Relationship Between Polypharmacy and Quality of Life Among People in 24 Countries Living With HIV

Okoli, Chinyere; Eremin, Anton; Brough, Gary; Young, Benjamin; Short, Duncan

doi:10.5888/pcd17.190359

Cited by 39 publications

(46 citation statements)

References 20 publications

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“…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 . Another study by Okoli et al 36 found that 66.6% of PLHIV worried about the long-term effects of HIV medicines, similar to 63.4% in our study. That same study reported that 18.6% (288/1550) of those who ever switched ART (or 13.6% [288/2112] of all study participants) reported switching because of drug-drug interactions; in our study, 15.4% of all participants reported ever changing ART because of drug-drug interactions.…”

Section: Discussionsupporting

confidence: 89%

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: 89%

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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“…We previously reported the percentage of PLHIV open to HIV treatments composed of fewer medicines in preliminary analyses of our data from 24 countries. 24 Here we provide an update of that estimate based on the full sample of 25 countries, along with additional multivariable analyses.…”

Section: Treatment Aspirationsmentioning

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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“…Inclusion criteria were men and women aged ≥ 18 years who were diagnosed with HIV and on antiretroviral therapy (ART); a total of 2389 PLHIV aged 19–86 years participated. The study methodology has been previously reported [ 11 ]. Participants were recruited using targeted and snowball sampling approaches across multiple platforms and in collaboration with multiple HIV organizations; responses were collected over the web or in-person.…”

Section: Methodsmentioning

confidence: 99%

“…As treatment is lifelong, many PLHIV start their therapy soon after diagnosis and once they become undetectable continue this treatment without review for some time, however as their lives evolve when living with HIV, needs may change and newer treatments may emerge that could benefit them. More so, as PLHIV age and develop co-morbidities, new treatment-related challenges may arise, especially if they experience polypharmacy [ 11 ]. More discussions between patients and HCPs may be needed in such situations; a review of treatment decisions may also be necessary, even in the absence of treatment failure, to optimize care, reduce the risk of drug toxicities, and improve quality of life.…”

Section: Introductionmentioning

confidence: 99%

Shared Decision Making Between Patients and Healthcare Providers and its Association with Favorable Health Outcomes Among People Living with HIV

Okoli

Brough²,

Allan

et al. 2020

AIDS Behav

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We assessed patient-provider communication in HIV care; data were from the 2019 Positive Perspectives Survey of people living with HIV (PLHIV) from 25 countries (n = 2389). A significantly greater proportion of recently diagnosed individuals were interested in being involved when it comes to decisions about their HIV treatment compared with any other group (72.8% [399/548], 63.1% [576/913], and 62.6% [581/928], diagnosis year: 2017–2019, 2010–2016, and pre-2010 respectively) but reported less understanding of their treatment compared with those reporting the longest duration (66.8% [366/548], 68.6% [626/913], and 77.3% [717/928], respectively). One-third of PLHIV with salient treatment-related concerns were uncomfortable discussing with providers. Of participants who felt that their HIV medication limited their life but did not discuss their concerns with their provider (n = 203), top reasons for not discussing were: perception nothing could be done (49.3% [100/203]), provider never brought up the issue (37.9% [77/203]), and not wanting to appear difficult (30.5% [62/203]). To continue to identify and address unmet treatment needs among PLHIV, providers need to ensure that there is ongoing open dialogue. Electronic supplementary material The online version of this article (10.1007/s10461-020-02973-4) contains supplementary material, which is available to authorized users.

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Relationship Between Polypharmacy and Quality of Life Among People in 24 Countries Living With HIV

Cited by 39 publications

References 20 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

Shared Decision Making Between Patients and Healthcare Providers and its Association with Favorable Health Outcomes Among People Living with HIV

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