Prevalence, determinants, and impact of suboptimal adherence to HIV medication in 25 countries

Okoli, Chinyere; Punekar, Yogesh Suresh; Allan, Brent; Muchenje, Marvelous; Castellanos, Erika; Richman, Bruce W.; Corbelli, Giulio Maria; Hardy, William; Young, Benjamin; Velde, Nicolas Van de

doi:10.1016/j.ypmed.2020.106182

Cited by 41 publications

(45 citation statements)

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“…Such stigma may explain findings from previous studies showing that on dimensions of mental health and psychological factors, PLHIV show a detriment versus the general population 35 . Consistent with our findings, previous research has documented patients' worries that their HIV status may be disclosed inadvertently if they store their antiretroviral medications at home and take them at regular intervals; therefore, patients have reported skipping or delaying doses to avoid stigma 12 . The percentage of PLHIV with suboptimal adherence in our study (23.8%) is very close to the 24.1% overall estimate reported in a recent multi-country study 12 .…”

Section: Discussionsupporting

confidence: 90%

“…daily) or route of administration (i.e. Quantifying people living with HIV who would benefit from an alternative to daily oral therapy: Perspectives from HIV physicians and people living with HIV oral) 12 . Daily intake can be a source of concern regarding unintentional disclosure of HIV status or serve as an unwanted reminder of HIV 13,14 .…”

Section: Introductionmentioning

confidence: 99%

“…Daily intake can be a source of concern regarding unintentional disclosure of HIV status or serve as an unwanted reminder of HIV 13,14 . Drug-drug and drug-food interactions, as well as pill aversion, can also complicate daily oral ART 12,[15][16][17] .…”

Section: Introductionmentioning

confidence: 99%

“…Given the anticipated change in treatment paradigm because of the advent of long-acting regimens 18,19 , it is important to quantify problems related to daily oral dosing to determine who may benefit most from long-acting regimens. While some problems have been previously identified [12][13][14][15][16][17]20,21 , the populations in some of those studies were either PLHIV alone [22][23][24] or healthcare providers (HCPs) alone 25,26 . This may not provide a complete picture of problems associated with treatment as attitudes and perceived priorities of patients versus providers may not always converge perfectly.…”

Section: Introductionmentioning

confidence: 99%

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Quantifying people living with HIV who would benefit from an alternative to daily oral therapy: Perspectives from HIV physicians and people living with HIV

Clark¹,

Karki²,

Noone³

et al. 2020

Popul. Med.

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INTRODUCTION Current antiretroviral therapies (ARTs) require daily oral dosing, which is a challenge for some people living with HIV (PLHIV). Measures of treatment needs that are associated with daily oral ARTs have been identified in studies/ interviews with healthcare professionals (HCPs) and PLHIV, and are grouped in four main categories: 1) medical conditions interfering with daily oral administration, 2) suboptimal adherence, 3) confidentiality concerns, and 4) emotional wellbeing related to daily tablet requirements. We quantified these categories to assess the potential benefits of alternatives to daily oral ARTs such as long-acting injectable regimens. METHODS Two separate online studies were completed by HCPs (n=120) and PLHIV (n=698) in France, Germany, Italy and the UK, in 2019. HCPs reported the number and percentage of their patients with challenges; unit of analysis among PLHIV was the respondents (%). Descriptive analyses were performed with R 3.6.1. RESULTS HIV physicians reported managing a mean of 299 (SD=177) patients, of whom 85.7% were on ART. Among PLHIV, 98.6% (688/698) were currently on ART, with mean age of 40.9 (SD=12.0) years, and 66.4% men. HCPs estimated that 10-15% of their patients were affected by each medical condition identified as interfering with daily oral administration. HCPs further estimated that 33.6% of their patients were suboptimally adherent. 'Non-adherence for any non-medical reason' was reported by HCPs as the primary cause of virologic failure. Of surveyed PLHIV on ART, 43.3% (298/688) reported hiding their medication and 29.7% (204/688) indicated they had never shared their HIV status with others. Furthermore, some PLHIV reported that having to remember to dose at the right time every day was stressful (27.3%; 188/688) and many saw their tablets as a daily reminder of HIV (45.1%; 310/688). CONCLUSIONS A significant proportion of PLHIV struggle with daily oral ART because of medical and/or HIV-specific issues. Alternatives to daily oral ARTs have the potential to improve treatment adherence and quality of life in PLHIV.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Quantifying people living with HIV who would benefit from an alternative to daily oral therapy: Perspectives from HIV physicians and people living with HIV

Clark¹,

Karki²,

Noone³

et al. 2020

Popul. Med.

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“…Addressing patients' preferences and concerns is key to meeting the fourth '90' target, ensuring that PLHIV not only survive, but thrive 16,17 . Besides ensuring patient convenience, improved quality of life can mitigate treatment failure by tackling the chief causes of non-adherence 27 , including emotional challenges and psychosocial barriers.…”

Section: Discussionmentioning

confidence: 99%

Treatment aspirations and attitudes towards innovative medications among people living with HIV in 25 countries

Okoli¹,

Young²,

Allan³

et al. 2020

Popul. Med.

