Quantifying people living with HIV who would benefit from an alternative to daily oral therapy: Perspectives from HIV physicians and people living with HIV

Clark, Laura; Karki, Chitra; Noone, Josh M.; Scherzer, Jenny; Bode, Martina; Rizzini, Paolo; Vecchio, Fabio Maria; Roustand, Laetitia; Nachbaur, Gaëlle; Finkielsztejn, Laurent; Chounta, Vasiliki; Velde, Nicolas Van de

doi:10.18332/popmed/126632

Cited by 8 publications

(12 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Good quality communication, including use of viewpoint questions, may be needed to draw out patients during consultations. Providers can use what they learn during such consultations to positively impact ART satisfaction and adherence by tailoring treatment to address specific concerns patients may have about ART, be they emotional, psychosocial, or medical challenges [ 7 , 9 , 23 ]. HCPs can also provide patients with information on new treatment options to help them make well-informed decisions [ 7 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Treatment Satisfaction Among People Living with HIV in Japan and Other Selected Countries: Examination of the Intertwined Roles of Medication, Patient, and Provider Characteristics

Koga¹,

Wakatabe²,

Okamoto³

et al. 2021

AIDS Behav

View full text Add to dashboard Cite

We examined satisfaction and perceived challenges with antiretroviral therapy (ART) among people living with HIV (PLHIV) in Japan vs three other Asian countries (China, Taiwan, South Korea), and 21 non-Asian countries, using data from the 2019 Positive Perspectives Study (pooled sample size from all 25 countries = 2389). Participants in other Asian countries were more likely than those in Japan to report they missed ART ≥ 1 time in the past month because they were depressed/overwhelmed (57.4%[89/155] vs 32.0%[24/75]), had privacy concerns (56.8%[88/155] vs 30.7%[23/75]), were concerned about the potential long-term negative impacts of ART (46.5%[72/155] vs 26.7%[20/75]), or just wanted to forget about HIV (45.8%[71/155] vs 22.7%[17/75]). ART satisfaction however did not differ significantly between surveyed PLHIV in Japan (54.7%[41/75]) vs those in other Asian countries (47.7%[74/155]). The percentage who felt that daily ART dosing limited their lives was 36.0%[27/75] among participants from Japan, 48.4%[75/155] among participants from other Asian countries, and 27.3%[589/2159] among those from non-Asian countries. Within a structural equation model using pooled data from all 25 countries, positive correlations were seen between ART satisfaction and “provider engagement” (β = 0.35), high perceived control over ART dosing schedule (β = 0.28), and the belief that ART prevents HIV transmission (β = 0.16). Conversely, negative correlations were seen between ART satisfaction and experience of ART side-effects (β = − 0.24), high “ART anxiety” (β = − 0.20); and being on multi-tablet regimens (β = − 0.13). Those ART-satisfied reported higher self-rated health and greater ART adherence. These findings underscore the need for patient-centered care to enhance treatment satisfaction and improve ART adherence.

show abstract

Section: Discussionmentioning

confidence: 99%

Factors Associated with Treatment Satisfaction Among People Living with HIV in Japan and Other Selected Countries: Examination of the Intertwined Roles of Medication, Patient, and Provider Characteristics

Koga¹,

Wakatabe²,

Okamoto³

et al. 2021

AIDS Behav

View full text Add to dashboard Cite

show abstract

“…Detailed recruitment of participants has been published elsewhere. 23 Overall response rate was 64.3%.…”

Section: Methodsmentioning

confidence: 93%

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

Akinwunmi¹,

Buchenberger

Scherzer³

et al. 2021

European Journal of Public Health

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…Within each of the four countries, 30 HIV physicians completed a web-based survey, yielding a pooled sample size of 120 physicians 16 . Inclusion criteria were: 1) Board certified/eligible physician with ≥5 years of practice as an internist or HIV/infectious disease specialist; 2) personally managed ≥50 unique HIV patients and saw ≥15 weekly.…”

