U.S. patient preferences for long‐acting HIV treatment: a discrete choice experiment

Abstract

Introduction Recent advances in long‐acting antiretroviral therapy (LA‐ART) could provide new options for HIV treatment and reduce adherence barriers, if regimens are acceptable to patients. We elicited preferences for key attributes of potential LA‐ART regimens among people with HIV (PWH) in the United States, focusing on four treatment modes (oral tablets, subcutaneous injections, intramuscular injections, and implants), product characteristics and location of administration. Methods A discrete choice experiment was conducted among PWH aged ≥18 years recruited from HIV clinics in Washington State and Atlanta, Georgia from March 2021 to June 2022. Participants responded to 17 choice scenarios, each with three options: two systematically generated hypothetical LA‐ART regimens and a constant opt‐out (their current daily oral treatment). LA‐ART regimen descriptions included treatment mode, pain, dosing frequency, location, pre‐treatment time with undetectable viral load, pre‐treatment negative reaction testing and “late‐dose leeway” (i.e. flexibility or forgiveness in timing the next dose). We used conditional logistic regression, with an interaction between treatment mode and pain, to estimate preference weights for all attribute levels. Results Seven hundred participants (350 at each site) enrolled, with median age 51 years (range 18–73); 70% identified as cisgender male, 24% as cisgender female and 6% as non‐binary or transgender. LA oral tablets were the only mode preferred over current daily oral treatment, with annual implants and injections the next most preferred LA‐ART option. Longer time between doses was preferred, and administration at home was preferred to clinics, which were preferred to pharmacies. Attributes with less impact on preferences included oral lead‐in treatment to achieve viral suppression or test for negative reactions and late‐dose leeway around the prescribed dosing interval. Participants in Atlanta were more likely to prefer their current daily oral ART than participants from Seattle. Conclusions PWH in the United States may soon have several options for LA‐ART. Our results suggest that LA oral tablets will be preferred by many patients over their current daily oral treatment, while implants and injections with longer duration may be acceptable to some. Future research should investigate sources of preference heterogeneity and actual uptake of and adherence to LA‐ART products, when available.

Long-acting prescriptions and therapy for HIV-1 from market launch to the present in Germany (May 2021 to December 2023)

“…Although the number of PLWHIV receiving LA therapy increased steadily, they accounted for just under 2% of the estimated total number of people receiving HIV therapy in Germany in 2023, almost 2 years after the market launch. In contrast, studies suggested a much higher demand and uptake, of around one-third to two-thirds of PLWHIV (4)(5)(6). The number of LA treatment initiations increased to ~100 per month in the first 4 months and decreased to approximately half by mid-2022.…”

“…This trend is unlikely to change drastically in the near future. With an estimated 2,500 persons newly initiating HIV therapy per year, the need compared to the forecasted demand for this mode of therapy in Germany appears to be limited in 2023 (4)(5)(6)10). The development and implementation of LA concepts in infectiology is still a novel area of clinical research and practice.…”

“…Studies on the willingness to switch to LA therapy indicate that 36 to 61% of people living with HIV (PLWHIV) prefer LA therapy (4)(5)(6). However, there are no real-world data on the number of people receiving LA therapy, in Germany or internationally.…”

In Situ Forming, Enzyme-Responsive Peptoid-Peptide Hydrogels: An Advanced Long-Acting Injectable Drug Delivery System

“…Recent efforts to improve patient adherence have focused on the development of long-acting injectables to increase the dosing interval, maintain drug concentrations within active therapeutic limits, reduce fluctuations associated with oral dosing, improve patient quality of life and potentially reduce some of the side effects experienced with oral dosing. There is also an urgent need for more discrete HIV/AIDS treatment and prevention strategies, with several at-risk groups preferring long-acting formulations, including injections, to daily dosing with tablet(s). , In January 2021, ViiV Healthcare’s Cabenuva (rilpivirine, cabotegravir) became the first Food and Drug Administration (FDA)-approved intramuscular long-acting injectable for HIV treatment in adults . This was shortly followed by the licensing of long-acting Apretude (cabotegravir) suspension for HIV prevention in at-risk groups because of its superiority compared to daily oral PrEP in reducing HIV incidence in randomized clinical trials (HIV Prevention Trials Network [HPTN] 083 and HPTN 084) …”

Advancing use of long‐acting and extended delivery HIV prevention and treatment regimens

“…Graham et al.’s [8] study examined the preferences for potential long‐acting antiretroviral therapies (LA‐ART) regimens among people with HIV in the United States. Using a discrete choice experiment, they found that LA oral tablets were the only mode preferred over the current daily oral treatment.…”