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 Finding new clues to brain cancer treatment
21.02.2020 | Case Western Reserve University

nachricht UIC researchers find unique organ-specific signature profiles for blood vessel cells
18.02.2020 | University of Illinois at Chicago

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: High-pressure scientists in Bayreuth discover promising material for information technology

Researchers at the University of Bayreuth have discovered an unusual material: When cooled down to two degrees Celsius, its crystal structure and electronic properties change abruptly and significantly. In this new state, the distances between iron atoms can be tailored with the help of light beams. This opens up intriguing possibilities for application in the field of information technology. The scientists have presented their discovery in the journal "Angewandte Chemie - International Edition". The new findings are the result of close cooperation with partnering facilities in Augsburg, Dresden, Hamburg, and Moscow.

The material is an unusual form of iron oxide with the formula Fe₅O₆. The researchers produced it at a pressure of 15 gigapascals in a high-pressure laboratory...

Im Focus: From China to the South Pole: Joining forces to solve the neutrino mass puzzle

Study by Mainz physicists indicates that the next generation of neutrino experiments may well find the answer to one of the most pressing issues in neutrino physics

Among the most exciting challenges in modern physics is the identification of the neutrino mass ordering. Physicists from the Cluster of Excellence PRISMA+ at...

Im Focus: Therapies without drugs

Fraunhofer researchers are investigating the potential of microimplants to stimulate nerve cells and treat chronic conditions like asthma, diabetes, or Parkinson’s disease. Find out what makes this form of treatment so appealing and which challenges the researchers still have to master.

A study by the Robert Koch Institute has found that one in four women will suffer from weak bladders at some point in their lives. Treatments of this condition...

Im Focus: A step towards controlling spin-dependent petahertz electronics by material defects

The operational speed of semiconductors in various electronic and optoelectronic devices is limited to several gigahertz (a billion oscillations per second). This constrains the upper limit of the operational speed of computing. Now researchers from the Max Planck Institute for the Structure and Dynamics of Matter in Hamburg, Germany, and the Indian Institute of Technology in Bombay have explained how these processes can be sped up through the use of light waves and defected solid materials.

Light waves perform several hundred trillion oscillations per second. Hence, it is natural to envision employing light oscillations to drive the electronic...

Im Focus: Freiburg researcher investigate the origins of surface texture

Most natural and artificial surfaces are rough: metals and even glasses that appear smooth to the naked eye can look like jagged mountain ranges under the microscope. There is currently no uniform theory about the origin of this roughness despite it being observed on all scales, from the atomic to the tectonic. Scientists suspect that the rough surface is formed by irreversible plastic deformation that occurs in many processes of mechanical machining of components such as milling.

Prof. Dr. Lars Pastewka from the Simulation group at the Department of Microsystems Engineering at the University of Freiburg and his team have simulated such...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

70th Lindau Nobel Laureate Meeting: Around 70 Laureates set to meet with young scientists from approx. 100 countries

12.02.2020 | Event News

11th Advanced Battery Power Conference, March 24-25, 2020 in Münster/Germany

16.01.2020 | Event News

Laser Colloquium Hydrogen LKH2: fast and reliable fuel cell manufacturing

15.01.2020 | Event News

 
Latest News

Turbomachine expander offers efficient, safe strategy for heating, cooling

25.02.2020 | Power and Electrical Engineering

The seismicity of Mars

25.02.2020 | Earth Sciences

Cancer cachexia: Extracellular ligand helps to prevent muscle loss

25.02.2020 | Life Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>