Section: Hcp Unmet Needs Surveymentioning

confidence: 99%

“…Across the four countries combined, a non-probability sample of 688 PLHIV on ART was selected (France, 144; Germany, 198; Italy, 150; UK, 196) 16,17 . Inclusion criteria were: 1) aged ≥18 years; and 2) confirmed HIV status, e.g.…”

Section: Plhiv Unmet Needs Surveymentioning

confidence: 99%

Comorbidities, comedications and polypharmacy among people living with HIV and associated challenges with HIV antiretroviral therapy: Findings from people living with HIV in four countries in Western Europe

Okoli¹,

Finkielsztejn²,

Appiah³

et al. 2022

Popul. Med.

Self Cite

View full text Add to dashboard Cite

INTRODUCTIONWe examined comorbidities, comedications and polypharmacy among people living with HIV (PLHIV) and associated challenges with HIV antiretroviral therapy (ART). METHODS A cross-sectional design was used in web-based surveys conducted during 2019 in France, Germany, Italy, and the UK. Pooled sample comprised 120 internists/ infectious disease specialists managing ≥50 HIV patients, and 1171 adult PLHIV combined who participated in two separate surveys, the Positive Perspective Survey (n=483), and the Unmet Needs Survey (n=688). The outcomes were perceptions and behaviors towards ART based on PLHIV and healthcare provider (HCP) perspectives. RESULTS According to HIV physicians, challenges associated with comedications were a major reason for their patients not starting ART, or stopping, switching, or skipping their HIV treatment after they started. In total, 16.8% of providers indicated that their patients had not started ART because of medical reasons/comorbidities that interfered with dosing (France 21.7%, Germany 15.4%, Italy 6.9%, and UK 24.1%). Other reasons cited by providers for patients not starting HIV treatment were: concerns about drug tolerability/side effects (overall 34.6%, France 39.1%, Germany 34.6%, Italy 27.6%, and UK 37.9%); concerns about long-term toxicities (overall 26.2%, France 39.1%, Germany 26.9%, Italy 24.1%, and UK 17.2%), as well as concerns about drug-drug interactions (overall 16.8%, France 13.0%, Germany 26.9%, Italy 17.2%, and UK 10.3%). Averaged across all ART regimen types, the percentage of PLHIV in the Unmet Needs Study who indicated that they needed monitoring when taking other medications with their ART was 5.8%, 15.9%, and 24.1% among those with none, 1, or ≥2 non-HIV comorbidities, respectively. Within the Positive Perspectives Survey, overall prevalence of polypharmacy was 38.8% (France 41.9%, Germany 24.2%, Italy 40.8%, and UK 48.0%). Compared to those without polypharmacy, those reporting polypharmacy had lower odds of reporting viral suppression (adjusted odds ratio, AOR=0.40) and optimal overall health (AOR=0.65); they were however more likely to be worried about taking more medicines as they grew older (AOR=2.15), and to be more concerned how their ART might affect other medicines they took (AOR=2.35) (all p<0.05). CONCLUSIONS A significant unmet need remains for PLHIV relating to co-management of comorbidities and associated challenges such as polypharmacy. Polypharmacy was associated with suboptimal self-rated health and concerns about the risk of long-term negative impacts from ART intake. Holistic care that provides simplified regimens to medically complex patients can help improve treatment outcomes.

show abstract

Quantifying people living with HIV who would benefit from an alternative to daily oral therapy: Perspectives from HIV physicians and people living with HIV

Cited by 8 publications

References 36 publications

Factors Associated with Treatment Satisfaction Among People Living with HIV in Japan and Other Selected Countries: Examination of the Intertwined Roles of Medication, Patient, and Provider Characteristics

Factors Associated with Treatment Satisfaction Among People Living with HIV in Japan and Other Selected Countries: Examination of the Intertwined Roles of Medication, Patient, and Provider Characteristics

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

Comorbidities, comedications and polypharmacy among people living with HIV and associated challenges with HIV antiretroviral therapy: Findings from people living with HIV in four countries in Western Europe

Contact Info

Product

Resources

About