Single-tablet regimens in HIV: does it really make a difference?

Aldir, Isabel; Horta, Ana; Serrado, Margarida

doi:10.1185/03007995.2013.844685

Cited by 43 publications

(28 citation statements)

References 41 publications

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“…Patients electing to remain on Triumeq ® had lower ART pill burdens and had more comorbidities requiring non‐ARV pills; they valued the convenience of an STF. This supports an earlier hypothesis that it is not ARV pill burden but the total pill burden that is important in the patient accepting or not accepting STFs or MTFs . Engelhard et al .…”

Section: Discussionsupporting

confidence: 86%

“…Walensky et al [18] projected a potential saving of > US$1 billion from de-simplifying one commonly used branded STF regimen. However, diverse concerns of both physicians and patients about the efficacy of generic drugs, the increase in pill burden, the risk of switching successful regimens, and patient acceptability may impact the uptake and use of generic ART [25][26][27][28][29][30][31][32][33][34]. Increasing pill burden may be seen as a step back [35][36][37].…”

Section: Introductionmentioning

confidence: 99%

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De‐simplifying single‐tablet antiretroviral treatments: uptake, risks and cost savings

et al. 2019

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Objectives As more HIV‐positive individuals receive antiretroviral therapy (ART), payers are seeking options for covering these increased and sustained drug costs. Strategic use of available generic antiretroviral (ARV) formulations may be feasible. De‐simplifying a single‐tablet co‐formulation (STF) into two or more tablets using both brand and generic drugs has been proposed. We determine if voluntary de‐simplification of one STF could be utilized as a cost‐saving strategy. We report on the challenges, uptake, outcomes and cost savings of this initiative. Methods Patients stable on the most commonly used STF (Triumeq®) were offered the option of remaining on Triumeq® or switching to generic abacavir/lamivudine and Tivicay® between 1 January 2015 and 1 January 2018; those starting ART consisting of abacavir/lamivudine/doulutegravir in the same period were offered the option of starting Triumeq® or generic abacavir/laminvudine and Tivicay®. No incentives were provided. We examined the acceptance/decline rates, patient satisfaction, health care outcomes and annual cost savings. Results Of 626 patients receiving Triumeq®, 321 were approached; 177 (55.1%) agreed to de‐simplify. Of patients initiating ART, 62.7% chose the generic co‐formulation. Patients switching to or starting on the generic co‐formulation were more likely to be male, > 45 years old, Caucasian, men who have sex with men (MSM) and more HIV‐experienced, and to have more comorbidities (all P < 0.05). Preference for STF was cited for declining de‐simplification. No concern about generic ARVs was expressed. The rate of viral load > 500 HIV‐1 RNA copies/mL after baseline was 2.7% in switched patients compared with 7.0% in those declining to switch. No de novo resistance occurred. A saving of Cdn$1 319 686 was achieved in the first year. Conclusions Reliance on altruism, while respecting patient autonomy, achieved de‐simplification in > 50% of patients approached, and generated immediate cost savings with no increased risk of adverse events, viral breakthrough or resistance.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

De‐simplifying single‐tablet antiretroviral treatments: uptake, risks and cost savings

et al. 2019

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“…Single tablet regimens have been found to be effective in improving adherence and enhancing patient quality of life (Aldir, Horta, & Serrado, 2013), and our results show that patients with once-daily dosing were more likely to be adherent.…”

Section: Discussionsupporting

confidence: 54%

Adherence to Antiretroviral Therapy Among HIV-Infected Adults in the United States

Beer¹,

Skarbinski²

2014

AIDS Education and Prevention

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National estimates of antiretroviral therapy (ART) adherence and adherence support services utilization are needed to inform efforts to improve the health of HIV-infected persons in the United States. In a nationally representative sample of HIV-infected adults receiving medical care, 86% self-reported taking all ART doses in the past 72 hours. Overall, 20% reported using adherence support services and 2% reported an unmet need for services. If all nonadherent persons not receiving adherence support and all persons with a self-perceived unmet need for adherence support accessed services, resources to support ~42,673 additional persons would be needed. Factors associated with lower adherence included younger age, female gender, depression, stimulant use, binge alcohol use, greater than once-daily dosing, longer time since HIV diagnosis, and patient beliefs. Predictors of adherence are multifactorial so multiple targeted strategies to improve adherence are warranted. Providing adherence support services to all those in need may require additional resources.

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“…The recent development of fixed-dose drug combinations (FDCs) represent a major advancement in cART, where the 'cocktail' regimen (up to 16 pills daily) has been simplified to the new once daily, single-tablet regimen (STR) (Aldir et al, 2014). This novel treatment therapy has been found to significantly enhance treatment adherence among people living with HIV, therefore improving their quality of life.…”

Section: The Treatment Of Hiv Infectionsmentioning

confidence: 99%

AIDS: Acquired Immune-Deficiency Syndrome

Lee

Everall²

2015

International Encyclopedia of the Social &Amp; Behavioral Sciences

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Single-tablet regimens in HIV: does it really make a difference?

Abstract: The associated benefits of STRs provide a valid strategy for the treatment of HIV-infected patients.

Cited by 43 publications

References 41 publications

De‐simplifying single‐tablet antiretroviral treatments: uptake, risks and cost savings

De‐simplifying single‐tablet antiretroviral treatments: uptake, risks and cost savings

Adherence to Antiretroviral Therapy Among HIV-Infected Adults in the United States

AIDS: Acquired Immune-Deficiency Syndrome

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