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Gray A, Ward MK, Fernandez SB, Nawfal ES, Gwanzura T, Li T, Sheehan DM, Jean-Gilles M, Beach MC, Ladner RA, Trepka MJ. Exploring the use of self-management strategies for antiretroviral therapy adherence among women with HIV in the Miami-Dade County Ryan White Program. J Behav Med 2024; 47:282-294. [PMID: 37946027 PMCID: PMC10947905 DOI: 10.1007/s10865-023-00459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Women with HIV (WWH) face increased difficulties maintaining adherence to antiretroviral therapy (ART) due to a variety of demographic and psychosocial factors. To navigate the complexities of ART regimens, use of strategies to maintain adherence is recommended. Research in this area, however, has largely focused on adherence interventions, and few studies have examined self-reported preferences for adherence strategies. The purpose and objectives of this study were to explore the use of ART self-management strategies among a diverse sample of WWH, examine demographic and psychosocial differences in strategy use, and assess the association between strategies and ART adherence. The current study presents secondary data of 560 WWH enrolled in the Miami-Dade County Ryan White Program. Participants responded to questionnaire items assessing demographic and psychosocial characteristics, use of adherence strategies, and ART adherence during the past month. Principal component analysis identified four categories among the individual strategies and multivariable binomial logistic regression assessed adherence while controlling for individual-level factors. The majority of WWH reported optimal ART adherence, and nearly all used multiple individual strategies. The number of individual strategies used and preferences for strategy types were associated with various demographic and psychosocial characteristics. Adjusting for demographic and psychosocial characteristics, optimal ART adherence during the past month was associated with the use of four or more individual strategies. When conducting regular assessments of adherence, it may be beneficial to also assess use of adherence strategies and to discuss with WWH how using multiple strategies contributes to better adherence.
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Affiliation(s)
- Aaliyah Gray
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA.
| | - Melissa K Ward
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Sofia B Fernandez
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- School of Social Work, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Ekpereka S Nawfal
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Tendai Gwanzura
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Tan Li
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Department of Biostatistics, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Diana M Sheehan
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Mary Catherine Beach
- Berman Institute of Bioethics, Johns Hopkins University, 2024 East Monument Street, Room 2-511, Baltimore, MD, 21287, USA
| | - Robert A Ladner
- Behavioral Science Research Corporation, 2121 Ponce de Leon Boulevard, Suite 240, Coral Gables, FL, 33134, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
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Dubé K, Perez-Brumer A, Patel H, Zhou C, Dee L, Graham G, Meanley S, Philbin MM. "This Is Actually a Really Unique Moment in Time": Navigating Long-Acting HIV Treatment and HIV Cure Research with Analytical Treatment Interruptions-A Qualitative Interview Study in the United States. AIDS Res Hum Retroviruses 2024. [PMID: 38386494 DOI: 10.1089/aid.2023.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Advancements in long-acting (LA) HIV treatment and cure research with analytical treatment interruptions (ATIs) have generated important scientific and implementation questions. There is an urgent need to examine challenges navigating the evolving HIV treatment and cure research landscape. From August to October 2022, we conducted 26 semistructured interviews with biomedical researchers and community members representing a predominantly woman demographic to explore the complexity of navigating the rapidly evolving HIV therapeutic and HIV cure research landscape. We purposively sampled individuals recruited from the AIDS Clinical Trials Group and the Martin Delaney Collaboratories for HIV Cure Research. Audio files were transcribed verbatim and analyzed through a thematic approach, using an inductive and iterative process. Among 26 participants, 10 were biomedical researchers and 16 community members, including 11 were people with HIV. Three main themes emerged: (1) We are at a pivotal moment in the evolving landscape of HIV therapeutics and LA HIV treatment and HIV cure research should not be siloed but considered together; (2) There are challenges with engagement in HIV cure research and in switching between oral daily antiretroviral treatment and LA formulations and, mainly, the prolonged pharmacokinetic tail of these compounds matched with limited patient education about their impacts; and (3) There are unique opportunities as a result of this evolving therapeutic landscape, including the key role of decision support for people with HIV, centering around patient autonomy, and the need to learn from the lived experiences of people with HIV who choose LA treatment and/or participation in HIV cure research. Despite a bias toward the woman gender, our study identifies key considerations for navigating concurrent LA HIV treatment and HIV cure research with ATIs from both community members and biomedical researchers' perspectives. Achieving optimal HIV control remains a formidable challenge, necessitating robust interdisciplinary collaborations and engagement with key stakeholders.
