1329. Experiences and Emotional Challenges of Antiretroviral Treatment (ART)—Findings from the Positive Perspectives Study

Abstract

BackgroundWhile advances in treatment have dramatically improved the lives of people living with HIV (PLHIV), a number of important unmet needs remain. We conducted an international survey of PLHIV to explore their treatment experience and emotional challenges of ART.MethodsQualitative in-depth interviews were performed with PLHIV to identify key hypotheses. A steering group (led by community members) developed the survey tool which was fielded online from November 2016 to July 2017 in 8 high-income countries in North America (NA), Europe, and Australia. A mixed sampling/recruitment approach was used to ensure a broad cross-section of PLHIV. Respondents were screened for eligibility prior to receiving access to the online survey.Results1111 PLHIV were surveyed (74% male, 41% 35–49 years; 39% from NA). The majority (98%) were currently taking ARTs with 53% taking a single tablet regimen. Of those on treatment, 87% were satisfied with their current ART. Overall, results for NA respondents were similar to the global results. Many participants reported emotional challenges associated with their daily HIV treatment experience: 66% agreed taking ART every day was a reminder of their HIV status; 25% agreed being tied to a daily medication limited their day-to-day life; and 29% agreed they felt stressed and under pressure to take their HIV medication at the right time every day. Those not “open” about their HIV status were more likely to feel stressed by their medication and felt that it limited them. 37% of participants frequently or quite often hid their HIV medication to avoid revealing their HIV status, particularly amongst those who reported experiencing stigma or high emotional impact of HIV. 89% felt that advances in treatment will improve their quality of life. Reducing long-term adverse effects of ART and lowering dosing frequency were considered the most important areas for improvement; this was similar across demographics such as country, age, and gender.ConclusionIn this international survey of PLHIV, despite overall satisfaction with current ART, significant emotional burden and daily impact of treatment persists. PLHIV consider the reduction of long-term adverse effects and dosing frequency important areas for improving ART.Disclosures All authors: No reported disclosures.

Long-Acting Injectable Cabotegravir + Rilpivirine for HIV Maintenance Therapy: Week 48 Pooled Analysis of Phase 3 ATLAS and FLAIR Trials

“…Some populations of PLWH may therefore find this a preferable option to their daily CAR, potentially facilitating improved adherence in those who report factors such as pill burden and forgetfulness as barriers to adherence. 4 The Positive Perspectives study involving over 1000 PLWH found that most regarded daily ART as a “reminder of their HIV status,” whereas 25% felt “being tied to daily medication limited their day to day life.” 7 Monthly CAB + RPV LA injections may therefore represent a more discreet regimen that could help some PLWH avoid the stigma associated with their HIV status. CAB + RPV LA would also enable the first option for directly observed therapy because of the monthly clinic visits required.…”

“… 4 – 6 Furthermore, the emotional burden of living with HIV may be compounded by daily oral pill taking and additional complexities. 7 Therefore, there is considerable interest in developing long-acting (LA) treatments that can address many of these issues while simplifying ART for PLWH. 8 …”

Patient-Reported Outcomes Through 1 Year of an HIV-1 Clinical Trial Evaluating Long-Acting Cabotegravir and Rilpivirine Administered Every 4 or 8 Weeks (ATLAS-2M)

“…This has culminated in the development of efficacious single-tablet daily oral regimens, which offer simplicity and convenience [3]. Despite this, the need for life-long daily pill-taking can present substantial challenges that can be broadly grouped into three categories: adherence issues [4]; emotional issues, including stigmatization concerns and the daily reminder of HIV status [5]; and medical issues, such as difficulty swallowing, drug-food and drug-drug interactions, and pill burden [6]. These challenges can impact the likelihood of treatment failure, with poor adherence to antiretroviral therapy linked to the emergence of resistance and virologic failure [7][8][9][10].…”

Antiretroviral Therapy–Related Experiences Predict Mental Health Status Among People Living with HIV in China: A Prospective Observational Cohort Study

“…We found that about three quarters of the participants reported inconvenience in daily life due to ART use, and this was a predictor of moderate/severe anxiety. Taking ART every day may be a reminder of their HIV status and make them feel stressed [35]. Scaling up the single tablet regimen and reducing dose frequency could thus help to improve mental health among PLWH on ART.…”

“…Moreover, the daily regimen of ART is inconvenient for PLWH. For example, 25% of PLWH in eight high-income countries agreed that being tied to daily medication limited their day-to-day life, and 29% felt stressed by the need to take their medication at the right time every day [35]. These experiences related to ART may also in uence mental health among PLWH.…”