Multimonth dispensing of antiretroviral therapy for HIV

Traub, Ariana; Ifafore-Calfee, Temitayo; Frymus, Diana; Phelps, B. Ryan

doi:10.1016/s2352-3018(20)30169-7

Cited by 12 publications

(11 citation statements)

References 6 publications

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“…All but one of the doctors surveyed here positively endorsed 90D, and 81% endorsed it with specific criteria that would need to be met before 90D could be used. Those criteria include the stability of the patient on ART for over 6 months which is in agreement with guidelines advocated in a recent paper in The Lancet [30], and with patients, who also felt that there needed to be criteria on who could receive longer refills [12]. This restriction was advocated by patients and healthcare workers, and across high-and lower-income settings.…”

Section: Plos Onesupporting

confidence: 55%

To what extent do people living with HIV, people on pre-exposure prophylaxis, doctors and pharmacists endorse 90-day dispensing of antiretroviral therapy in France?

Jacomet¹,

Goncalves²,

Lambert³

et al. 2022

PLoS ONE

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Justification The WHO 95-95-95 targets for 2030 do not imply that people living with HIV (PLHIV) achieve a good quality of life. The current 30-day dispensing interval for antiretroviral (ART) burdens the healthcare system. Lengthening dispensing intervals could alleviate this burden as well as enhance patient well-being. Objectives To capture perceptions on 90-day dispensing interval (90D) for ART from the perspective of PLHIV, people on pre-exposure prophylaxis (PrEP), doctors, and pharmacists. Methods Multi-centre observational survey led in France from 16 to 20 October 2020, among doctors agreeing to participate via regional coordinated care organisations for HIV, all PLHIV or people on PrEP consulting these outpatient-clinic doctors, and pharmacists doing ART dispensing. Results The survey was completed by 220 doctors who saw 1087 people (999 PLHIV; 88 on PrEP) and 176 pharmacists from 55 centres. Among the PLHIV, 855 (85.6%, 95% CI: 83.2%–87.7%) and among the patients on PrEP, 70 (79.5%, 95% CI: 69.6%–87.4%) stated they would be interested in 90D. All in all, patients who were more likely to endorse 90D are those who opt exclusively for hospital dispensing (OR 3.22 [1.57–6.58]) and who rotate between hospital and community pharmacy dispensing (OR 3.29 [1.15–9.32]). Patients who were less likely to endorse 90-D were those who consult in a city located outside the 3 French high HIV prevalence regions (OR 0.66 [0.44–0.99]), receive 2 vs 1 pill QD regimens (OR 0.53 [0.31–0.91]), and anticipate at least one vs no limitation to 90D (OR 0.27 [0.17–0.42]). 90D was perceived as possible by 152 pharmacists (86.4%), including 8 (5%) without restriction, and 219 doctors (99.6%), including 42 (19.2%) regardless of PLHIV’s immunovirologic status or social conditions (health insurance coverage, access to housing or accommodation, access to rights, resources). Comparison of the benefits and limitations of a 90-day ART dispensing interval as perceived by PLHIV and people on PrEP, doctors and pharmacists shows that doctors anticipate a higher number of benefits than people on ART and/or pharmacists, chiefly that 90D would be more convenient and create less risk of drug shortages and that patients would gain autonomy and a better quality of life. Pharmacists were found to clearly perceive the economic benefits (90D would be less expensive) but anticipate more drawbacks than doctors and the people on ART themselves: more administrative burdens, more non-dispensing if doses get lost, harder to track adherence and more drug–drug interaction issues, and more work as they shall have to warn the patient of potential risks of shortages due to the cost of the stock. Conclusion A clear majority of PLHIV, people on PrEP, doctors, and pharmacists endorsed 90D of ART. Most patients thought that 90D would be a good option, whereas most pharmacists and doctors thought that eligibility for 90D dispensing should depend on immunovirologic factors and social condition criteria. Moreover, pharmacists thought it would be necessary to commit regulatory resources and a better follow-up on adherence and drug–drug interactions.

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Section: Plos Onesupporting

confidence: 55%

To what extent do people living with HIV, people on pre-exposure prophylaxis, doctors and pharmacists endorse 90-day dispensing of antiretroviral therapy in France?