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Affiliation(s)
- Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, California, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hursch Patel
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Carina Zhou
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Lynda Dee
- AIDS Action Baltimore, Baltimore, Maryland, USA
| | - Gail Graham
- PATIENTS Program, University of Maryland, College Park, Maryland, USA
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Morgan Mari Philbin
- Division of Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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McCrimmon T, Collins LF, Perez-Brumer A, Bazzi AR, Shaffer VA, Kerrigan D, Alcaide ML, Philbin MM. Long-Acting Injectable Antiretrovirals for HIV Treatment: A Multi-Site Qualitative Study of Clinic-Level Barriers to Implementation in the United States. AIDS Patient Care STDS 2024; 38:61-69. [PMID: 38381949 DOI: 10.1089/apc.2023.0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Long-acting injectable antiretroviral therapy (LAI ART) has the potential to address adherence obstacles associated with daily oral ART, leading to enhanced treatment uptake, adherence, and viral suppression among people living with HIV (PLWH). Yet, its potential may be limited due to ongoing disparities in availability and accessibility. We need a better understanding of the organizational context surrounding the implementation of LAI ART, and to inform its widespread rollout, we conducted 38 in-depth interviews with medical and social service providers who offer HIV care at private and hospital-based clinics across six US cities. Our findings highlight real-world implementation barriers outside of clinical trial settings. Providers described ongoing and anticipated barriers across three stages of LAI ART implementation: (1) Patient enrollment (challenges registering patients and limited insurance coverage), (2) medication delivery (insufficient personnel and resources), and (3) leadership and management (lack of interprofessional coordination and a lack of programming guidelines). Providers described how these barriers would have a disproportionate impact on under-resourced clinics, potentially exacerbating existing disparities in LAI ART access and adherence. Our findings suggest strategies that clinic leadership, policymakers, and other stakeholders can pursue to promote rapid and equitable LAI ART implementation in clinics across the United States. Resource and staffing investments could support clinics to begin, sustain, and scale up LAI ART delivery; additionally, the establishment of guidelines and tools could facilitate wider adoption of LAI ART across clinical settings. These efforts are crucial to promote resourced, standardized, and equitable implementation of LAI ART and maximize its potential to help end the HIV epidemic.
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Affiliation(s)
- Tara McCrimmon
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Lauren F Collins
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Angela R Bazzi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Victoria A Shaffer
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Maria L Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Morgan M Philbin
- Division of Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Sciannameo S, Zalazar V, Spadaccini L, Duarte M, Cahn P, Aristegui I, Sued O. Preference for long-acting injectable for ART and PrEP among people with and without HIV: a cross-sectional study in Argentina. Ther Adv Infect Dis 2024; 11:20499361241228341. [PMID: 38380160 PMCID: PMC10878205 DOI: 10.1177/20499361241228341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/09/2024] [Indexed: 02/22/2024] Open
Abstract
Background Little is known about the preferences for antiretroviral therapy (ART) administration methods, such as oral daily pills or long-acting injectable (LAI) options, as well as preferences for pre-exposure prophylaxis (PrEP) administration methods among people without HIV in Latin America. Objectives This study aimed to assess the preferences for ART administration methods among people with HIV and PrEP methods among those without HIV, as well as to examine the correlations and reasons for these preferences. Design We conducted a cross-sectional web-based questionnaire between April and July 2021, using social media accounts of a HIV non-governmental organization. The questionnaire was open to all adults living in Argentina, irrespective of their sexual orientation or gender identity. Methods The questionnaire included questions on substance use, depression, chronic treatment, previous experiences with injectable medication, and HIV status. Those with HIV answered questions about ART adherence and their preferences for ART methods, while those without HIV were asked about condom use, awareness of PrEP, and their preferences for PrEP methods. Results Out of 1676 respondents, 804 had HIV, and 872 did not. Among those with HIV, 91.5% expressed a high preference for LAI-ART, with significantly higher preferences among participants with higher educational levels, cisgender gay, bisexual, and queer men, younger individuals, and those with prior injectable medication experience. Among those without HIV, 68% preferred LAI-PrEP, and this preference was positively associated with previous positive experiences with injectable medication. Conclusion The strong preference for LAI-ART suggests the potential for improved adherence and well-being among people with HIV. Additionally, the preference for LAI-PrEP among those without HIV emphasizes the importance of considering this option for HIV prevention strategies. This study highlights the need to offer diverse methods for ART and prevention to accommodate different preferences and improve health care outcomes in Latin America.
