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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.

Background The R21/Matrix-M vaccine has significantly reduced incident malaria in children aged 3–36 months, but awareness, acceptance, and affordability of the vaccine are key to its successful rollout. The objective of this study was to assess the awareness, acceptability, and willingness to pay (WTP) for the R21/Matrix-M malaria vaccine among pregnant women and nursing mothers in Enugu State, Nigeria. Methods A descriptive cross-sectional study was carried out in the selected locations via a 30-item, 4-section questionnaire. Descriptive statistics (frequency, percentage, mean and median) and inferential statistics (chi-square test and binary logistic regression) were used to analyze the data, with the significance level set at p  ≤ 0.05. Results Of the 310 participants, most were aged 22–33 years, 232 (75.0%) and had at least one child aged 3 years and younger, 180 (58.1%). Additionally, the majority were not aware of the R21/Matrix-M malaria vaccine, 262 (84.5%); agreed to vaccinate their child, 292 (94.2%); and declared a WTP, 247 (79.7%). The mean and median maximum WTP values were US $0.82 ± 1.41 (₦639.27 ± 1097) and US $0.38 (₦300) [Official USD ($) rate; (1 USD = ₦780) as of June–July 2023], respectively. Age ( p  = 0.005) and health insurance ( p  = 0.021) were significantly associated with the respondents’ WTP. Health insurance (OR: 0.417, 95% CI: 0.19–0.92) also predicted a lower WTP. Conclusion Despite limited awareness of the R21/Matrix-M malaria vaccine, participants demonstrated high acceptance and a strong WTP, suggesting that increased awareness could lead to high vaccine coverage.

Pharmaceutical care is the core of pharmacy practice. The reform and development of this practice are essential for the optimization of patient care and improvement of population safety. While pharmaceutical care has been established to have a long history in Nigeria, the implementation of the practice in Nigeria's tertiary health system is very limited and, in some regions, non-existent. Challenges such as knowledge deficits of pharmacists and the inadequacy of practice guidelines, a lack of knowledge, support, and an enabling environment to foster inclusiveness, limited access to patient records, the absence of documentation of interventions and the paucity of policy support and implementation, among others, stall pharmaceutical care provision in Nigeria's tertiary institutions. Here, we recommend that improving the interprofessional environment through collaboration, adequate regulations and policy development, the design of insurance and health support, pharmacy education, training and research optimization will bolster the pharmaceutical care practice in Nigerian tertiary hospitals. Moving the practice of pharmaceutical care in Nigerian tertiary hospitals requires transformational change and strategic collaboration among the pharmacists and health community.