Rapid initiation of antiretroviral therapy in Turkey: a modeling study.

Background: To effectively control the HIV epidemic and meet global targets, policymakers recommend the rapid initiation of antiretroviral therapy (ART). Our study aims to investigate the effect of rapid ART programs on individuals diagnosed with HIV, considering varying coverage and initiation days after diagnosis, and compare it to standard-of-care ART treatment in Turkey. Methods: We used a dynamic compartmental model to simulate the dynamics of HIV infection in Turkey. Rapid treatment, defined as initiation of ART within 7 days of diagnosis, was contrasted with standard-of-care treatment, which starts within 30 days of diagnosis. This study considered three coverage levels (10%, 50%, and 90%) and two rapid periods (7 and 14 days after diagnosis), comparing them to standard-of-care treatment in evaluating the number of HIV infections between 2020 and 2030. Results: Annual HIV incidence and prevalence for a 10-year period were obtained from model projections. In the absence of a rapid ART program, the model projected approximately 444,000 new HIV cases while the number of cases were reduced to 345,000 (22% reduction) with 90% of diagnosed cases included in the rapid ART program. Similarly, 10% and 50% rapid ART coverage has resulted in 3% and 13% reduction in HIV prevalence over a 10-year period. Conclusion: Rapid ART demonstrates the potential to mitigate the increasing HIV incidence in Turkey by reducing the number of infections. The benefit of the rapid ART program could be substantial when the coverage of the program reaches above a certain percentage of diagnosed population.

Modeling the future of HIV in Turkey: Cost-effectiveness analysis of improving testing and diagnosis.

AIMS: This study aimed to determine HIV incidence and prevalence in Turkey and to estimate the cost-effectiveness of improving testing and diagnosis in the next 20 years. BACKGROUND: HIV incidence in Turkey has been rapidly increasing in the last decade with a particularly high rate of infection for younger populations, which underscores the urgent need for a robust prevention program and improved testing capacity for HIV. METHODS: We developed a dynamic compartmental model of HIV transmission and progression among the Turkish population aged 15-64 and assessed the effect of improving testing and diagnosis. The model generated the number of new HIV cases by transmission risk and CD4 level, HIV diagnoses, HIV prevalence, continuum of care, the number of HIV-related deaths, and the expected number of infections prevented from 2020 to 2040. We also explored the cost impact of HIV and the cost-effectiveness of improving testing and diagnosis. RESULTS: Under the base case scenario, the model estimated an HIV incidence of 13,462 cases in 2020, with 63% undiagnosed. The number of infections was estimated to increase by 27% by 2040, with HIV incidence in 2040 reaching 376,889 and HIV prevalence 2,414,965 cases. Improving testing and diagnosis to 50%, 70%, and 90%, would prevent 782,789, 2,059,399, and 2,336,564 infections-32%, 85%, and 97% reduction in 20 years, respectively. Improved testing and diagnosis would reduce spending between $1.8 and $8.8 billion. CONCLUSIONS: In the case of no improvement in the current continuum of care, HIV incidence and prevalence will significantly increase over the next 20 years, placing a significant burden on the Turkish healthcare system. However, improving testing and diagnosis could substantially reduce the number of infections, ameliorating the public health and disease burden aspects.

A study in four European countries to examine the importance of sensory attributes of oral nutritional supplements on preference and likelihood of compliance.

BACKGROUND/AIMS: A study designed to examine the importance of the sensory attributes of oral nutritional supplements on preference and likelihood of compliance. MATERIALS AND METHODS: Independent individuals ≥ 50 years not currently receiving oral nutritional supplements were recruited to a two-stage, single-blind, randomised, preference study, conducted in four European countries. Stage 1 consisted of a 5-day trial period during which two units of commonly prescribed oral nutritional supplements were administered, with a different oral nutritional supplements being consumed each day. In Stage 2, all participants consumed two units daily of one oral nutritional supplements for five days and two units daily of a second oral nutritional supplements for a further five days. Using standardised hedonic scales, participants reported their perceptions of each oral nutritional supplements for a range of sensory attributes, and estimated how many units of each oral nutritional supplements they could consume. RESULTS: One thousand seven hundred seventy one individuals completed the study. The overall opinion of each oral nutritional supplements was strongly correlated with taste (r=0.91; p<0,0001), while unit volume demonstrated a weak relationship (r =0,29; p<0,0001). One oral nutritional supplements (Reformulated Ensure Plus) was preferred overall, scoring significantly higher for taste (p<0,05) and oral sensation (p<0,05) than other oral nutritional supplements. CONCLUSIONS: This study contributes to the understanding of how sensory attributes, particularly taste and oral sensation, influence preference and compliance to oral nutritional supplements.