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Affiliation(s)
| | - Virginia Zalazar
- Fundación Huésped, Pasaje Carlos Gianantonio 3932, Buenos Aires C1202AB, Argentina
| | | | - Mariana Duarte
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Pedro Cahn
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Ines Aristegui
- Research Department, Fundación Huésped, Buenos Aires, Argentina
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Wang W, Zhao S, Wu Y, Duan W, Li S, Li Z, Guo C, Wang W, Zhang T, Wu H, Huang X. Safety and Efficacy of Long-Acting Injectable Agents for HIV-1: Systematic Review and Meta-Analysis. JMIR Public Health Surveill 2023; 9:e46767. [PMID: 37498645 PMCID: PMC10415942 DOI: 10.2196/46767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/13/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND HIV-1 infection continues to affect global health. Although antiretrovirals can reduce the viral load or prevent HIV-1 infection, current drugs require daily oral use with a high adherence level. Long-acting antiretrovirals (LA-ARVs) significantly improve medication adherence and are essential for HIV-1 prophylaxis and therapy. OBJECTIVE This study aimed to investigate the safety and efficacy of long-acting cabotegravir (CAB-LA) and long-acting rilpivirine (RPV-LA) in the prevention and treatment of HIV-1 infection. METHODS PubMed, Embase, and the Cochrane Library were searched for studies from database inception to November 12, 2022. We included studies that reported efficacy and safety data on LA-ARV intervention in people living with HIV and excluded reviews, animal studies, and articles with missing or duplicate data. Virological suppression was defined as plasma viral load <50 copies/mL 6 months after antiviral therapy initiation. We extracted outcomes for analysis and expressed dichotomous data as risk ratios (RRs) and continuous data as mean differences. Depending on the heterogeneity assessment, a fixed- or random-effects model was used for data synthesis. We performed subgroup analyses of the partial safety and efficacy outcomes of CAB-LA+RPV-LA. The protocol was registered with the Open Science Framework. RESULTS We included 12 trials comprising 10,957 individuals, of which 7 were prevention trials and 5 were treatment trials. CAB-LA and RPV-LA demonstrated safety profiles comparable with those of the placebo in terms of adverse event-related withdrawal. Moreover, the efficacy data showed that CAB-LA had a better effect on HIV-1 prevention than tenofovir disoproxil fumarate-emtricitabine (17/5161, 0.33% vs 75/5129, 1.46%; RR 0.21, 95% CI 0.07-0.61; I2=70%). Although CAB-LA+RPV-LA had more drug-related adverse events (556/681, 81.6% vs 37/598, 6.2%; RR 12.50, 95% CI 3.98-39.23; I2=85%), a mild or moderate injection site reaction was the most common reaction, and its frequency decreased over time. The efficacy of CAB-LA+RPV-LA was comparable with that of daily oral drugs at 48 and 96 weeks (1302/1424, 91.43% vs 915/993, 92.2%; RR 0.99, 95% CI 0.97-1.02; I2=0%), and a high level of virological suppression of 80.9% (186/230) was maintained even after 5 years of LA-ARV use. Similar efficacy outcomes were observed in both treatment-naive and treatment-experienced patients (849/911, 93.2% vs 615/654, 94%; RR 0.99, 95% CI 0.96-1.02; I2=0%). According to the questionnaires, more than 85% of people living with HIV favored LA-ARVs. CONCLUSIONS LA-ARVs showed favorable safety profiles for both the prevention and treatment of HIV-1 infection and were well tolerated. CAB-LA has more satisfactory efficacy than tenofovir disoproxil fumarate-emtricitabine, significantly reducing the rate of HIV-1 infection. CAB-LA+RPV-LA maintains virological suppression for a long time and may be a viable switching strategy with enhanced public health benefits by reducing transmission. However, further trials are required to confirm the efficacy of these drugs.
