RESEARCH PAPER
Quantifying people living with HIV who would benefit from an alternative to daily oral therapy: Perspectives from HIV physicians and people living with HIV
Laura Clark 1  
,   Chitra Karki 1  
,   Josh Noone 1  
,   Jenny Scherzer 2  
,   Martina Bode 2  
,   Paolo Rizzini 3  
,   Fabio Vecchio 3  
,   Laetitia Roustand 4  
,   Gaelle Nachbaur 4  
,   Laurent Finkielsztejn 5  
,   Vasiliki Chounta 6  
,   Nicolas Van de Velde 6  
 
More details
Hide details
1
Ipsos Insights LLC, New York, United States
2
ViiV Healthcare Limited, Munich, Germany
3
ViiV Healthcare Limited, Verona, Italy
4
GlaxoSmithKline Pharmaceuticals, Saint Amant les Eaux, France
5
ViiV Healthcare Limited, Rueil-Malmaison, France
6
ViiV Healthcare Limited, Brentford, United Kingdom
CORRESPONDING AUTHOR
Nicolas Van de Velde   

ViiV Healthcare
Submission date: 2020-08-08
Acceptance date: 2020-08-21
Publication date: 2020-10-08
 
Popul. Med. 2020;2(October):33
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Current antiretroviral therapies (ARTs) require daily oral dosing, which is a challenge for some people living with HIV (PLHIV). Measures of treatment needs that are associated with daily oral ARTs have been identified in studies/interviews with healthcare professionals (HCPs) and PLHIV, and are grouped in four main categories: 1) medical conditions interfering with daily oral administration, 2) suboptimal adherence, 3) confidentiality concerns, and 4) emotional wellbeing related to daily tablet requirements. We quantified these categories to assess the potential benefits of alternatives to daily oral ARTs such as long-acting injectable regimens.

Methods:
Two separate online studies were completed by HCPs (n=120) and PLHIV (n=698) in France, Germany, Italy and the UK, in 2019. HCPs reported the number and percentage of their patients with challenges; unit of analysis among PLHIV was the respondents (%). Descriptive analyses were performed with R 3.6.1.

Results:
HIV physicians reported managing a mean of 299 (SD=177) patients, of whom 85.7% were on ART. Among PLHIV, 98.6% (688/698) were currently on ART, with mean age of 40.9 (SD=12.0) years, and 66.4% men. HCPs estimated that 10–15% of their patients were affected by each medical condition identified as interfering with daily oral administration. HCPs further estimated that 33.6% of their patients were suboptimally adherent. ‘Non-adherence for any non-medical reason’ was reported by HCPs as the primary cause of virologic failure. Of surveyed PLHIV on ART, 43.3% (298/688) reported hiding their medication and 29.7% (204/688) indicated they had never shared their HIV status with others. Furthermore, some PLHIV reported that having to remember to dose at the right time every day was stressful (27.3%; 188/688) and many saw their tablets as a daily reminder of HIV (45.1%; 310/688).

Conclusions:
A significant proportion of PLHIV struggle with daily oral ART because of medical and/or HIV-specific issues. Alternatives to daily oral ARTs have the potential to improve treatment adherence and quality of life in PLHIV.

ACKNOWLEDGEMENTS
Data collection was supported by Ipsos Healthcare. Data analyses and medical writing services were supported by Zatum LLC.
CONFLICTS OF INTEREST
The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. L. A. Clark was a full-time employee at Ipsos Insights, LLC, during the conduct of the study. C. Karki and J. Noone report personal fees from Ipsos Insights, LLC during the conduct of the study. L. Roustand, V. Chounta and N. Van de Velde report other grants from GlaxoSmithKline, outside the submitted work. L. Finkielsztejn, V. Chounta and N. Van de Velde report personal fees from ViiV Healthcare, outside the submitted work. G. Nachbaur reports that she is an employee and holds shares of GlaxoSmithKline, during the conduct of the study.
FUNDING
The research was funded by ViiV Healthcare.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
REFERENCES (40)
1.
Mills EJ, Nachega JB, Buchan I, et al. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. JAMA. 2006;296(6):679-690. doi:10.1001/jama.296.6.679
 
2.
Iacob SA, Iacob DG, Jugulete G. Improving the adherence to antiretroviral therapy, a difficult but essential task for a successful HIV treatment—clinical points of view and practical considerations. Front Pharmacol. 2017;8:831. doi:10.3389/fphar.2017.00831
 
3.
Nachega JB, Marconi VC, van Zyl GU, et al. HIV treatment adherence, drug resistance, virologic failure: evolving concepts. Infect Disord Drug Targets. 2011;11(2):167-174. doi:10.2174/187152611795589663
 
4.
Nachega JB, Hislop M, Dowdy DW, et al. Adherence to highly active antiretroviral therapy assessed by pharmacy claims predicts survival in HIV-infected South African adults. J Acquir Immune Defic Syndr. 2006;43(1):78-84. doi:10.1097/01.qai.0000225015.43266.46
 
5.
Joint United Nations Programme on HIV/AIDS. 90-90-90: An ambitious treatment target to help end the AIDS epidemic. Geneva, Switzerland: UNAIDS; 2014. https://www.unaids.org/en/reso.... Accessed March 30, 2020.
 
