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

Abstract

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.

Physical, Emotional, and Psychosocial Challenges Associated with Daily Dosing of HIV Medications and Their Impact on Indicators of Quality of Life: Findings from the Positive Perspectives Study

“…Data were obtained from the second wave of the Positive Perspectives Study, a cross-sectional survey of 2389 adults aged 18 years or older with positive diagnosis of HIV 1. We have previously reported on the study methodology as well as research findings in other areas such as polypharmacy, suboptimal adherence, patient-provider engagement, and aspirations towards improved treatment [ 35 – 39 ]. In brief, participants were recruited from 25 countries using non-probability sampling approaches and surveys were completed online.…”

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

“…New non-oral long-acting directly observed ARTs could potentially address some of the unmet problems identified in this study. Indeed, previous studies show that many PLHIV believe that a long-acting ART would address some of the challenges they face with daily oral ART 20,21 .…”

“…With injections every two months, long-acting cabotegravir and rilpivirine (CAB LA + RPV LA) is an innovative HIV treatment regimen designed to provide PLHIV with an alternative that is as effective as daily oral ART 18,19 . In a 25-country survey of PLHIV, the long-acting attribute was highly favored as a key 'improvement to HIV medicines', second only to improvements in the long-term safety profile of medicines 20 . In that same study, 54.7% of participants indicated preference for long-acting regimens, especially those with confidentiality concerns, suboptimal adherence, and gastrointestinal ART side effects 20 .…”

“…In a 25-country survey of PLHIV, the long-acting attribute was highly favored as a key 'improvement to HIV medicines', second only to improvements in the long-term safety profile of medicines 20 . In that same study, 54.7% of participants indicated preference for long-acting regimens, especially those with confidentiality concerns, suboptimal adherence, and gastrointestinal ART side effects 20 . In qualitative interviews of patients being treated with CAB LA + RPV LA in the phase IIb clinical trial LATTE-2, patients described the regimen as being more 'discreet' than pills, with less opportunity for stigma, discrimination or undesired disclosure 21 .…”

“…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.…”