American patients admitted that they are not ready to switch to new ways of ART delivery
According to a US study published in Open Forum Infectious Diseases, two-thirds of people taking combined antiretroviral therapy (ART) will be interested in switching to the oral regimen once a week. The idea of switching to long-term injection therapy is supported by less than 40% of respondents, while treatment with the use of implants is of relatively small interest.
“Promising patient-centered treatment options for HIV infection require a lot of attention to patient preferences for new ARVT delivery systems,” the authors comment.
“Understanding which patients want to switch to other methods of treatment, what are their motives and benefits from the transition, and finally, the concessions that patients are willing to make in order to change the form of ART, are not well known.”
Currently, a number of promising studies are underway that could lead to the emergence of a weekly, monthly and even two-year method of ART dosing. However, the proportion of patients who would prefer these regimens to traditional ones is not yet clear. Also, the specific characteristics of the patient associated with the preference for new dosing schedules are unknown.
To answer these questions, researchers from North and South Carolina developed a study of 263 adult patients on ART. The recruitment was conducted from February to August 2017.
Participants were presented with the following statement:
“Currently, several new HIV drugs are being developed, which can be taken less frequently than the current ones. Compared to your current HIV drugs, how much you are interested in switching to a new treatment, which is ... one pill once a week, two injections at the clinic every two months, or implantation and removal of two plastic rods the size of a match in every forearm every six months? ”
Patients were asked to rate their preferences on a scale from 1 (not quite interested) to 5 (very interested).
The average age of study participants was 47 years old, 56% were men, the majority (81%) were from a racial or ethnic minority. More than half of the sample had a secondary education (42%) or less (12%). They have been taking ART for an average of 12 years. 82% of volunteers had undetectable viral load (below 200 copies / ml).
One in five stated that he had experience of skipping therapy at least once in the previous two weeks. It was also reported that a third of participants had side effects on ART, and 39% indicated that they experience long-term side effects.
With regard to new methods of treatment, one tablet once a week became a clear favorite: 66% of respondents said that they would be very interested in this option, 20% - that they would be moderately interested, and 14% - not at all interested.
Opinions were divided on injection therapy: 39% said they were very interested, 23% were moderately interested, and 38% were not at all interested.
And only 18% of patients said that they are very interested in implants, 23% are moderately interested, and a clear majority - 58%, who are not at all interested in this option.
A higher level of education was significantly associated with an increased interest in new forms of therapy, especially injecting therapy (p <0.001). The younger age (p = 0.036) and the experience of long-term side effects (p = 0.018) were also associated with interest in injection products.
“Our findings [...] draw attention to the need for drug developers to increase patient loyalty by responding to their preferences, to clearly state the risks and benefits of each option and to involve them in continuous ARVT treatment,” the authors comment.
Scientists suggest that the preference given to weekly treatment is probably due to the fact that patients are already familiar with oral dosing. Opinions about the new forms of ARVT delivery will change only as patients become more aware of these options.