BACKGROUND:Cancer care faces increasing sustainability challenges due to the structural growth of health care costs, driven by longer survival, expanding treatment indications, and the rapid diffusion of high-cost technologies. In this context, policymakers have implemented prospective payment systems (PPS) as policy strategies to promote care coordination, efficiency, and resource optimization in oncology. OBJECTIVE:To evaluate the association between the implementation of PPS and key outcomes in cancer care, including health care expenditure, service utilization, quality of care, and patient survival or mortality, compared with fee-for-service (FFS) payment models. METHODS:We conducted a systematic literature following PRISMA guidelines. Eligible studies, published between 2000 and 2024, assessed PPS mechanisms in adult cancer patient populations, mostly using cohort and case-control studies. We synthesized evidence across four predefined domains: health expenditures, service utilization, quality of care, and survival or mortality. RESULTS:Across included studies, findings were heterogeneous and context dependent. Nine studies evaluated health expenditures, of which 90 % reported reductions. Among six studies assessing service utilization, 66.7 % found no significant variation. Eleven studies examined quality outcomes; 54.5 % reported improvements. For survival, 57.1 % of seven studies showed favourable results. CONCLUSION:Our review synthesizes the evidence on the implementation of PPS applied to cancer care compared with FFS models. PPS are consistently associated with cost containment, while evidence regarding utilization, quality, and survival remains mixed and, in some cases, inconclusive. Our findings underscore the potential of PPS as a policy instrument to improve financial sustainability in oncology, while also highlighting the need for careful design, implementation, and monitoring to mitigate unintended risks.
Since 1997, a laboratory-based survey on cryptococcosis has been conducted in Colombia. We present the results for the period 2017–2024. A total of 891 surveys were received. The overall incidence was 0.22 cases per 100,000 people. Among those living with HIV, the incidence was 38, and among HIV-negative people, it was 0.08. Cryptococcosis demonstrated a higher prevalence among men than women (3.2:1). Among patients living with Human Immunodeficiency Virus (HIV), the condition primarily affected younger adults (26–40 years). In contrast, among HIV-negative people, it was mostly observed in older adults (≥60 years). HIV infection was the most significant risk factor (63%), but another cause of immunosuppression was identified in 21.2% cases. Neurocryptococcosis was the most common form of presentation (62.2%), followed by disseminated cryptococcosis (31.1%). The diagnosis was confirmed by culture in 99.4% of patients; the most important sample was cerebrospinal fluid (67.3%), followed by blood (35.4%). Cryptococcus neoformans was identified in 93.1% of cases, and Cryptococcus gatti in 6.9%. Predominant molecular patterns were VNI (92.4%) and VGII (45.3%). The epidemiology of cryptococcosis in Colombia is changing, with a progressive decrease in HIV coinfection and an increase in other immunosuppressive conditions in older people. This study highlights the importance of cryptococcosis in Colombia and the need to report it in order to improve knowledge and thereby promote the quality of diagnosis and the opportunity for more effective treatment.
Clinical trajectories following Trypanosoma cruzi infection are heterogeneous, and the determinants of post-treatment parasitological dynamics and cardiac progression remain incompletely characterized, particularly in TcI-predominant regions. This study assessed, in both the acute phase and the indeterminate chronic form, the association between TcI infection and molecular clearance kinetics, cardiac progression, and the prognostic value of early molecular response. An ambispective cohort in Colombia included patients with acute or indeterminate chronic infection followed between 2000 and 2023. Sustained clearance was defined as two consecutive negative quantitative polymerase chain reaction results obtained at separate visits. Time-to-event analyses were conducted using Kaplan-Meier curves and Cox proportional hazards models. TcI infection was consistently associated with delayed molecular clearance in both clinical presentations. Although long-term clearance was achieved in most patients, TcI infection was independently associated with a higher risk of cardiac progression. In contrast, quantitative polymerase chain reaction negativity at 12 months was associated with reduced subsequent progression risk, indicating that sustained molecular response is a clinically meaningful prognostic marker. Collectively, these findings support the incorporation of early molecular monitoring into risk-stratified follow-up strategies in TcI-predominant settings and reinforce the need for phase-specific clinical management approaches.
