2499. Perceptions of and Preferences for Oral or Long-Acting Injectable Antiretroviral Treatment Regimens in the United States and Canada

Abstract

BackgroundAntiretroviral treatment (ART) for patients living with HIV (PLHIV) has improved greatly, however, challenges with daily oral dosing remain. New ART options with reduced dosing frequency and innovative delivery methods may help address these challenges. This study assesses patient and physician satisfaction with current treatments and preferences for switching to a monthly or every other month long-acting injectable (LAI) ART.MethodsThis is a cross-sectional online survey of PLHIV and physicians treating PLHIV in United States and Canada. A literature review, clinical expert input, and qualitative and quantitative pilots informed survey design. Eligible PLHIV were on ART for ≥ 6 months and virally suppressed (self-reported). Survey questions for patients evaluate satisfaction and adherence to current ART. Treatment preferences are assessed using a discrete choice experiment (DCE), where respondents choose between staying on current ART, switching to another oral ART or switching to a LAI ART. DCE treatment attributes include dosing frequency, side effects, forgivability, food/mealtime restrictions, and mode of administration. Pilot data for US patients is included here; the main survey will include approximately 550 patients and 450 physicians.ResultsOf 51 PLHIV completing the pilot survey, 80% were male, mean age was 54 years, and 63% were on ART for ≥10 years. Switching ART was common, with 55% reporting changing their ART ≥ 3 times. Just under half of patients (47%) were not totally satisfied with their current ART. Most common reasons for dissatisfaction included daily reminder of having HIV (31%) and having to take medicine every day (28%). Just over a quarter of patients (28%) reported forgetting to take their ART in the prior month. Across all DCE choices, patients preferred to remain on their current treatment 47% of the time, while 45% of the time patients preferred switching to the LAI, and for the remaining 8%, patients chose switching to another oral ART regimen.ConclusionDespite advances in ART, treatment challenges remain. Among the treatment-experienced PLHIV in this pilot survey, over half of their choices resulted in switching to an alternative regimen, and when opting to switch, most patients preferred the long-acting injectable treatment regimen.Disclosures All authors: No reported disclosures.

Therapeutic review of cabotegravir/rilpivirine long‐acting antiretroviral injectable and implementation considerations at an HIV specialty clinic

“…As previously discussed, potential benefits anticipated with the first complete parenteral regimen for HIV included increased convenience, reduced inadvertent HIV status disclosure, and removal of the daily reminder to the patient of their HIV status. These predictions held largely true with improved confidentiality and flexibility being reported by patients participating in several of the clinical trials for CAB/RPV 29–34 …”

Perceptions of Long-Acting Injectable Antiretroviral Treatment Regimens in a United States Urban Academic Medical Center

“…They additionally reported that such an injection may reduce chances that others would discover their diagnosis. 21 Further study is needed on these social and environmental factors, which may prove advantageous when attempting to engage patients in challenging or highly-stigmatized locations and settings.…”

“…While minimal data do exist in this area, none represent the full landscape of upcoming treatment options under development. [19][20][21][22] Our study seeks to further describe patient acceptability of long-acting injectable antiretrovirals through the presentation of multiple formulation and delivery factors.…”

Past and future of HIV infection. A document based on expert opinion

“…Finally, the possibility of a transitional oral treatment was also explored, in case the patient could not receive the intramuscular dosage, and the result has been satisfactory [ 130 ]. In addition, the stigma experienced by people living with HIV may be alleviated by the possibility of switching from oral to injectable treatment, particularly when administered as a long-acting treatment such as CARLA [ 131 ].…”