6.
Yu Y, Luo D, Chen X, et al. Medication adherence to antiretroviral therapy among newly treated people living with HIV. BMC Public Health. 2018;18(1):825. doi:10.1186/s12889-018-5731-z
 
7.
Durvasula R. HIV/AIDS in older women: unique challenges, unmet needs. Behav Med. 2014;40(3):85-98. doi:10.1080/08964289.2014.893983
 
8.
Lennon CA, Pellowski JA, White AC, et al. Service priorities and unmet service needs among people living with HIV/AIDS: results from a nationwide interview of HIV/AIDS housing organizations. AIDS Care. 2013;25(9):1083-1091. doi:10.1080/09540121.2012.749337
 
9.
Sok P, Gardner S, Bekele T, et al. Unmet basic needs negatively affect health-related quality of life in people aging with HIV: results from the Positive Spaces, Healthy Places study. BMC Public Health. 2018;18(1):644. doi:10.1186/s12889-018-5391-z
 
10.
Beach SR, Schulz R, Friedman EM, et al. Adverse Consequences of Unmet Needs for Care in High-Need/High-Cost Older Adults. J Gerontol B Psychol Sci Soc Sci. 2020;75(2):459-470. doi:10.1093/geronb/gby021
 
11.
European Centre for Disease Prevention and Control, World Health Organization. HIV/AIDS surveillance in Europe 2019: 2018 Data. https://www.ecdc.europa.eu/sit.... Published 2019. Accessed November 30, 2019.
 
12.
de los Rios P, Okoli C, Punekar Y, et al. Prevalence, determinants, and impact of suboptimal adherence to HIV medication in 25 countries. Prev Med. 2020;139:106182. doi:10.1016/j.ypmed.2020.106182
 
13.
Loutfy M, Johnson M, Walmsley S, et al. The association between HIV disclosure status and perceived barriers to care faced by women living with HIV in Latin America, China, Central/Eastern Europe, and Western Europe/Canada. AIDS Patient Care and STDs. 2016;30(9):435-444. doi:10.1089/apc.2016.0049
 
14.
Rydström LL, Eriksson LE, Berlin A. “The Medication always Reminds Me”. Living with Perinatal acquired HIV-Children and Parentsʼ View Points. Madridge Journal of AIDS. 2019;3(1):62-68. doi:10.18689/mja-1000111
 
15.
Marzolini C, Back D, Weber R, et al. Ageing with HIV: medication use and risk for potential drug-drug interactions. J Antimicrob Chemother. 2011;66(9):2107-2111. doi:10.1093/jac/dkr248
 
16.
Holtzman C, Armon C, Tedaldi E, et al. Polypharmacy and risk of antiretroviral drug interactions among the aging HIV-infected population. Journal of General Internal Medicine. 2013;28(10):1302-1310. doi:10.1007/s11606-013-2449-6
 
17.
Dorman RM, Sutton SH, Yee LM. Understanding HIV-Related Pill Aversion as a Distinct Barrier to Medication Adherence. Behav Med. 2019;45(4):294-303. doi:10.1080/08964289.2018.1534076
 
18.
Margolis DA, Gonzalez-Garcia J, Stellbrink HJ, et al. Long-acting intramuscular cabotegravir and rilpivirine in adults with HIV-1 infection (LATTE-2): 96-week results of a randomised, open-label, phase 2b, non-inferiority trial. Lancet. 2017;390(10101):1499-1510. doi:10.1016/S0140-6736(17)31917-7
 
19.
Margolis DA, Brinson CC, Smith GHR, et al. Cabotegravir plus rilpivirine, once a day, after induction with cabotegravir plus nucleoside reverse transcriptase inhibitors in antiretroviral-naive adults with HIV-1 infection (LATTE): a randomised, phase 2b, dose-ranging trial. Lancet Infect Dis. 2015;15(10):1145-1155. doi:10.1016/S1473-3099(15)00152-8
 
20.
de los Rios P, Okoli C, Young B, et al. Treatment Aspirations and Attitudes Towards Innovative Medications Among People Living with HIV in 25 Countries. Popul Med. 2020;2(July):1-13. doi:10.18332/popmed/124781
 
21.
Kerrigan D, Mantsios A, Gorgolas M, et al. Experiences with long acting injectable ART: a qualitative study among PLHIV participating in a Phase II study of cabotegravir + rilpivirine (LATTE-2) in the United States and Spain. PloS one. 2018;13(1):e0190487. doi:10.1371/journal.pone.0190487
 
