Do people with HIV really have the choice between oral and injectable ART?: evidence from a multicentric survey in the Swiss HIV cohort study

INTRODUCTION:

 Injectable long-acting antiretroviral therapy (iLA-ART) offers a valuable alternative to oral ART (oART). While the efficacy of these treatment strategies is similar, adequate information on their specific characteristics is essential to enable people with HIV (PWH) to decide which option best suits their values and preferences.

METHODS: 

We conducted a multicentric survey of PWH on oART in the Swiss HIV Cohort Study (SHCS). Using a questionnaire co-developed with expert patients, we assessed participants' (1) values and preferences on characteristics of modern oART and treatment satisfaction, (2) knowledge about iLA-ART with cabotegravir/rilpivirine, (3) reasons influencing their interest to switch or not to iLA-ART and (4) perceived burden of treatment (BOT) taking oART. Outcomes were rated on an 11-point (0-10) Likert scale. We explored outcomes' determinants using multivariate analyses.

RESULTS:

 A total of 200 PWH on oART participated (response rate 87%), with a median age of 52 years (Interquartile Range 45-59), 58 (29%) were women, and 90 (45%) were men who have sex with men. Treatment satisfaction was very high (mean 9.3, Standard Deviation [SD] 1.3) and perceived BOT on oART was low (mean 2.5, SD 2.0). The two most valued oART characteristics were effectiveness (mean 9.9, SD 0.3) and absence of side effects (mean 9.5, SD 1.7). Overall, 76 (39%) participants had never heard about iLA-ART, with large differences between the 3 participating centres (60% vs. 3% vs. 50%). In multivariable analysis, women (Odds Ratio 0.35, 95% confidence interval [CI] 0.14-0.85) and PWH ≥60 years (0.27, 0.08-0.94) were less aware about iLA-ART. Reasons influencing PWH's potential interest to switch to iLA-ART varied individually, while the main reason for preferring to stay on oART was the bimonthly dosing interval of iLA-ART.

CONCLUSION:

 In Switzerland, over one-third of PWH were unaware of iLA-ART despite its reimbursed availability. The provider of care appears to be the main driver of these findings, while women and older individuals showed the lowest awareness. As ART characteristics are valued individually, providing systematic information on available treatment options and engaging PWH in shared decision-making could help address identified disparities and empower them to choose the treatment that best aligns with their preferences.