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INTRODUCTION The worldview in relation to patient care has shifted from conquering diseases to improving overall wellbeing and quality of life. We examined treatment aspirations among people living with HIV (PLHIV). METHODS In all, 2389 PLHIV were surveyed in the 25-country 2019 Positive Perspectives Study. Descriptive and multivariable analyses were used to explore attitudes towards treatment. RESULTS Participants were from: Northern America (USA, Canada), 21.8% (520/2389); Europe, 46.8% (1119/2389); and other international regions, 31.4% (750/2389). Factors associated with some level of dissatisfaction with HIV medication among those otherwise fully satisfied with their HIV management included being on a multi-tablet regimen (AOR=2.76; 95% CI: 1.93-3.96), reporting polypharmacy (AOR=2.10; 95% CI: 1.45-3.03), and experiencing side effects from current HIV medication (AOR=2.12; 95% CI: 1.49-3.02). Of seven improvements to HIV medications assessed, the percentage ranking each attribute, as the first or second most important, was: 'reduced long-term impact on my body' (46.7%); 'longer-lasting medicine so I don't have to take it every day' (43.1%); 'fewer side effects' (40.5%); 'less HIV medicine each day but just as effective' (25.4%); 'less chance of affecting other medicines' (21.6%); 'no food restrictions/ requirements' (14.0%); and 'smaller pills' (8.7%). Overall, 77.1% (1842/2389) believed 'future advances in HIV treatment will improve my overall wellbeing', 72.2% (1726/2389) were 'open to taking an HIV treatment composed of fewer medicines', while 54.7% (1306/2389) expressed openness towards longer-acting (non-daily) HIV medication. Compared to those not fully satisfied with either their HIV medication or management, those fully satisfied with both reported significantly higher prevalence of optimal treatment adherence (89.2% [372/417] vs 69.5% [763/1098]) and optimal overall health (70.3% [293/417] vs 47.8% [525/1098]) (all p<0.001). CONCLUSIONS Many PLHIV perceived gaps in their care and aspired for novel treatments. Providing flexible treatment options can help patients across the spectrum of unmet needs and improve health-related quality of life.

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Adherence to option B+ PMTCT program and its predictors among HIV‐positive women in Ethiopia. A systematic review and meta‐analysis

Geremew¹,

Geremew

Abdisa³

et al. 2023

Health Science Reports

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Background: Previously, few studies investigated level of adherence to option B+ lifelong antiretroviral therapy (ART) in Ethiopia. However, their findings were inconsistent. Therefore, this review aimed to determine the pooled magnitude of adherence to option B+ lifelong ART and its predictors among human immune virus (HIV)-positive women in Ethiopia.Methods: A comprehensive web-based search was conducted using PubMed, Cochrane Library, Science Direct, Google scholar, and African Journals Online databases to retrieve relevant articles. STATA 14 statistical software was used to carry out the meta-analysis. We used the random effects model to account for the large heterogeneity across included studies. Egger's regression test in conjunction with funnel plot and I 2 statistics were utilized to assess publication bias and heterogeneity among included studies respectively.Result: Twelve studies with a total of 2927 study participants were involved in this analysis. The pooled magnitude of adherence to option B+ lifelong ART was 80.72% (95% confidence interval [CI]: 77.05−84.39; I 2 = 85.4%). Disclosure of sero-status (OR 2.58 [95% CI: 1.55−4.3]), receiving counseling (OR 4.93 [95% CI: 3.21−7.57]), attending primary school and above (OR 2.45 [95% CI: 1.31−4.57]), partner support (OR 2.24 [95% CI: 1.11, 4.52]), good knowledge about prevention of mother-to-child transmission (PMTCT) (OR 4.22 [95% CI: 2.02−8.84]), taking less time to reach health facility (OR 1.64 [95% CI: 1.13−2.4]), and good relation with care provider (OR 3.24 [95% CI: 1.96−5.34]) were positively associated with adherence. Whereas, fear of stigma and discrimination (OR 0.12 [95% CI: 0.06−0.22]) and advanced disease stage (OR 0.59 [95% CI: 0.37−0.92]) were negatively associated. Conclusion:The level of adherence to option B+ lifelong ART was suboptimal.Strengthened comprehensive counseling and client education on PMTCT, HIV status disclosure, and male partner involvement are important to eliminate mother to child transmission and control the pandemic.

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Prevalence, determinants, and impact of suboptimal adherence to HIV medication in 25 countries

Cited by 41 publications

References 21 publications

Quantifying people living with HIV who would benefit from an alternative to daily oral therapy: Perspectives from HIV physicians and people living with HIV

Quantifying people living with HIV who would benefit from an alternative to daily oral therapy: Perspectives from HIV physicians and people living with HIV

Treatment aspirations and attitudes towards innovative medications among people living with HIV in 25 countries

Adherence to option B+ PMTCT program and its predictors among HIV‐positive women in Ethiopia. A systematic review and meta‐analysis

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