Adherence to single-tablet versus multiple-tablet regimens in the treatment of HIV infection—A questionnaire-based survey on patients satisfaction

Retention in care and adherence to HIV and AIDS treatment in Anambra State Nigeria

Background

Retaining patients on antiretroviral treatment in care is critical to sustaining the 90:90:90 vision. Nigeria has made some progress in placing HIV-positive patients on treatment. In an effort to increase access to treatment, ART decentralization has been implemented in the country. This is aimed at strengthening lower level health facilities to provide comprehensive antiretroviral treatment. We determined the level of retention and adherence to treatment as well as the associated factors among private and public secondary level hospitals in Anambra State.

Method

We conducted a cross-sectional study among patients who had taken antiretroviral treatment for at least one complete year. A structured questionnaire and patient record review were used to extract information on patient adherence to treatment, and retention in care. Adherence to treatment was ascertained by patient self-report of missed pills in the 30 days prior to date of interview. Retention in care was ascertained using the 3-month visit constancy method reviewing the period spanning 12 months prior to the study.

Result

We found a comparable level of retention in care (private 81.1%; public 80.3%; p = 0.722). However, treatment adherence was significantly higher amongst participants in the private hospitals compared to those in the public hospitals (private: 95.3%; public: 90.7%; p = 0.001). Determinants of good retention in the private hospitals included disclosure of one’s HIV status (AOR: 1.94, 95% CI: 1.09–3.46), being on first-line regimen (AOR: 3.07, 95% CI: 1.27–7.41), whereas being on once-daily regimen (AOR: 0.58, 95% CI: 0.36–0.92), and being currently married (AOR: 0.54 95% CI: 0.32–0.91) determined poor retention. In the public hospitals, only disclosure (AOR: 3.12 95% CI: 1.81–5.56) determined good retention, whereas, spending less than N1000 on transport (AOR: 0.230 95% CI: 0.07–0.78) and residing in a rural area (AOR: 0.64 95% CI: 0.41–0.99) determined poor retention. None of the factors determined adherence.

Conclusion

Retention in care was high and comparable among the different hospital types and HIV disclosure status was an important factor relating to retention in care. The other factors that determined retention were however different at public and private hospitals. The HIV program manager should consider these variations in designing programs to improve patient retention in care and adherence to treatment.

A meta-analysis comparing 48-week treatment outcomes of single and multi-tablet antiretroviral regimens for the treatment of people living with HIV

OBJECTIVES

To compare outcomes with single tablet regimens (STR) versus multi-tablet regimens (MTR) for human immunodeficiency virus (HIV) treatment using published data.

DESIGN

Systematic review and random-effects meta-analysis of literature on approved and investigational HIV regimens.

METHODS

The research followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Single or un-blinded studies reporting a direct comparison between STR and MTR were eligible for the meta-analysis. Double-blinded studies were excluded due to lack of difference in pill burden between cohorts. The key outcomes of interest included: adherence rates/proportion meeting target, efficacy, safety/tolerability, non-clinical and economic outcomes.

RESULTS

After screening 63 full-text articles and posters, 14 studies were eligible for the meta-analysis. The analysis showed that patients taking STR had improved outcomes over those taking MTR. Patients were significantly more adherent regardless of daily dosing frequency (odds ratio [OR]: 1.96, p < 0.001) and were more likely to achieve virological suppression (relative risk [RR]: 1.05, p = 0.002). There was a trend toward a lower discontinuation risk in the STR cohort, together with reported higher therapy satisfaction, better symptom control, improved health status, reduced healthcare resource utilization and demonstrated cost-effectiveness compared to MTR. There were no differences in CD4 cell count increase (at 48 weeks) or safety outcomes.

CONCLUSIONS

The findings of this study confirm previously reported preliminary findings of the advantages of STR over MTR for HIV treatment in adherence, therapy continuation, viral suppression, tolerability, quality of life improvement, cost-effectiveness and healthcare resource utilization.

Single Tablet Regimen Usage and Efficacy in the Treatment of HIV Infection in Australia

Single tablet regimens (STRs) for HIV infection improve patient satisfaction, quality of life, medication adherence, and virological suppression compared to multitablet regimens (MTRs). This is the first study assessing STR uptake and durability in Australia. This retrospective audit of all patients receiving an STR (n = 299) at a large Sydney HIV clinic (January 2012–December 2013) assessed patient demographics, treatment prior to STR, HIV RNA load and CD4 during MTR and STR dosing, and reasons for STR switch. 206 patients switched from previous antiretroviral treatment to an STR, of which 88% switched from an MTR. Reasons for switching included desire to simplify treatment (57%), reduced side effects or toxicity (18%), and cost-saving for the patient. There was no switching for virological failure. Compared to when on an MTR, patients switching to an STR had significantly lower HIV RNA counts (p < 0.001) and significantly higher CD4 counts (p < 0.001). The discontinuation rate from STR was very low and all patients who switched to an STR maintained virological suppression throughout the study duration, although the study is limited by the absence of a control group.

Meta-Analysis of Studies Comparing Single and Multi-Tablet Fixed Dose Combination HIV Treatment Regimens

Availability of a single source review of once-daily fixed-dose single tablet regimen (STR) and multiple tablet fixed-dose regimen (MTR) would optimally inform healthcare providers and policy makers involved in the management of population with human immunodeficiency virus (HIV).We conducted a meta-analysis of published literature to compare patient adherence, clinical, and cost outcomes of STR to MTR.Published literature in English between 2005 and 2014 was searched using Embase, PubMed (Medline in-process), and ClinicalTrials.Gov databases. Two-level screening was undertaken by 2 independent researchers to finalize articles for evidence synthesis. Adherence, efficacy, safety, tolerability, healthcare resource use (HRU), and costs were assessed comparing STR to MTR. A random-effects meta-analysis was performed and heterogeneity examined using meta-regression.Thirty-five articles were identified for qualitative evidence synthesis, of which 9 had quantifiable data for meta-analysis (4 randomized controlled trials and 5 observational studies). Patients on STR were significantly more adherent when compared to patients on MTR of any frequency (odds ratio [OR]: 2.37 [95% CI: 1.68, 3.35], P < 0.001; 4 studies), twice-daily MTR (OR: 2.53 [95% CI: 1.13, 5.66], P = 0.02; 2 studies), and once-daily MTR (OR: 1.81 [95% CI: 1.15, 2.84], P = 0.01; 2 studies). The relative risk (RR) for viral load suppression at 48 weeks was higher (RR: 1.09 [95% CI: 1.04, 1.15], P = .0003; 3 studies) while RR of grade 3 to 4 laboratory abnormalities was lower among patients on STR (RR: 0.68 [95% CI: 0.49, 0.94], P = 0.02; 2 studies). Changes in CD4 count at 48 weeks, any severe adverse events (SAEs), grade 3 to 4 AEs, mortality, and tolerability were found comparable between STR and MTR. Several studies reported significant reduction in HRU and costs among STR group versus MTR.Study depicted comparable tolerability, safety (All-SAE and Grade 3-4 AE), and mortality and fewer Grade 3 to 4 lab abnormalities and better viral load suppression and adherence among patients on FDC-containing STR versus MTR; literature depicted favorable HRU and costs for STRs.These findings may help decision makers especially in resource-poor settings to plan for optimal HIV disease management when the choice of both STRs and MTRs are available.