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Treatment Adherence And Persistence Among HIV-1 Patients Newly Starting Treatment

Authors Hines DM, Ding Y, Wade RL, Beaubrun A, Cohen JP

Received 9 March 2019

Accepted for publication 1 August 2019

Published 7 November 2019 Volume 2019:13 Pages 1927—1939


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Naifeng Liu

Dionne M Hines,1 Yao Ding,1 Rolin L Wade,1 Anne Beaubrun,2 Joshua P Cohen3

1Health Economics and Outcomes Research, IQVIA Inc, Plymouth Meeting, PA, USA; 2Health Economics and Outcomes Research, Gilead Sciences Inc, Foster City, CA, USA; 3Institute for Clinical Research and Health Policy Studies, Tufts University, Boston, MA, USA

Correspondence: Rolin L Wade
IQVIA Inc., One IMS Drive, Plymouth Meeting, PA 19462, USA
Tel +1 215 434 812 2958

Objective: To assess adherence and persistence with first-line single-tablet regimen (STR) and multi-tablet regimen (MTR) antiretroviral therapy (ART) in newly treated HIV-1 patients.
Methods: Retrospective analysis of longitudinal pharmacy claims among US patients initiating ART between 1/1/2016 and 5/31/2016 (index date was defined by first ART claim for STRs, and fill date for the last therapy in the regimen for MTRs). Adherence was assessed over a 12-month period and reported as the proportion of adherent or non-adherent (defined as ≤5-day and > a 5-day gap between successive fills, respectively) patients. Sensitivity analysis using ≤7-day and ≤14-day gap thresholds to define adherence was performed. Persistence was assessed as the number of days on therapy from index until treatment discontinuation (>90 day gap in therapy). Kaplan–Meier curves and Cox Proportional Hazard models were generated to evaluate discontinuation rates. Assessments were performed on STRs vs MTRs overall and by regimen.
Results: Patients initiating ART (STR: n=10,623; MTR: n=2504) had a mean age of 42.8 years; 76.0% were male. STR patients were >2 times more likely to be adherent over 12 months than MTR patients (24.9% vs 11.7%, respectively). Patients using EVG/COBI/FTC/TAF had greater adherence than those using other STRs. Among MTRs, patients were more adherent with FTC/TDF+DTG (15.1%) than other MTRs. Persistence was also greater with STRs, with MTR patients being 61% more likely to discontinue therapy. Persistence was best for FTC/TAF-based regimens. Predictors of treatment discontinuation included younger age, female gender, and Medicare or Medicaid insurance type.
Conclusion: Patients receiving STRs were significantly less likely to discontinue therapy and were more adherent with their regimens, providing further evidence of greater adherence and persistence with STRs versus MTRs. However, there was a large proportion of patients who interrupted or discontinued treatment. Further research examining treatment patterns beyond first line is warranted.

Keywords: antiretroviral, HIV, adherence, persistence

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