A new study published in the Journal of Acquired Immune Deficiency Syndrome in March showed that most women living with HIV that were interviewed preferred long-acting injectable (LAI) adherence to antiretroviral therapy (ART) over daily pills. LAI ART has completed phase 3 trials and is currently awaiting FDA approval.1

Adherence to ART by patients with HIV is imperative in order to allow for the effective suppression of the virus and a reduction of HIV transmission, but many patients have reported that sustaining long-term adherence can be difficult. For this reason, LAI ART has the potential to transform HIV treatment and prevention for patients.1

However, there has been little research conducted on LAI ART-related behaviors in female patients, particularly outside of clinical trials.1

Due to this lack of knowledge regarding women’s experience with LAI ART, the researchers in this new study explored women's interest in LAI HIV therapy, making it the first study to do so. This study is also one of the first to be a non-clinical trial sample, which means it consists of patients who more accurately represent the population that will be using LAI ART.1

The researchers conducted interviews with 59 women living with HIV who were not included in LAI ART clinical trials, but who receive care at university settings that will administer LAI ART once it is approved by the FDA. The interviews were conducted in 6 Women's Interagency HIV Study (WIHS) sites: New York, Chicago, Washington, DC, Atlanta, Chapel Hill, and San Francisco. The researchers conducted the interviews over a period of 11 months, from November 2017 to October 2018.1

The results of the study showed that more than half of the 59 women interviewed (56%) would choose LAI ACT over daily pills for reasons of convenience, privacy, and perceived efficacy. Of those who reported that they would not prefer LAI ACT, 34% would prefer daily oral pills and 10% would prefer neither.1 

In the United States, approximately one-quarter of people living with HIV are women. Among this population, 89% know their diagnosis, 65% receive care, and 51% are virally suppressed. In previous HIV treatment research, women living with HIV have historically been underrepresented, including in prior trials investigating LAI ACT as a treatment.2

“It is therefore imperative to understand their interest in this new technology, since it has the potential to transform HIV treatment,” said Morgan Philbin, PhD, co-author of the study and assistant professor of sociomedical sciences at Columbia Mailman School, in a press release.2

In the previously conducted ATLAS and FLAIR LAI ART trials, the participants were mostly male, and they reported a high preference (97% in FLAIR, 91% in ATLAS) for LAI ACT over daily oral pills. These participants also reported that the adverse effects, which include fatigue, fever, headache, and nausea, rarely led them to pursue trial discontinuation.2

Although the majority of women in the most recent study also preferred LAI ACT over daily pills, they expressed the presence of significant challenges that participants in the previous studies did not. These challenges included the increased frequency of physicians’ visits (every month for LAI ACT versus every 3 or 4 months with the daily pill) and related transportation barriers, a distrust of new and perceived untested medication, and frustration that LAI would only relieve some of the burden of the daily pill, according to the researchers.1

“Our study demonstrated that women living with HIV are open to long acting injectable antiretroviral therapy, and many believe it will provide distinct benefits over daily pills,” Philbin said in a press release. “However, women also described challenges unique to them as women that would need to be addressed in order to ensure that they fully benefit from these new technologies, including the role of children and childbearing, caregiving responsibilities and long histories of medical mistrust. As a result, we want to highlight the need to incorporate women into the process of LAI ART roll out to ensure their inclusion.”2

REFERENCES
  1. Philbin MM, Parish C, Kinnard EN, et al. A multi-site study of women living with HIV’s perceived barriers to, and interest in, long-acting injectable anti-retroviral therapy. Journal of Acquired Immune Deficiency Syndrome. 2020. doi: 10.1097/QAI.0000000000002337.
  2. Women living with HIV prefer long-acting injectable anti-retroviral therapy over daily pill [news release]. Eurekalert; April 22, 2020. new.eurekalert.org/pub_releases/2020-04/cums-wlw042220.php. Accessed April 24, 2020.