Antiretroviral Medication Taking Behavior among HIV-Infected Patients in the US and India

Background: Adherence to antiretroviral therapy (ART) is a key factor to improve overall health, quality of life and survival among HIV infected patients. Optimum adherence and persistence to ART during the early months after initiation of antiretroviral therapy (ART) is crucial to ensure long-term immuno-virological success. Methods: We conducted retrospective cohort studies using IQVIA LRx™ de-identified patient-level longitudinal prescription database (2011-2016) to estimate the incidence and factors associated with adherence to ART (N=27,216) and to compare rate of discontinuation of ART between patients prescribed different initial ART regimens (N=52,494) among treatment naïve patients in the US. We conducted a systematic review and meta-analysis using electronic databases to estimate pooled prevalence of ART adherence among adult HIV-infected patients in India (29 studies, N=11,298). Results: Overall, 42.9% were optimally adherent to ART. In multivariable analysis, adherence was significantly lower among patients prescribed protease inhibitor (PI) based regimens, women, blacks, Hispanics and patients in low income communities. In a subset analysis, there were stronger association between pill burden and adherence among patients on integrase strand transfer inhibitor (INSTI) based regimens, in comparison to those on non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimens. There was a higher expected hazard of ART discontinuation among patients prescribed NNRTI-based single-tablet regimen (STR) compared to patients in INSTI-based STR. The overall pooled proportion of patients’ adherent to ART in India was 78% (95% CI, 73-82%, I2, 96.85%, p<0.01). Studies with percent of female participants below median had a significantly lower pooled prevalence of ART adherence than the studies with percent female participants above the median. Conclusion: The analyses using the nationally representative prescription fills database showed that while the incidence of adherence is low among treatment naïve HIV-infected adults in the US, adherence and persistence to ART are affected by the characteristics of the initial regimen. Future research should focus on using prescription fill databases in real time to identify patients at risk of being nonadherent or discontinuing ART and to study interventions targeting those patients to improve adherence and minimize risk of discontinuation of ART. Research should be conducted in India to identify and address the factors that drive the gender disparities on ART adherence.