HIV TREATMENT ADHERENCE FOR PEOPLE LIVING WITH HIV

Two men outside on street smilling

While improvements in HIV care have been made, some people living with HIV still struggle with their HIV treatments. Results from the Positive Perspectives study highlighted barriers to adherence, and authors noted these may be addressed through increased treatment choices, particularly options that are simplified or less conspicuous parts of the lives of people living with HIV could help improve self-reported health outcomes.1 Published data from Positive Perspectives show that some people living with HIV still struggle with their daily oral antiretroviral therapy (ART). For this group, the result of this struggle may be suboptimal adherence*, or not conforming with the healthcare provider’s (HCP) recommendations for medication dosage and frequency.1 Suboptimal adherence in HIV is known to impact disease progression, transmission and the development of treatment resistance.2,3,4

Nearly 1 in 4 (24%, n=575/2389) people living with HIV in the Positive Perspectives study reported suboptimal adherence.1

  • Those who reported emotional or psychosocial challenges with daily oral therapy, including fear of unwanted sharing of their HIV status, had higher odds of reported suboptimal adherence to daily oral ART
  • Those study participants who reported being told that Undetectable = Untransmittable (U=U) by their HCPs had lower odds of reported suboptimal adherence than those who reported not being told about U=U by their HCPs
  • Groups within the study who reported poorer adherence than other study participants included those who reported polypharmacy (defined in the study as taking five or more pills per day or medications for five or more health conditions), those reporting experiencing gastrointestinal side effects from their medicines and, those who reported not being informed about the benefits of adherence by their HCPs

Looking into the reasons for suboptimal adherence reported by people living with HIV in the Positive Perspectives study, feelings of depression/being overwhelmed (7%, n=176/2389), a desire to forget about having HIV (7%, n=168/2389), and work (6%, n=145/2389) were the top reported reasons for missing daily oral ART for ≥5 times per month. Those study participants who reported multiple reasons for missing daily oral ART had higher odds of self-reported virologic non-suppression.1

two women walking on street, one with hand on shoulder of other

“Even those people living with HIV who have access to treatment still have challenges that need to be addressed. Open dialogue with healthcare providers about emotional and practical challenges can support quality of life and health outcomes.”

The Positive Perspectives study authors suggest that a possible strategy for reducing treatment challenges for those who are struggling with suboptimal adherence may be offering treatments that reduce the need for daily dosing: “Simplifying HIV regimens so they are a less conscious or conspicuous part of patients' lives … may improve adherence and health outcomes.” 1

The Positive Perspectives study is one of the largest, global, HIV patient-reported outcomes (PROs) studies to date, with 2,389 people living with HIV participating from 25 countries. Participants were asked to rate their own health, how living with HIV impacts their lives and affects their outlook for the future, as well as examining their interactions and relationships with HCPs and their experiences with ART. All findings are self-reported.

Click the image below to read the full Positive Perspectives results report

*In the Positive Perspectives study, suboptimal adherence was defined as a report of ≥1 reason for missing ART ≥5 times within the past month.

References

  1. de los Rios P, Okoli C, Punekar Y, Allan B, Muchenje M, Castellanos E, Richman B, Corbelli G M, Hardy W D, Young B, Van de Velde N; Prevalence, determinants and impact of suboptimal adherence to HIV medication in 25 countries; Preventive Medicine 139 (2020) 106182
  2. Gross R, Yip B, Lo Re III V, Wood E, Alexander C, P. Harrigan P R, Bangsberg D R, Montaner J S G, Hogg R S; A Simple, Dynamic Measure of Antiretroviral Therapy Adherence Predicts Failure to Maintain HIV-1 Suppression; The Journal of Infectious Diseases 2006; 194:1108–14
  3. Glass T, Sterne J A C, Schneider M-P, De Geest S, Nicca D, Furrer H, Gunthard H F, Bernasconi E, Calmy A, Rickenbach M, Battegay M, Bucher H C, the Swiss HIV Cohort Study; Self-reported non-adherence to antiretroviral therapy as a predictor of viral failure and mortality; AIDS 2015, Vol 29 No 16
  4. Lepik K, Harrigan P R, Yip B, Wang L, Robbins M A, Zhang W W, Toy J, Akagi L, Lima V D, Guillemi iS, Montaner J S G, Barrios R; Emergent drug resistance with integrase strand transfer inhibitor-based regimens; AIDS 2017, 31:1425–1434

YOU MAY ALSO BE INTERESTED IN:

Global Positive Perspectives data demonstrate a strong link between high reported engagement with healthcare providers (HCPs) and positive self-reported health outcomes for people living with HIV (PLHIV), yet study results also show many do not feel comfortable raising important treatment issues.

The latest Positive Perspectives (Wave 2) is one of the largest, global, HIV patient-reported outcomes (PROs) studies to date and provides perspectives from a diverse group of people living with HIV across the world. 

Find out more about how taking multiple medications can affect quality of life for people living with HIV. Data from Positive Perspectives study (Wave 2).