Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Multiple characteristics of HAART affect adherence

28.10.2002


Pill count has the greatest impact on adherence, survey reports



The total number of pills that need to be taken every day in HAART therapy has the greatest impact on adherence of 10 characteristics studied, according to a survey of HIV positive individuals, nearly two-thirds of whom had experienced at least three treatment regimens. The findings of the Perspectives on Adherence and Simplicity for HIV+ Patients on Antiretroviral Therapy (PASPORT) survey were presented here today at the 40th Annual Meeting of the Infectious Diseases Society of America (IDSA).

Of the 10 attributes evaluated in the survey, total pills per day had a mean attribute importance score of 14 percent, followed by dosing frequency (13 percent), adverse events (12 percent), diet restrictions (11 percent), pill size (10 percent); number of refills (9 percent) number of insurance co-pays (9 percent), number of prescriptions (8 percent) number of medication bottles (8 percent) and the requirement of bedtime dosing (6 percent).


"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, M.D., M.P.H., lead investigator, Associate Chief, General Medicine Unit, Department of Medicine, Massachusetts General Hospital; and Associate Professor of Medicine, 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.

Dr. Stone presented the results of the survey at IDSA today.

Based on survey results, the preferred characteristics of a regimen would include 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.

"The PASPORT Survey supports research documenting that multiple factors impact a patient´s ability to follow a treatment plan exactly as prescribed," said Dr. Stone. Adherence is a complex problem, and over reliance on any single factor may, in fact, impede adherence for some patients, as our survey suggests. Multiple treatment characteristics and the interactions among them should be taken into consideration in tailoring a treatment regimen that may enhance adherence for the individual patient.

Despite a lack of data, it is a common assumption that QD dosing will improve adherence. Although QD dosing was deemed the most desirable dosing schedule by the individuals surveyed, actual QD regimens currently available were perceived as no more likely to improve adherence than a BID regimen consisting of one pill per dose when multiple attributes of HAART regimens were considered simultaneously. This seems to be in large part again, because patients seem to prefer low pill count over QD dosing as the most important attribute,¡¨ said Dr. Stone. Further, the survey found that QD regimens requiring more than two pills per day were less favorably rated than a BID regimen requiring a total of two pills per day.

The main findings related to dosing simplicity derived from the survey were:

  • Total number of pills per day. Patients rated fewer pills higher and the fewest number of pills evaluated two the highest.
  • Dosing frequency. Taking medication less often was rated higher by patients. Taking all drugs once a day at the same time was rated the highest.
  • Adverse events. Although the differences in adverse events (AEs) among the regimens studied was not large, AEs ranked third in importance relative to other treatment characteristics considered in the survey. "This reinforces the importance of discussing potential side effects with patients, and taking steps to prevent them or manage them aggressively should they occur," Dr. Stone said.
  • Dietary restrictions. The requirement that pills be taken on an empty stomach was viewed as a greater barrier to adherence than other dietary restrictions, according to survey responses. Having no food restrictions or requirements was rated the highest.
  • Number of prescriptions/copays. Patients rated fewer number of prescriptions/co-pays higher, with one prescription filled monthly with one co-pay being rated the highest.

In addition to assessing the relative impact on anticipated adherence of dosing characteristics, the survey participants also evaluated seven triple-HAART regimens frequently prescribed for patients with HIV, including three regimens comprising QD medications. The regimens were evaluated individually, and also in head-to-head paired comparisons in which each of the seven regimens was compared with every other regimen, for a total of 21 comparisons. Information about the specific attributes of each regimen, and pictures and symbols were used to indicate features such as food requirements, pill size, number of pills and adverse event profiles.

Neither the brand nor the generic names of the medications were mentioned and identifying markers were obscured. The data collected in the survey are not necessarily representative of all HIV+ individuals. The survey population included 299 HIV+ patients ranging in age from 17 to 72 (median 43), 76 percent of whom were males. African Americans comprised approximately 45 percent of participants, Caucasians 38 percent, Hispanics 15 percent and Asian and other ethnic groups made up the remainder. The survey was conducted in six U.S. cities with a high proportion of citizens infected with HIV (Seattle, San Francisco, Miami, New York City, Atlanta and Washington, D.C.).

All individuals who participated in the survey were treatment-experienced with the majority having been on HAART regimens for four years or more. Of 295 patients who responded to a question on their current level of adherence, 26 percent reported no doses missed in the past three months. Another 32 percent said they had missed 1 or 2 doses; 24 percent said 3 to 5, 8 percent said 6 to 8, and 10 percent said 9 or more.

Elaine Salewske | EurekAlert!
Further information:
http://www.pcipr.com/

More articles from Health and Medicine:

nachricht Millions through license revenues
27.04.2017 | Rheinische Friedrich-Wilhelms-Universität Bonn

nachricht New High-Performance Center Translational Medical Engineering
26.04.2017 | Fraunhofer ITEM

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Making lightweight construction suitable for series production

More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.

Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...

Im Focus: Wonder material? Novel nanotube structure strengthens thin films for flexible electronics

Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.

"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Fighting drug resistant tuberculosis – InfectoGnostics meets MYCO-NET² partners in Peru

28.04.2017 | Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

 
Latest News

Wireless power can drive tiny electronic devices in the GI tract

28.04.2017 | Medical Engineering

Ice cave in Transylvania yields window into region's past

28.04.2017 | Earth Sciences

Nose2Brain – Better Therapy for Multiple Sclerosis

28.04.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>