Perspectives on Adherence and Simplicity for HIV-Infected
Perspectives on Adherence and Simplicity for HIV-Infected
Background: Adherence to highly active antiretroviral therapy (HAART) of 95% or greater seems to be required for successful treatment of HIV/AIDS. Efforts to simplify regimens to improve adherence are ongoing, including the advent of once-daily (QD) dosing regimens, which are presumed to be beneficial, although data regarding their overall impact on adherence are not yet available.
Objective: To assess patient perceptions of the impact on adherence of 10 attributes of HAART, including QD dosing, and to compare 7 actual regimens based on patients' perceptions of their likelihood to promote adherence.
Methods: Two hundred ninety-nine highly treatment-experienced patients with HIV/AIDS completed a questionnaire that evaluated perceptions of the impact on adherence of 10 HAART regimen attributes using a modified adaptive conjoint analysis. Patients' perceptions of the likelihood that they would adhere to 7 actual HAART regimens were scored on Likert scales.
Results: Pill count, dosing frequency, and adverse events had the greatest impact on patients' perceived ability to adhere to antiretroviral medication regimens. QD was the preferred dosing frequency, but QD dosing regimens did not score better than other regimens. Among actual regimens, predicted adherence was highest for a twice-daily (BID) regimen with 2 pills daily, no dietary restrictions, and 1 prescription and copayment and lowest for a BID regimen with 13 pills daily, food requirements, and 3 prescriptions and copayments.
Conclusions: All HAART regimen attributes studied were perceived to have an impact on adherence, but pill count, dosing frequency, and adverse events had the greatest perceived impact. These data are of potential importance to clinicians as they seek to structure HAART regimens to which their patients are most likely to adhere.
It has been estimated that >95% of all highly active antiretroviral therapy (HAART) doses must be taken to maintain durable suppression of HIV in >80% of patients. Many providers now consider adherence as equal in importance to the potency of a regimen. The complexity of medication regimens has been the most frequently cited determinant of adherence across a range of chronic diseases, and recent studies suggest that regimen complexity may be one of the most important adherence barriers in HIV/AIDS as well. In a survey of HIV/AIDS providers, simplifying regimens was reported as the most frequent strategy used to improve adherence among HIV-infected individuals; it was mentioned by 64% of respondents.
Regimen complexity is composed of a number of regimen attributes, including the number of pills (pill burden); pill size; frequency and timing of doses; dietary and/or water requirements or restrictions; adverse events (AEs); medication storage requirements; number of prescriptions; and related factors such as the number of copayments, refills, and medication bottles as well as the influence of these or other factors on a patient's lifestyle. Past studies of HIV/AIDS treatment regimen complexity have examined pill count, dosing frequency, food restrictions, and total number of medications. These studies typically focused on a single attribute and its relation to adherence, and only 1 study focused on the effect of 2 attributes simultaneously.
Recently, the availability of 4 antiretrovirals with US Food and Drug Administration (FDA) labeling for once-daily (QD) dosing has been of particular interest, and many providers and patients view QD antiretrovirals as more likely to promote adherence than other strategies to simplify regimens, although no definitive studies have been published to date. It is reasonable to assume that most patients prefer to take medications as infrequently as possible. Yet, only limited preliminary data are available evaluating the perceived impact of dosing frequency relative to other regimen attributes and which of the inevitable tradeoffs patients are willing to make. Gallant and Block have demonstrated that providers frequently do not correctly anticipate the issues, attributes, or interaction of those factors that are most important to patients in maintaining adherence.
The objectives of the present study were to evaluate the relative impact on HAART adherence of 10 regimen attributes when they are considered simultaneously and in various combinations and to compare HIV/AIDS patients' perceptions of the convenience of a variety of commonly prescribed HAART regimens and their perceived ability to adhere to them.
Background: Adherence to highly active antiretroviral therapy (HAART) of 95% or greater seems to be required for successful treatment of HIV/AIDS. Efforts to simplify regimens to improve adherence are ongoing, including the advent of once-daily (QD) dosing regimens, which are presumed to be beneficial, although data regarding their overall impact on adherence are not yet available.
Objective: To assess patient perceptions of the impact on adherence of 10 attributes of HAART, including QD dosing, and to compare 7 actual regimens based on patients' perceptions of their likelihood to promote adherence.
Methods: Two hundred ninety-nine highly treatment-experienced patients with HIV/AIDS completed a questionnaire that evaluated perceptions of the impact on adherence of 10 HAART regimen attributes using a modified adaptive conjoint analysis. Patients' perceptions of the likelihood that they would adhere to 7 actual HAART regimens were scored on Likert scales.
Results: Pill count, dosing frequency, and adverse events had the greatest impact on patients' perceived ability to adhere to antiretroviral medication regimens. QD was the preferred dosing frequency, but QD dosing regimens did not score better than other regimens. Among actual regimens, predicted adherence was highest for a twice-daily (BID) regimen with 2 pills daily, no dietary restrictions, and 1 prescription and copayment and lowest for a BID regimen with 13 pills daily, food requirements, and 3 prescriptions and copayments.
Conclusions: All HAART regimen attributes studied were perceived to have an impact on adherence, but pill count, dosing frequency, and adverse events had the greatest perceived impact. These data are of potential importance to clinicians as they seek to structure HAART regimens to which their patients are most likely to adhere.
It has been estimated that >95% of all highly active antiretroviral therapy (HAART) doses must be taken to maintain durable suppression of HIV in >80% of patients. Many providers now consider adherence as equal in importance to the potency of a regimen. The complexity of medication regimens has been the most frequently cited determinant of adherence across a range of chronic diseases, and recent studies suggest that regimen complexity may be one of the most important adherence barriers in HIV/AIDS as well. In a survey of HIV/AIDS providers, simplifying regimens was reported as the most frequent strategy used to improve adherence among HIV-infected individuals; it was mentioned by 64% of respondents.
Regimen complexity is composed of a number of regimen attributes, including the number of pills (pill burden); pill size; frequency and timing of doses; dietary and/or water requirements or restrictions; adverse events (AEs); medication storage requirements; number of prescriptions; and related factors such as the number of copayments, refills, and medication bottles as well as the influence of these or other factors on a patient's lifestyle. Past studies of HIV/AIDS treatment regimen complexity have examined pill count, dosing frequency, food restrictions, and total number of medications. These studies typically focused on a single attribute and its relation to adherence, and only 1 study focused on the effect of 2 attributes simultaneously.
Recently, the availability of 4 antiretrovirals with US Food and Drug Administration (FDA) labeling for once-daily (QD) dosing has been of particular interest, and many providers and patients view QD antiretrovirals as more likely to promote adherence than other strategies to simplify regimens, although no definitive studies have been published to date. It is reasonable to assume that most patients prefer to take medications as infrequently as possible. Yet, only limited preliminary data are available evaluating the perceived impact of dosing frequency relative to other regimen attributes and which of the inevitable tradeoffs patients are willing to make. Gallant and Block have demonstrated that providers frequently do not correctly anticipate the issues, attributes, or interaction of those factors that are most important to patients in maintaining adherence.
The objectives of the present study were to evaluate the relative impact on HAART adherence of 10 regimen attributes when they are considered simultaneously and in various combinations and to compare HIV/AIDS patients' perceptions of the convenience of a variety of commonly prescribed HAART regimens and their perceived ability to adhere to them.
Source...