Dose-related and contextual aspects of suboptimal adherence to antiretroviral therapy among persons living with HIV in Western Europe

Abstract

Background The daily oral dosing requirement for antiretroviral therapy (ART) may be challenging for some people living with HIV (PLWHIV) with comorbid conditions, confidentiality concerns or pill fatigue. We investigated suboptimal adherence from the perspective of PLWHIV and HIV physicians. Methods PLWHIV on ART (n = 688) and HIV physicians (n = 120) were surveyed during 2019 in France, Germany, Italy and the UK. Suboptimal adherence was a report the participant missed taking their dose as prescribed ‘Sometimes’/‘Often’/‘Very often’. Physicians’ interest in offering a hypothetical long-acting HIV regimen for suboptimally adherent patients was assessed. Descriptive and multivariable analyses were performed (P < 0.05). Results Of PLWHIV, 23.8% (164/688) reported suboptimal adherence vs. providers’ estimated prevalence of 33.6% (SD = 28.8). PLWHIV-reported prevalence of specific suboptimal adherence behaviors were: mistimed dose [16.1% (111/688)]; missed a dose [15.7% (108/688)]; dosed under wrong conditions [e.g. food restrictions, 10.5% (72/688)] and overdosed [3.3% (23/688)]. Odds of suboptimal adherence were higher among those with vs. without a report of the following: dysphagia (AOR = 3.61, 95% CI = 2.28–5.74), stress/anxiety because of their daily dosing schedule (AOR = 3.09, 95% CI = 1.97–4.85), gastrointestinal side effects (AOR = 2.09, 95% CI = 1.39–3.15), neurocognitive/mental health conditions (AOR = 1.88, 95% CI = 1.30–2.72) or hiding their HIV medication (AOR = 1.51, 95% CI = 1.04–2.19). Of providers, 84.2% indicated they Definitely/Probably will offer a hypothetical long-acting HIV regimen ‘for patients who have suboptimal levels of adherence to daily oral therapy (50–90%) for non-medical reasons’. Conclusions Dysphagia, stressful daily oral dosing schedule, gastrointestinal side effects, neurocognitive/mental health conditions and confidentiality concerns were associated with suboptimal adherence in our study. Adherence support and alternative regimens, such as long-acting antiretroviral therapies, could help address these challenges.

Stigmatizing Policies Interact with Mental Health and Sexual Behaviours to Structurally Induce HIV Diagnoses Among European Men Who Have Sex with Men

“…Research also links poor mental health to HIV risk by reducing the likelihood of condom use during sex, increasing utilization of substances, and elevating numbers of sexual partners [ 6 , 18 , 19 ], all well known risk factors for HIV transmission. A study in France, Germany, Italy, and the United Kingdom indicated that depression was associated with reduced adherence to HIV treatment among PLHIV [ 20 ]. A meta-analysis of 39 studies, reported significant associations between depression and lower odds of retention in HIV care among PLHIV [ 21 ].…”

Patient experiences of switching from Efavirenz- to Dolutegravir-based antiretroviral therapy: a qualitative study in Uganda

“…Other participants reported depression, dizziness, and headache which resulted in treatment discontinuation. Since it has been demonstrated that experiencing side effects may result in poor adherence [ 24 , 25 ], there is need for support from health care providers to encourage patients to report any unusual event from the drug, manage toxicities as well as offer adherence support.…”

Patient preferences and health state utilities associated with the treatment process of antiretroviral therapy for people living with HIV

“…A targeted literature review was conducted to inform the initial draft of the health states. This review focused on the experience of living with HIV [4,10,17,18,36], ART [10,12,36,37], and the ART treatment process [12,15,16,[38][39][40][41]. Based on this literature, initial drafts of four health states were developed, along with a detailed background information document providing details on the four ART options.…”