Abstract
Objectives
The objectives were 1) to elicit relative preferences for attributes of antiretroviral therapies (ART) in people living with HIV (PLWH) and 2) to explore satisfaction and adherence with current ART.
Patients and methods
We conducted a multicenter cross-sectional study, consecutively enrolling PLWH receiving an ART. The quantitative part estimated the strength of preference for different attributes using an online discrete choice experiment (DCE). DCE data were analyzed using a mixed logit regression model. Qualitative data were collected through individual interviews. A preliminary coding framework was developed which was then further refined and applied during thematic analysis of factors influencing satisfaction and adherence.
Results
A total of 101 PLWH took part in the quantitative part and 31 in the qualitative part. Over 90% had an undetectable viral load. Quantitative data revealed a strong preference for a treatment with limited drug–drug interactions, diarrhea and long-term health problems (P<0.0001), and that did not need to be taken on an empty stomach (P<0.0001). Patients also preferred to avoid problems associated with treatment failure (P<0.0001) or one that left them with a higher viral load after the first weeks of treatment (P=0.044). Differences in CD4 cell count, and pills that must be taken with food were not significant drivers of treatment choice. The strength of these attributes was reflected in the qualitative data, highlighting the importance patients place on treatment efficacy, and also suggesting that some of these attributes may impact adherence. Many factors influencing adherence and satisfaction with treatment were identified, including pill size, worry about sexual transmission and impact on social life.
Conclusion
Most of the attributes included in this survey were important to participants when choosing an ART, in particular those related to quality of life, and these should be taken into account in order to optimize adherence and satisfaction.
Acknowledgments
We would like to thank the patients who agreed to take part in this study, the investigators, Miranda Murray, Nathalie Dang (ViiV Healthcare, London, UK), Paul Swinburn, Katy Gallop, Hayley de Freitas, Andrew Lloyd (Icon plc, Oxford, UK), Julie Salia (patient reported outcomes, Lyon), Céline Aubin and Camille Correia Da Silva (GlaxoSmithKline, Paris, France). Study sponsored and financed by ViiV Healthcare.
Author contributions
S Brégigeon-Ronot, A Cheret, A Cabié, T Prazuck and JJ Parienti approved the protocol, recruited patients and reviewed the analyses. A Volny-Anne approved the protocol and reviewed the analyses. S Ali performed the data analysis. C Bottomley contributed to writing the article, monitoring and performing the data analysis. L Finkielsztejn approved the protocol, reviewed the analyses and was involved in monitoring. C Philippe was responsible for recruitment and monitoring of centers, gathering data, monitoring, reviewing the analyses and writing the article. All authors read and approved the final version of the manuscript and approved its submission. JJ Parienti was responsible for submission of the manuscript. All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.
Disclosure
S Brégigeon-Ronot: Gilead, Janssen, ViiV Healthcare. A Cheret: ViiV Healthcare. A Cabié: Gilead, Janssen, ViiV Healthcare. T Prazuck: Gilead, ViiV Healthcare, Janssen. A Volny-Anne: none. S Ali: employed by Icon, contract research organization at time of study. C Bottomley: employed by Icon, contract research organization at time of study. L Finkielsztejn: employed by ViiV Healthcare. C Philippe: employed by Qualees, contract research organization. JJ Parienti: Gilead science, Janssen Pharmaceuticals, ViiV Healthcare, MSD. The authors report no other conflicts of interest in this work.