Patient Preference and Adherence (Jul 2017)
Evaluating patient preference and satisfaction for human immunodeficiency virus therapy in France
Abstract
Sylvie Brégigeon-Ronot,1 Antoine Cheret,2,3 André Cabié,4 Thierry Prazuck,5 Alain Volny-Anne,6 Shehzad Ali,7 Catherine Bottomley,7 Laurent Finkielsztejn,8 Caroline Philippe,9 Jean-Jacques Parienti10–12 1Clinical Immunohematology Department, Marseille Public University Hospital System (AP-HM), Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, 2Department of Infectious Diseases, Guy-Chatilliez Hospital, Tourcoing, 3Internal Medicine Department, Paris Public University Hospital System (AP-HP), Bicêtre University Hospital Center, EA 7327, University Paris Descartes, Paris, 4Infectious and Tropical Diseases Department, French National Institute of Health and Medical Research (INSERM), CIC 1424, Martinique University Hospital Center, Fort De France, Martinique, 5Infectious Diseases Department, Orleans Regional Hospital Center, Orléans, 6Patient, Paris, France; 7ICON, Contract Research Organization, Patient Reported Outcomes Department, Oxford, United Kingdom; 8ViiV Healthcare, Medical affairs, Marly le Roi, 9Qualees, Contract Research Organization, Epidemilogy Department, Paris, 10Infectious Diseases Department, Caen University Hospital Center, 11Biostatistics and Clinical Research Unit, Caen University Hospital Center, 12EA2656 Microbial Adaptation Research Group (GRAM 2.0), Caen Normandy University, Caen, France Objectives: The objectives were 1) to elicit relative preferences for attributes of antiretroviral therapies (ART) in people living with HIV (PLWH) and 2) to explore satisfaction and adherence with current ART.Patients and methods: We conducted a multicenter cross-sectional study, consecutively enrolling PLWH receiving an ART. The quantitative part estimated the strength of preference for different attributes using an online discrete choice experiment (DCE). DCE data were analyzed using a mixed logit regression model. Qualitative data were collected through individual interviews. A preliminary coding framework was developed which was then further refined and applied during thematic analysis of factors influencing satisfaction and adherence.Results: A total of 101 PLWH took part in the quantitative part and 31 in the qualitative part. Over 90% had an undetectable viral load. Quantitative data revealed a strong preference for a treatment with limited drug–drug interactions, diarrhea and long-term health problems (P<0.0001), and that did not need to be taken on an empty stomach (P<0.0001). Patients also preferred to avoid problems associated with treatment failure (P<0.0001) or one that left them with a higher viral load after the first weeks of treatment (P=0.044). Differences in CD4 cell count, and pills that must be taken with food were not significant drivers of treatment choice. The strength of these attributes was reflected in the qualitative data, highlighting the importance patients place on treatment efficacy, and also suggesting that some of these attributes may impact adherence. Many factors influencing adherence and satisfaction with treatment were identified, including pill size, worry about sexual transmission and impact on social life.Conclusion: Most of the attributes included in this survey were important to participants when choosing an ART, in particular those related to quality of life, and these should be taken into account in order to optimize adherence and satisfaction. Keywords: antiretroviral therapy, adherence, HIV infection, preference elicitation, satisfaction, ARV treatments
