Achieving and maintaining viral suppression can help decrease HIV-associated complications, prevent development of drug resistance, and prevent transmission.1 Regimens with simple administration, including low pill burden and no food requirement, help improve treatment adherence.1-4 Additionally, single-tablet regimens (STRs) minimize the possibility of selective noncompliance and the risk of patients taking an incomplete regimen.3,5,6
Patients need to take their medication every day as prescribed to achieve virologic suppression.1 Side effects of patients’ treatment can lead to discontinuation or altering of therapy. Management strategies must be individualized for each patient.1
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COMMON BARRIERS TO ADHERENCE
Despite prescribing a simple regimen and other efforts to maintain patients on the HIV continuum of care, a multitude of patient-related factors can pose barriers to adherence1,7:
Inconsistent access to medications1
Depression and other mental illnesses1
Low levels of social support1,8
Low health literacy1
Stressful life events1,8
Nondisclosure of HIV serostatus/denial1,8-10
People who are not adherent risk becoming resistant to medications and they have fewer regimen options.1 Despite being on a regimen with simple administration, common barriers to adherence can prevent patients from maintaining virologic control.1,11
Methods to help improve patient adherence
Consistently assess adherence1
The DHHS Panel’s recommendations on adherence to the continuum of care include assessing (and reassessing) the patient’s linkage to care and adherence to antiretroviral therapy (ART) and clinic appointments; approaching patients about adherence problems in a constructive, collaborative, nonjudgmental way; and tailoring the approach to each patient’s needs or barriers to care.
Measuring retention in care should be done consistently1
Consistency measures that can be used for clinic quality assurance:
Minimum of 2 visits at least 90 days apart over a period of 1 year
At least 1 visit every 6 months over a period of 2 years
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Benefits of simple administration
Characteristics of a regimen can affect adherence differently.1,13 Higher levels of adherence are associated with the following attributes1,14,15:
Lower pill size/burden
Fewer side effects
No food requirement
When selecting a regimen for your patients, components and configuration are important.1 Simple administration, reducing side effects, finding assistance with co-pays or out-of-pocket costs, and maintaining an uninterrupted supply of ART medication can help patients overcome adherence barriers.1 Prescribing an STR can help minimize the risk of resistance by promoting adherence through a lower pill burden and by eliminating the need to refill multiple prescriptions to provide a complete HIV treatment.1-3,5,6
Potential benefits of dosing simplification1,5,14,16
Lower dose frequency
Decreased healthcare costs
Fewer prescriptions needed
Simplified administration could help improve virologic suppression5
A simplified treatment such as an STR can help provide sustained viral suppression, allowing for improved immune function. While data that support or refute the superiority of an STR versus a once-daily multiple-tablet regimen (MTR) are limited, the study below suggests that an STR may offer advantages.1
In a clinical study5:
Virologic suppression (<50 copies/mL) was greater in patients using an STR (~84%) compared to an MTR (~78%)
It’s important to note that this study is not representative of all studies and that individual results can vary.
Regimen selection can affect retention in care5
Treatment adherence includes retention in care, which is defined as regularly attending appointments, and remaining in medical care.1
In the same study5:
One year after starting ART, ~81% of patients on an STR were retained in care versus ~73% of patients on an MTR
Additional endpoints were reported as part of this study.
Treatment persistence can be improved by
selecting a regimen with SIMPLE ADMINISTRATION4
Persistence is the duration of treatment from initiation to discontinuation. This can be measured by the number of consecutive days medication is taken without exceeding permissible intervals of therapy.4
Bangsberg et al2
STRs demonstrated greater pill count, which is a measure of adherence
~86% of patients remained adherent
~73% of patients remained adherent
Yager et al3
More prescription refills were seen in the STR group
~81% of treatment-naive patients refilled prescriptions
~66% of treatment-naive patients refilled prescriptions
Juday et al4
Significantly longer time on treatment (average) was seen in patients taking STRs
370 days on treatment
295 days on treatment
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