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Affiliation(s)
- Wenjing Wang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Shengnan Zhao
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yaxin Wu
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wenshan Duan
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Sibo Li
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zhen Li
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Caiping Guo
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wen Wang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiaojie Huang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
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Elbur AI, Ghebremichael M, Konkle-Parker D, Jones DL, Collins S, Adimora AA, Schneider MF, Cohen MH, Tamraz B, Plankey M, Wilson T, Adedimeji A, Haberer JE, Jacobson DL. Dual trajectories of antiretroviral therapy adherence and polypharmacy in women with HIV in the United States. AIDS Res Ther 2023; 20:29. [PMID: 37179294 PMCID: PMC10182649 DOI: 10.1186/s12981-023-00520-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Polypharmacy, using five or more medications, may increase the risk of nonadherence to prescribed treatment. We aimed to identify the interrelationship between trajectories of adherence to antiretroviral therapy (ART) and polypharmacy. METHODS We included women with HIV (aged ≥ 18) enrolled in the Women's Interagency HIV Study in the United States from 2014 to 2019. We used group-based trajectory modeling (GBTM) to identify trajectories of adherence to ART and polypharmacy and the dual GBTM to identify the interrelationship between adherence and polypharmacy. RESULTS Overall, 1,538 were eligible (median age of 49 years). GBTM analysis revealed five latent trajectories of adherence with 42% of women grouped in the consistently moderate trajectory. GBTM identified four polypharmacy trajectories with 45% categorized in the consistently low group. CONCLUSIONS The joint model did not reveal any interrelationship between ART adherence and polypharmacy trajectories. Future research should consider examining the interrelationship between both variables using objective measures of adherence.
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Affiliation(s)
| | | | - Deborah Konkle-Parker
- Schools of Nursing, Medicine and Population Health, University of Mississippi Medical Center, Jackson, MS USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL USA
| | - Shelby Collins
- Division of Infectious Disease, Emory University School of Medicine, Atlanta, GA USA
| | - Adaora A. Adimora
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Michael F. Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago, IL USA
| | - Bani Tamraz
- School of Pharmacy, University of California, San Francisco, San Francisco, CA USA
| | - Michael Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC USA
| | - Tracey Wilson
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY USA
| | - Adebola Adedimeji
- Dept of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Jessica E. Haberer
- Center for Global Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Denise L. Jacobson
- Center for Biostatistics in AIDS Research, Department of Biostatistics , Harvard T. H. Chan School of Public Health, Boston, MA USA
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Tross S, Spector AY, Ertl MM, Berg H, Turrigiano E, Hoffman S. A Qualitative Study of Barriers and Facilitators of PrEP Uptake Among Women in Substance Use Treatment and Syringe Service Programs. AIDS Behav 2023; 27:1162-1172. [PMID: 36318430 PMCID: PMC10796210 DOI: 10.1007/s10461-022-03853-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/05/2022]
Abstract
PrEP is an HIV prevention option that could benefit substance-involved women, a high-risk population with low PrEP uptake. Little is known about their interest in PrEP. This qualitative study used in-depth interviews to examine PrEP willingness, barriers, and facilitators among 16 women in outpatient psychosocial substance use treatment, methadone, and/or harm reduction/syringe programs in NYC. All expressed willingness to use PrEP, but only during periods of perceived risk. Women perceived themselves to be at high risk for HIV when engaging in active substance use and/or transactional sex. They perceived themselves to be at low risk and therefore unmotivated to take PrEP when abstinent from these activities. Paradoxically, a major barrier to using PrEP was anticipated interference from substance use and transactional sex, the very same activities that create a perception of risk. Facilitators of PrEP use included perceptions of it as effortless (as opposed to barrier methods during sex) and effective, safe, and accessible. Other barriers included fear of stigma and doubts about adhering daily. Recommendations for best PrEP implementation practices for substance-involved women included tailored and venue-specific PrEP information and messaging, PrEP discussion with trusted medical providers, and on-site PrEP prescription in substance use treatment and harm reduction programs.
