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Multiple Characteristics of HAART Affect Adherence Described
Reported by Jules Levin
  The total number of pills taken daily in HAART therapy has the greatest impact on adherence, according to the Perspectives on Adherence and Simplicity for HIV-Positive Patients on Antiretroviral Therapy (PASPORT) survey. The findings were presented in October at the annual meeting of the Infectious Diseases Society of America (IDSA).
The survey covered 299 patients, the majority of whom had been on HAART regimens for four years or more. Of the 10 attributes evaluated, total pills per day had the greatest impact on adherence, followed by dosing frequency, adverse events, diet restrictions, pill size, number of refills, number of insurance co-pays, number of prescriptions, number of medication bottles, and the requirement of bedtime dosing.
"In the past, studies have looked primarily at one or two factors related to adherence and measured their impact as single entities," said Valerie Stone, MD, MPH, lead investigator and associate chief, general medicine unit, department of medicine at Massachusetts General Hospital. She is also an associate professor of medicine at Harvard Medical School-Boston. "In the PASPORT survey, we used an adaptive conjoint methodology, sometimes called 'trade off' analysis, which reflects the reality of making HIV treatment decisions as patients consider various trade-offs to tailor a regimen that fits their lifestyles and preferences." The survey shows that patients preferred a regimen of two small pills dosed at the same time each day with no food requirements or restrictions, an "acceptable" adverse event profile, and one prescription refilled monthly with one co-pay.
This study was I think sponsored by Glaxo, thus 2 pills twice daily is preferable which is Trizivir. Still, total pill count and easy dosing is preferable by patients and encourages adherence. My sense is that patients would prefer once daily dosing with as few pills as possible. But, prospective studies are needed to truely understand if once daily dosing is in effect preferable and more effective compared to twice daily dosing. In effect, dosing may be better decided upon on an individual basis. Once daily may be effective for some individuals and twice daily may be better for some individuals. Again, prospective studies are important to sorting these questions out.
The survey population included patients ranging in age from 17 to 72, 76 percent of whom were males. African Americans comprised approximately 45 percent of participants, with 38 percent Caucasians, 15 percent Hispanics, and Asian and other ethnic groups making up the remainder. Researchers interviewed HIV-infected subjects in Seattle, San Francisco, Miami, New York, Atlanta, and Washington. Of the 295 participants who answered a question about their current adherence, 26 percent reported no doses missed in the past three months; 32 percent said they had missed one or two doses; 24 percent noted three to five; 8 percent said six to eight; and 10 percent reported missing nine or more.
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