In Loreto, Peru, unsuccessful treatment outcomes among patients with drug-resistant tuberculosis (DR-TB) remain high, underscoring the need to identify associated factors in this Amazonian region. This retrospective cohort study included 417 DR-TB cases registered in the national TB system in Loreto between 2015 and 2023. Loss to follow-up, death, and treatment failure were combined into a single composite outcome variable defined as unsuccessful treatment outcome. Bivariate and multivariable logistic regression analyses were performed to estimate associations between sociodemographic, clinical, and programmatic factors and this outcome. Among the 417 cases analyzed, 49.5% had unsuccessful treatment outcomes: 34.1% due to loss to follow-up, 3.6% due to treatment failure, and 11.8% due to death. Loss to follow-up was the main driver of unsuccessful outcomes, suggesting important gaps in continuity of care and adherence support within the regional health system. In bivariate analyses, unsuccessful outcomes were associated with age 18-30 years (OR: 3.7; 95% CI: 1.6-8.5; p = 0.002), TB-HIV coinfection (OR: 2.4; 95% CI: 1.2-4.6; p = 0.012), previous treatment after loss to follow-up (OR: 2.9; 95% CI: 1.6-5.2; p < 0.001), high bacillary load (+++) (OR: 1.9; 95% CI: 1.0-3.5; p = 0.041), alcoholism (OR: 4.6; 95% CI: 1.5-14.1; p = 0.006), and drug addiction (OR: 7.0; 95% CI: 2.0-24.2; p = 0.002). In the multivariable analysis, alcoholism remained independently associated with unsuccessful outcomes (aOR: 4.0; 95% CI: 1.1-14.2; p = 0.029), while individualized treatment was associated with lower odds of unsuccessful outcomes (aOR: 0.4; 95% CI: 0.1-0.9; p = 0.023). Unsuccessful treatment outcomes among DR-TB patients in Loreto were mainly driven by loss to follow-up, highlighting persistent gaps in treatment continuity and adherence support. Programmatic priorities should include decentralized access to drug-susceptibility testing, community-based adherence strategies, and integrated screening and management of alcohol use within DR-TB care.
OBJECTIVES:To evaluate continuity of once-weekly isoniazid plus rifapentine for 12 weeks (3HP) tuberculosis preventive treatment in a Paraguayan prison cohort, focusing on adherence, strict completion, safety and institutional transitions as drivers of non-completion. METHODS:We conducted a longitudinal implementation cohort study at Coronel Oviedo Penitentiary Center, Paraguay, during July-October 2025. Persons with QuantiFERON-TB Gold Plus-confirmed tuberculosis infection and active tuberculosis excluded by the program algorithm were offered 3HP under directly observed therapy. Weekly dose administration, missed-dose reasons and self-reported adverse reactions were recorded. RESULTS:Of 1846 people incarcerated in the facility, 240 accessed QuantiFERON testing and 170 tested positive. Among QFT-positive individuals, 50 did not initiate 3HP because of transfer, release or refusal. A total of 120 initiated 3HP; 90 achieved acceptable adherence, defined as receipt of at least 11 of 12 doses (75.0%), and 82 completed all 12 doses (68.3%). Medication was administered in 1195 of 1440 scheduled person-weeks (83.0%). Non-completion occurred in 30 participants; 28 cases (93.3%) were attributable to release or transfer. Fifty-seven participants (47.5%) reported at least one adverse reaction, mostly mild or moderate. CONCLUSION:High adherence was achieved with 3HP, but institutional transitions interrupted completion, highlighting the need for prison-to-community continuity mechanisms after incarceration.