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Affiliation(s)
- Susan Tross
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, 722 West 168th Street, 10032, New York, NY, USA.
| | - Anya Y Spector
- Department of Human Services, Stella and Charles Guttman Community College, City University of New York, New York, NY, USA
| | - Melissa M Ertl
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, 722 West 168th Street, 10032, New York, NY, USA
| | - Hayley Berg
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, 722 West 168th Street, 10032, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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Kiyingi J, Nabunya P, Kizito S, Nabayinda J, Nsubuga E, Bahar OS, Jennings Mayo-Wilson L, Namuwonge F, Nattabi J, Magorokosho N, Tozan Y, Witte SS, Ssewamala FM. Self-Reported Adherence to Antiretroviral Therapy (ART) Among Women Engaged in Commercial Sex Work in Southern Uganda. AIDS Behav 2023; 27:1004-1012. [PMID: 36066764 PMCID: PMC9974600 DOI: 10.1007/s10461-022-03837-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/01/2022]
Abstract
We examined the correlates of self-reported adherence to antiretroviral therapy (ART) among women engaged in commercial sex work (WESW) in Uganda. We used baseline data from a longitudinal study, which recruited 542 WESW in Southern Uganda. We used nested regression models to determine the individual and family, and economic level correlates of self-reported adherence. Study findings show that older age (OR = 1.07, 95% CI = 1.013, 1.139), secondary education (OR = 2.01, 95% CI = 1.306, 3.084), large household size (OR = 1.08, 95% CI = 1.020, 1.136), high family cohesion (OR = 1.06, 95% CI = 1.052, 1.065), and high financial self-efficacy (OR = 1.07, 95% CI = 1.006, 1.130) were associated with good self-reported adherence to ART. Married women (OR=-0.39, 95% CI = 0.197, 0.774), depression (OR = 0.85, 95% CI = 0.744, 0.969), alcohol use (OR = 0.72, 95% CI = 0.548, 0.954), ever been arrested (OR = 0.58, 95% CI = 0.341, 0.997), and high household assets ownership (OR = 0.48, 95% CI = 0.313, 0.724) were associated with poor self-reported adherence to ART. Findings suggest a need to adopt a multi-level approach to address gaps in ART adherence among WESW.
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Affiliation(s)
- Joshua Kiyingi
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Samuel Kizito
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Josephine Nabayinda
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Edward Nsubuga
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Larissa Jennings Mayo-Wilson
- University of North Carolina Gillings School of Global Public Health, 170 Rosenau Hall, 27599, Chapel Hill, NC, USA
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - Jennifer Nattabi
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Natasja Magorokosho
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Yesim Tozan
- New York University College of Global Public Health, 14 East 4th street, 3rd floor, 10003, New York, NY, USA
| | - Susan S Witte
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 10027, New York, NY, USA
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA.
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Elbur AI, Ghebremichael M, Konkle-Parker D, Jones DL, Collins S, Adimora AA, Schneider MF, Cohen MH, Tamraz B, Plankey M, Wilson T, Adedimeji A, Haberer JE, Jacobson DL. Dual Trajectories of Antiretroviral Therapy Adherence and Polypharmacy in Women with HIV in the United States. Res Sq 2023:rs.3.rs-2443973. [PMID: 36747684 PMCID: PMC9901001 DOI: 10.21203/rs.3.rs-2443973/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Polypharmacy, using five or more medications, may increase the risk of nonadherence to prescribed treatment. We aimed to identify the interrelationship between trajectories of adherence to antiretroviral therapy (ART) and polypharmacy. Methods We included women with HIV (aged ≥ 18) enrolled in the Women's Interagency HIV Study in the United States from 2014 to 2019. We used group-based trajectory modeling (GBTM) to identify trajectories of adherence to ART and polypharmacy and the dual GBTM to identify the interrelationship between adherence and polypharmacy. Results Overall, 1,538 were eligible (median age of 49 years). GBTM analysis revealed five latent trajectories of adherence with 42% of women grouped in the consistently moderate trajectory. GBTM identified four polypharmacy trajectories with 45% categorized in the consistently low group. Conclusions The joint model did not reveal any interrelationship between ART adherence and polypharmacy trajectories. Future research should consider examining the interrelationship between both variables using objective measures of adherence.
