Wang Hongmei, Torres Cecilia M, Giordano Thomas P, Dang Bich N, Liang Dong
Joan M. Lafleur College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX 77004, USA.
Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
Medicina (Kaunas). 2025 Mar 20;61(3):544. doi: 10.3390/medicina61030544.
: Effective HIV treatment and prevention rely heavily on patient adherence to the prescribed regimen. Therapeutic drug monitoring (TDM), which involves measuring medication concentrations in blood circulation, offers an objective method to evaluate toxic or ineffective drug levels. TDM is not routinely used in HIV treatment in clinical practice. Therefore, the purpose of this study is to survey infectious disease providers' attitudes and barriers toward therapeutic drug monitoring for antiretroviral therapy in people living with HIV. : A 15-item online survey was distributed to infectious disease providers in the Greater Houston area, including physicians, pharmacists, and mid-level practitioners involved in HIV patient care. The survey was disseminated via the Houston Citywide Infectious Disease Provider Network and the Houston AIDS Education and Training Center. The survey employed close-ended questions to evaluate providers' attitudes, perceptions, practices, and barriers toward antiretroviral drug level monitoring. Responses were recorded using a five-point Likert scale. Demographic characteristics and information regarding research involvement were collected to contextualize the findings. The survey results were analyzed using descriptive statistics, with categorical variables expressed as frequencies and percentages using SAS software. : A total of 139 responses were received, with 89 participants meeting the inclusion criteria; the majority were female (62.9%), nearly half were aged 34 or younger (53.4%), 50% were physicians and 36.3% pharmacists, and most worked in hospitals (52.3%) or clinics (35.2%). The findings demonstrate participants' predominantly positive attitudes toward TDM. Nearly 70% agree (agree or strongly agree) that TDM will be helpful and will positively impact improving drug efficacy and medication adherence. The results revealed barriers to implementing TDM, including a lack of evidence supporting TDM's impact on HIV outcomes, and the absence of clinical guidelines. The results indicated that >90% were ambivalent or agreed that there was not enough evidence to support the use of TDM, and nearly all recognized that the guidelines do not endorse it or did not know if they do not endorse it. : This study highlighted positive attitudes and significant barriers to implementing therapeutic drug monitoring, including a lack of evidence supporting TDM's impact on HIV outcomes and the absence of clinical guidelines supporting TDM's widespread use. The findings emphasize the need for clinical trials and longitudinal studies to establish definitive evidence on the effectiveness of TDM in improving HIV treatment outcomes.
有效的艾滋病病毒治疗和预防在很大程度上依赖于患者坚持规定的治疗方案。治疗药物监测（TDM），即测量血液循环中的药物浓度，提供了一种评估有毒或无效药物水平的客观方法。在临床实践中，TDM在艾滋病病毒治疗中并非常规使用。因此，本研究的目的是调查传染病医疗服务提供者对艾滋病病毒感染者抗逆转录病毒治疗药物监测的态度和障碍。
一项包含15个项目的在线调查被分发给大休斯顿地区的传染病医疗服务提供者，包括参与艾滋病病毒患者护理的医生、药剂师和中级从业者。该调查通过休斯顿全市传染病医疗服务提供者网络和休斯顿艾滋病教育与培训中心进行传播。该调查采用封闭式问题来评估医疗服务提供者对抗逆转录病毒药物水平监测的态度、看法、做法和障碍。使用五点李克特量表记录回答。收集人口统计学特征和有关研究参与情况的信息，以便将研究结果置于具体情境中。使用描述性统计分析调查结果，分类变量使用SAS软件以频率和百分比表示。
共收到139份回复，其中89名参与者符合纳入标准；大多数为女性（62.9%），近一半年龄在34岁及以下（53.4%），50%是医生，36.3%是药剂师，大多数在医院工作（52.3%）或诊所工作（35.2%）。研究结果表明参与者对TDM总体持积极态度。近70%的人同意（同意或强烈同意）TDM会有帮助，并将对提高药物疗效和治疗依从性产生积极影响。结果揭示了实施TDM的障碍，包括缺乏支持TDM对艾滋病病毒治疗结果影响的证据，以及缺乏临床指南。结果表明，超过90%的人持矛盾态度或同意没有足够证据支持使用TDM，几乎所有人都认识到指南不认可TDM或不知道指南是否不认可。
本研究强调了对实施治疗药物监测的积极态度和重大障碍，包括缺乏支持TDM对艾滋病病毒治疗结果影响的证据，以及缺乏支持TDM广泛使用的临床指南。研究结果强调需要进行临床试验和纵向研究，以确定TDM在改善艾滋病病毒治疗结果方面有效性的确切证据。
