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October 3 -7, 2019
San Francisco, CA
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Online US/Canada Survey Finds Preference
for Long-Acting Injectable ART

  IDWeek, October 2-6, 2019, Washington, DC
Mark Mascolini
An online survey of 553 adults taking antiretroviral therapy (ART) in the United States and Canada found a preference for long-acting injectable treatment compared with daily oral drugs--even a "best-case" oral regimen. Conducted by researchers from ViiV Healthcare (maker of long-acting cabotegravir) and collaborators at other institutions, the survey also confirmed persisting internalized stigma among North Americans with HIV.
Researchers designed the survey on the basis of a literature review, clinical expert advice, and qualitative and quantitative pilot surveys. By self-report, treated participants had to have an undetectable load while taking ART for at least 6 months. Respondents chose between (1) taking one pill every day versus two injections every month or two injections every 2 months, (2) a 5%, 15%, or 30% risk of side effects, (3) forgivability* less than, the same as, or more than the current regimen, (4) forgivability of 1, 2, or 3 weeks after a missed dose, and (5) more, the same, or fewer food and mealtime restrictions with an oral regimen. Physicians treating people with HIV completed a separate survey addressing similar questions in a different format. Researchers recruited survey respondents via patient and physician panels.
Antiretroviral-treated respondents included 453 people from the United States and 100 from Canada. One third were women and 1% transgender, and age averaged 39. While 62% of participants described themselves as straight, 29% called themselves LGBTQ and 8% men who have sex with men (MSM). Racial/ethnic proportions were 56% white, 19% black, 14% Hispanic, 6% Asian, and 19% other. Only 18% of respondents had begun ART less than 1 year ago. There were 305 physician respondents from the United States and 151 from Canada. They had spent an average 13 years treating people with HIV, who represented about one third of their patient population.
On a scale from 1 (totally unsatisfied) to 7 (totally satisfied), satisfaction with current ART medications averaged 5.5 among patients and 5.2 among physicians--results indicating some room for improvement. While 72% of patients said they were not totally satisfied with their medications, 93% of physicians were less than totally satisfied. Frequent reasons for dissatisfaction among patients were daily dosing (37%), side effects (27%), impact on when people can eat (25%), and treatment as a constant reminder of having HIV (24%). Reasons physicians recommended switching ART were resistance (58%), toxicity (54%), virologic failure (53%), and poor adherence (50%).
While half of patients said they forgot to take their antiretrovirals at least once in the past 4 weeks, 27% intentionally did not take their drugs. Majorities of patient respondents felt HIV stigma, defined as being careful whom they told about their HIV (85%), hiding that they have HIV (67%), and being concerned others would find out they have HIV (65%).
Asked to choose among three type of therapy, 58.7% of patients picked once-monthly injections, 30.1% chose a best-case oral pill (more forgivability and fewer food restrictions than current oral therapy), and 11.2% opted to stay with their current therapy. People who forgot to take their antiretrovirals at least once in the past 4 weeks were more likely to want a once-monthly injectable therapy (P < 0.001), whereas people whose treatment challenge primarily involved lifestyle factors were more likely to stick with their current therapy (P < 0.01).
Among physicians, 55% to 61% leaned toward recommending a switch to once-monthly injections, depending on specific treatment challenges.
The researchers stressed that many North Americans with HIV continue to feel stigma associated with their infection. The investigators noted that their study is limited because recruitment relied on patient and physician panels and patients self-reported their HIV diagnosis. In addition, a higher than expected proportion of patient respondents identified themselves as straight (heterosexual), so respondents may not comprise a completely representative North American HIV population.
1. Garris CP, Heidenreich S, Arthurs E, et al. Perceptions of and preferences for oral or long-acting injectable antiretroviral treatment regimens in the United States and Canada. IDWeek, October 2-6, 2019, Washington, DC. Abstract 984.
*Forgivability indicates how many doses can be missed before HIV resistant to a drug emerges.