Compliance with clinical guidelines and adherence to antiretroviral therapy among patients living with HIV

Abstract

Objective: Evaluation of provider compliance with antiretroviral (ARV) treatment guidelines and patient adherence to ARVs is important for HIV care quality assessment; however, there are few current real-world data for guideline compliance and ARV adherence in the US. This study evaluated provider compliance with US Department of Health and Human Services (DHHS) guidelines and patient adherence to ARVs in a US population of patients with HIV.

Methods: This was a retrospective claims study of adults with HIV-1 receiving ARV treatment between January 2010–December 2014. Follow-up began at first ARV treatment and ended at health plan disenrollment or study end. ARV regimens for treatment-naïve patients were categorized as “preferred/recommended”, “alternative”, or “non-preferred/recommended/alternative” according to DHHS guidelines. ARV adherence was evaluated using proportion of days covered (PDC) and medication possession ratio (MPR).

Results: The analysis included 25,320 patients (84.4% male, mean age 45.3 years) and 39,071 regimens. Preferred/recommended regimens were most common during each study year, but the proportion of non-preferred/recommended/alternative regimens was substantial (15.9–20.6%). Only 53.6% of patients had optimal adherence by PDC ≥0.95, and 57.9% by MPR ≥0.95. Guideline non-compliance and sub-optimal adherence were more prevalent among female vs male patients (22.6% vs 14.8% [in 2014] and 65.9% vs 53.7%, respectively).

Conclusions: Provider non-compliance with DHHS guidelines and sub-optimal ARV adherence among patients with HIV remain common in real-world practice, particularly for female patients. Healthcare providers should follow the latest clinical guidelines to ensure that patients receive recommended therapy, and address non-adherence when selecting ARV regimens.

Keywords:

• Adherence
• HIV
• Treatment
• Guidelines
• DHHS
• Non-compliance
• Non-adherence

Transparency

Declaration of funding

This study was sponsored by Janssen Scientific Affairs, LLC.

Declaration of financial/other relationships

N. Tandon, A. Shprecher, and K. Brown are employees of Janssen. X. Jiao was an employee of Janssen at the time the study was conducted. J. Mao, A. Anderson, and F. Cao are employees of Optum, which was contracted by Janssen to conduct this research.

Acknowledgments

Medical writing support was provided by Yvette Edmonds, PhD (Optum). The authors would also like to thank Shiqiang Li, MS; Yiyu Fang, PhD; Damon Van Voorhis; and Vincent Peichel (all of Optum) for assistance with programming, study dataset creation, and table verification; and Jamie Forlenza, PharmD (Janssen) for contributions to the study design, data analysis, and study report.

Note

Notes

1 For the purpose of regimen determination, NRTIs were treated as a single medication; i.e., the appearance or disappearance of NRTIs as a whole from a regimen triggered a regimen change, but switching from one NRTI to another did not.