 complications are likely to cause a substantial strain on health and social care in the coming years. These data will help in the design and provision of services aimed at the post-hospitalisation care of patients with COVID-19. National Institute for Health Research and the UK Medical Research Council.

Abstract Background We conducted this study to assess the prevalence of viral coinfection in a well characterized cohort of hospitalized coronavirus disease 2019 (COVID-19) patients and to investigate the impact of coinfection on disease severity. Methods Multiplex real-time polymerase chain reaction testing for endemic respiratory viruses was performed on upper respiratory tract samples from 1002 patients with COVID-19, aged <1 year to 102 years old, recruited to the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK study. Comprehensive demographic, clinical, and outcome data were collected prospectively up to 28 days post discharge. Results A coinfecting virus was detected in 20 (2.0%) participants. Multivariable analysis revealed no significant risk factors for coinfection, although this may be due to rarity of coinfection. Likewise, ordinal logistic regression analysis did not demonstrate a significant association between coinfection and increased disease severity. Conclusions Viral coinfection was rare among hospitalized COVID-19 patients in the United Kingdom during the first 18 months of the pandemic. With unbiased prospective sampling, we found no evidence of an association between viral coinfection and disease severity. Public health interventions disrupted normal seasonal transmission of respiratory viruses; relaxation of these measures mean it will be important to monitor the prevalence and impact of respiratory viral coinfections going forward. In a multi-centre prospective cohort study of viral co-infection in hospitalised COVID-19 patients using unbiased systematic PCR testing, co-infection was rare during the first 18 months of the pandemic, with no observed association between viral co-infection and disease severity.