Department of Psychiatry, UC San Diego, La Jolla, California, USA.
Division of Infectious Disease and Global Public Health, UC San Diego, La Jolla, California, USA.
AIDS Res Hum Retroviruses. 2022 Nov;38(11):856-862. doi: 10.1089/AID.2022.0029. Epub 2022 Oct 14.
Antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are key strategies in ending the HIV epidemic. However, poor adherence to daily ART and PrEP increases the risk of HIV transmission and acquisition. Long-acting ART and PrEP formulations attempt to improve adherence through providing long-lasting forms of the medication delivered through different routes of administration: oral (potentially monthly), injection (1-6 months), and subdermal implant (up to annually). This study explored patient and physician preferences for long-acting ART and PrEP as well as adherence support strategies. Adult patients ( = 42) with experience taking ART or PrEP participated in individual interviews or focus groups. Physicians ( = 13) currently prescribing ART and/or PrEP completed an online questionnaire. Rapid qualitative analysis systematically synthesized qualitative data, and descriptive statistics examined survey responses. Patients supported improved adherence as a top potential advantage of long-acting ART and PrEP, and reduced internal stigma as a strong benefit specific to long-acting ART. Annual coverage offered through subdermal implants had strong appeal; however, oral was the preferred modality for long-acting ART and PrEP. Patients preferred injectable ART and PrEP if concurrently receiving hormone therapy injections. Side effects, medication cost, and treatment accessibility were potential barriers. Patients preferred calendar tracking and text messages/phone reminders for adherence supports. Physicians reported that they would reduce clinic visits and HIV testing for all patients on long-acting PrEP, except men who have sex with men who would continue to complete HIV testing every 3 months. Physicians were mixed on whether they believed long-acting ART and PrEP would improve patient adherence. Overall, findings demonstrate the potential benefits of long-acting ART and PrEP, while highlighting the need to obtain additional information to address treatment concerns.
抗逆转录病毒疗法（ART）和暴露前预防（PrEP）是终结艾滋病流行的关键策略。然而，每日 ART 和 PrEP 依从性差会增加 HIV 传播和感染的风险。长效 ART 和 PrEP 制剂试图通过提供通过不同给药途径（口服[潜在每月]、注射[1-6 个月]和皮下植入[长达每年]）提供长效形式的药物来提高依从性。本研究探讨了长效 ART 和 PrEP 的患者和医生偏好以及依从性支持策略。有服用 ART 或 PrEP 经验的成年患者（ = 42）参加了个人访谈或焦点小组。目前正在开具 ART 和/或 PrEP 处方的医生（ = 13）完成了在线问卷调查。快速定性分析系统地综合了定性数据，描述性统计分析了调查结果。患者支持改善依从性作为长效 ART 和 PrEP 的最大潜在优势，减少内在污名作为长效 ART 的一个强烈优势。通过皮下植入物提供的年度覆盖具有很强的吸引力；然而，口服是长效 ART 和 PrEP 的首选方式。如果同时接受激素治疗注射，患者更喜欢注射用 ART 和 PrEP。副作用、药物费用和治疗可及性是潜在的障碍。患者更喜欢日历跟踪和短信/电话提醒来支持依从性。医生报告说，他们将减少所有长效 PrEP 患者的诊所就诊和 HIV 检测，除非与男性发生性关系的男性继续每 3 个月完成一次 HIV 检测。医生对长效 ART 和 PrEP 是否会提高患者的依从性存在分歧。总体而言，研究结果表明长效 ART 和 PrEP 的潜在益处，同时强调需要获得更多信息来解决治疗问题。