Jacomet¹,

Goncalves²,

Lambert³

et al. 2022

PLoS ONE

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“…Although support for MMD has grown markedly in PEPFAR-supported countries in recent years, the supply chain infrastructure requires reinforcement to make this the universal service delivery norm. 34 A growing base of successful experience with community-based provision of ARVs by outreach workers without clinical credentials laid the foundation for rapid approval of home delivery in the face of the COVID-19 crisis. 35 Continued investment in DSD models is warranted to alleviate the burden on already overstrained health facilities and to prepare for future shocks threatening service continuity.…”

Section: Lessons Learned On Accelerating Introduction and Expansion Of Home Delivery Of Arvsmentioning

confidence: 99%

How Home Delivery of Antiretroviral Drugs Ensured Uninterrupted HIV Treatment During COVID-19: Experiences From Indonesia, Laos, Nepal, and Nigeria

Hoke

Bateganya

Toyo

et al. 2021

Glob Health Sci Pract

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Across diverse contexts, home delivery of antiretroviral (ARV) medications was a feasible and acceptable approach for ensuring access to HIV treatment when COVID-19-related lockdowns and travel restrictions imposed barriers to treatment.nThe ARV home delivery models were rapidly designed and successfully implemented to meet emergency needs brought on by the pandemic. Home delivery of ARVs requires further attention before it can be implemented at greater scale in response to the current pandemic and when health services face future shocks.

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“…Additionally, given the predominantly agrarian economy, many clients are occupied with farming activities for long stretches during planting season and may miss ART appointments. Policies that encourage multi-month scripting and dispensing can reduce the number of visits and thus missed appointments for pill pick-up [20]. They may also encourage retention on ART, which is intrinsically linked with on-time pill pick-up.…”

Section: Across-and Within-region Performancementioning

confidence: 99%

Early warning indicators of HIV drug resistance in the southern highlands region of Tanzania: Lessons from a cross-sectional surveillance study

Khamadi

Mavere²,

Bahemana³

et al. 2023

PLOS Glob Public Health

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The World Health Organization early warning indicators (EWIs) permit surveillance of factors associated with the emergence of HIV drug resistance (HIVDR). We examined cross- and within-region performance on HIVDR EWIs for selected HIV care and treatment clinics (CTCs) in five regions of southern Tanzania. We retrospectively abstracted EWI data from 50 CTCs for the January to December 2013 period. EWIs included the following: on time ART pick-up, retention on ART, ARV stockouts, and pharmacy prescribing and dispensing practices. Data for pediatric and adult people living with HIV were abstracted from source files, and frequencies and proportions were calculated for each EWI overall, as well as stratified by region, facility, and age group. Across and within all regions, on average, on-time pick-up of pills (63.0%), retention on ART (76.0%), and pharmacy stockouts (69.0%) were consistently poor for the pediatric population. Similarly, on-time pill pick up (66.0%), retention on ART (72.0%) and pharmacy stockouts (53.0%) for adults were also poor. By contrast, performance on pharmacy prescribing and dispensing practices were as desired for both pediatric and adult populations with few facility-level exceptions. In this study, regions and facilities in the southern highlands of Tanzania reported widespread presence of HIVDR risk factors, including sub-optimal timeliness of pill pickup, retention on ART, and drug stockouts. There is an urgent need to implement the WHO EWIs monitoring to minimize the emergence of preventable HIV drug resistance and to maintain the effectiveness of first and second-line ART regimens. This is particularly critical in the context of new ART drug roll-out such as dolutegravir during the COVID-19 pandemic when resultant HIV service disruptions require careful monitoring, and for virologic suppression as countries move closer to epidemic control.

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Multimonth dispensing of antiretroviral therapy for HIV

Cited by 12 publications

References 6 publications

To what extent do people living with HIV, people on pre-exposure prophylaxis, doctors and pharmacists endorse 90-day dispensing of antiretroviral therapy in France?

To what extent do people living with HIV, people on pre-exposure prophylaxis, doctors and pharmacists endorse 90-day dispensing of antiretroviral therapy in France?

How Home Delivery of Antiretroviral Drugs Ensured Uninterrupted HIV Treatment During COVID-19: Experiences From Indonesia, Laos, Nepal, and Nigeria

Early warning indicators of HIV drug resistance in the southern highlands region of Tanzania: Lessons from a cross-sectional surveillance study

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