| Summary: | Introduction
Daily antiretroviral treatment (ART) can be
challenging for some people living with HIV (PLHIV). Longacting
injectable regimens (LAR) allow for non-daily dosing.
We explored unmet needs associated with daily ART dosing
and examined PLHIV’s preference for LAR in the Netherlands,
a country that has made enormous strides in improving HIV
care; and 11 other European countries.
Methods
Data were from the second wave of the Positive
Perspectives survey of PLHIV on ART conducted in 2019
(Europe-wide, n=969 including Netherlands, n=51).
Within four domains of ART-related challenges (emotional,
psychosocial/stigma, physical, adherence), we used
multivariable logistic regression to examine the relationship
between the extent of unmet needs (tertiles) and LAR
preference (p<0.05).
Results
In pooled Europe-wide analysis, within each
domain of unmet need, LAR preference increased with an
increasing number of challenges. By the extent of ART-related
emotional challenges, LAR preference odds were 1.76 (95%
CI: 1.45–2.13) among those with a ‘moderate’ burden, and
4.05 (95% CI: 3.26–5.03) among those with a ‘high’ burden,
compared to those with a ‘low’ burden. For anticipated
stigma, LAR preference odds were 1.50 (95% CI: 1.11–2.04)
for moderate and 2.33 (95% CI: 1.68–3.21) for high versus
low. For adherence barriers, LAR preference odds were 1.53
(95% CI: 1.14–2.04) and 2.06 (95% CI: 1.45–2.91) among
those with moderate and high levels of adherence barriers,
respectively, compared to low. LAR preference odds were
1.71 (95% CI: 1.25–2.34) higher among PLHIV with 2+
non-HIV comorbidities versus HIV only, and 1.57 (95%
CI: 1.12–2.34) higher among those on 2+ co-medications
versus on ART exclusively. Of Dutch participants, 58.8%
(30/51) indicated LAR preference, and 32.2% ranked LAR
as the single most important ART improvement. Regarding
daily oral ART dosing, 11.8% (6/51) of Dutch participants
felt that it limited their daily life; 3.9% (2/51) were stressed
by it, and 35.3% (18/51) said that it reminded them of
HIV. Furthermore, 23.5% (12/51) hid/disguised their HIV
medication to prevent unwanted disclosure of their HIV
status. Also, 13.7% (7/51) reported adherence anxiety,
37.2% (19/51) missed ART 1+ times during the past month,
and 13.7% (7/51) had difficulty swallowing pills.
Conclusions
PLHIV’s preference for LAR can be for a variety
of reasons other than clinical indications. LAR preference
was associated with different domains of unmet needs,
including emotional, psychosocial, physical, and adherencerelated
challenges.
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