22.
Horne R, Cooper V, Gellaitry G, et al. Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence: the utility of the necessity-concerns framework. J Acquir Immune Defic Syndr. 2007;45(3):334-341. doi:10.1097/QAI.0b013e31806910e3
 
23.
Kalichman S, Kalichman MO, Cherry C. Medication beliefs and structural barriers to treatment adherence among people living with HIV infection. Psychol Health. 2016;31(4):383-395. doi:10.1080/08870446.2015.1111371
 
24.
Gonzalez JS, Penedo FJ, Llabre MM, et al. Physical symptoms, beliefs about medications, negative mood, and long-term HIV medication adherence. Ann Behav Med. 2007;34(1):46-55. doi:10.1007/BF02879920
 
25.
Valverde E, Beer L, Johnson C, et al. Prevention counseling practices of HIV care providers with patients new to HIV medical care: medical monitoring project provider survey, 2009. J Int Assoc Provid AIDS Care. 2014;13(2):127-134. doi:10.1177/2325957413516496
 
26.
Shaw S, Modi R, Mugavero M, et al. HIV Standard of Care for ART Adherence and Retention in Care Among HIV Medical Care Providers Across Four CNICS Clinics in the US. AIDS Behav. 2019;23(4):947-956. doi:10.1007/s10461-018-2320-1
 
27.
Ddumba-Nyanzi I, Kaawa-Mafigiri D, Johannessen H. Barriers to communication between HIV care providers (HCPs) and women living with HIV about child bearing: A qualitative study. Patient Educ Couns. 2016;99(5):754-759. doi:10.1016/j.pec.2015.11.023
 
28.
Mallinson RK, Rajabiun S, Coleman S. The provider role in client engagement in HIV care. AIDS Patient Care STDS. 2007;21(Suppl 1):S77-S84. doi:10.1089/apc.2007.9984
 
29.
U.S. Department of Health & Human Services. National HIV/AIDS Strategy for The United States: Updated to 2020. https://files.hiv.gov/s3fs-pub.... Published 2015. Accessed Feb 29, 2020.
 
30.
Brown AE, Hayes R, Noori T, et al. HIV in Europe and Central Asia: progress in 2018 towards meeting the UNAIDS 90-90-90 targets. Euro Surveill. 2018;23(48):1800622. doi:10.2807/1560-7917.ES.2018.23.48.1800622
 
31.
Roche Laboratories Inc., Trimeris Inc. Fuzeon (enfurvitide) for injection. https://www.accessdata.fda.gov.... Published 2003. Accessed Feb 29, 2020.
 
32.
Rice WS, Turan B, Fletcher FE, et al. A Mixed Methods Study of Anticipated and Experienced Stigma in Health Care Settings Among Women Living with HIV in the United States. AIDS Patient Care STDS. 2019;33(4):184-195. doi:10.1089/apc.2018.0282
 
33.
Chan BT, Tsai AC. HIV stigma trends in the general population during antiretroviral treatment expansion: analysis of 31 countries in sub-Saharan Africa, 2003-2013. J Acquir Immune Defic Syndr. 2016;72(5):558-564. doi:10.1097/QAI.0000000000001011
 
34.
Lazarus JV, Safreed-Harmon K, Barton SE, et al. Beyond viral suppression of HIV - the new quality of life frontier. BMC Med. 2016;14(1):94. doi:10.1186/s12916-016-0640-4
 
35.
Miners A, Phillips A, Kreif N, et al. Health-related quality-of-life of people with HIV in the era of combination antiretroviral treatment: a cross-sectional comparison with the general population. Lancet HIV. 2014;1(1):e32-40. doi:10.1016/S2352-3018(14)70018-9
 
36.
Okoli C, de Los Rios P, Eremin A, et al. Relationship Between Polypharmacy and Quality of Life Among People in 24 Countries Living With HIV. Prev Chronic Dis. 2020;17:E22. doi:10.5888/pcd17.190359
 
37.
Okoli C, Van de Velde N, Richman B, et al. Undetectable Equals Untransmittable (U = U): Awareness and associations with health outcomes among people living with HIV in 25 countries. Sex Transm Infect. 2020. doi:10.1136/sextrans-2020-054551
 
38.
Engelhard E, Smith C, Vervoort S, et al. Patients' willingness to take separate component antiretroviral therapy regimens for HIV in the Netherlands. J Int AIDS Soc. 2014;17(4Suppl 3):19536. doi:10.7448/IAS.17.4.19536
 
39.
Suzuki T, Hara N, Osa M, et al. Efficacy of switching to dolutegravir plus rilpivirine, the small-tablet regimen, in patients with dysphagia: two case reports. J Pharm Health Care Sci. 2017;3:23. doi:10.1186/s40780-017-0093-8
 
40.
Best BM, Capparelli EV, Diep H, et al. Pharmacokinetics of lopinavir/ritonavir crushed versus whole tablets in children. J Acquir Immune Defic Syndr. 2011;58(4):385-391. doi:10.1097/QAI.0b013e318232b057
 
ISSN:2654-1459