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10
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Jain JP, Sheira LA, Frongillo EA, Neilands TB, Cohen MH, Wilson TE, Chandran A, Adimora AA, Kassaye SG, Sheth AN, Fischl MA, Adedimeji AA, Turan JM, Tien PC, Weiser SD, Conroy AA. Mechanisms linking gender-based violence to worse HIV treatment and care outcomes among women in the United States. AIDS 2022; 36:1861-1869. [PMID: 35950940 PMCID: PMC9529878 DOI: 10.1097/qad.0000000000003329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To test whether substance use mediates the associations between gender-based violence (GBV) and suboptimal adherence to antiretroviral therapy (ART), and GBV and poor engagement in care, among women living with HIV (WLHIV) in the United States (US). DESIGN We analyzed longitudinal data collected among 1717 WLHIV in the Women's Interagency HIV Study (WIHS). METHODS From 2013 to 2017, WLHIV completed semi-annual assessments on GBV, substance use, and HIV treatment and care. Adjusted multilevel logistic regression models were built to estimate the impact of GBV on; suboptimal (<95%) adherence and at least one missed HIV care appointment without rescheduling in the past 6 months. Mediation analyses were performed to test whether heavy drinking and illicit drug use mediated the associations between GBV and the two HIV outcomes. RESULTS The mean age was 47 (standard deviation = 9), 5% reported experiencing GBV, 17% reported suboptimal adherence and 15% reported at least one missed appointment in the past 6 months. Women who experienced GBV had a significantly higher odds of suboptimal adherence [adjusted odds ratio (aOR) = 1.99; 95% confidence interval (CI) = 1.40-2.83] and missed appointments (aOR = 1.92, 95% CI = 1.32-2.33). Heavy drinking and illicit drug use mediated 36 and 73% of the association between GBV and suboptimal adherence and 29 and 65% of the association between GBV and missed appointments, respectively. CONCLUSIONS Substance use is an underlying mechanism through which GBV affects outcomes along the HIV care continuum among WLHIV in the US. To optimize HIV treatment and care among women, interventions should address the combined epidemics of substance use, violence, and HIV.
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Affiliation(s)
| | - Lila A Sheira
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, University of California, San Francisco
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital, Chicago, Illinois
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Health Sciences University, School of Public Health, Brooklyn, New York
| | - Aruna Chandran
- Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Seble G Kassaye
- Department of Family Medicine, Georgetown University Medical Center, Washington, District of Columbia
| | - Anandi N Sheth
- School of Medicine, Emory University, Atlanta, and Grady Health System, Atlanta, Georgia
| | | | - Adebola A Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Janet M Turan
- Department of Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Phyllis C Tien
- Department of Medicine, UCSF and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, California, USA
| | - Sheri D Weiser
- Center for AIDS Prevention Studies, University of California, San Francisco
| | - Amy A Conroy
- Center for AIDS Prevention Studies, University of California, San Francisco
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11
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Leung T, McCrimmon T, Shaffer VA, Kerrigan D, Pereyra M, Cohen MH, Sosanya O, Sheth AN, Adimora AA, Topper EF, Rana A, Tamraz B, Goparaju L, Wilson TE, Alcaide M. A Patient Decision Aid (i.ARTs) to Facilitate Women's Choice Between Oral and Long-Acting Injectable Antiretroviral Treatment for HIV: Protocols for its Development and Randomized Controlled Pilot Trial. JMIR Res Protoc 2022; 11:e35646. [PMID: 36099004 PMCID: PMC9516368 DOI: 10.2196/35646] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/06/2022] [Accepted: 07/30/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Many women with HIV (WWH) have suboptimal adherence to oral antiretroviral therapy (ART) due to multilevel barriers to HIV care access and retention. A long-acting injectable (LAI) version of ART was approved by the US Food and Drug Administration in January 2021 and has the potential to overcome many of these barriers by eliminating the need for daily pill taking. However, it may not be optimal for all WWH. It is critical to develop tools that facilitate patient-provider shared decision making about oral versus LAI ART modalities to promote women's adherence and long-term HIV outcomes. OBJECTIVE This study will develop and pilot test a web-based patient decision aid called i.ART+support (i.ARTs). This decision aid aims to support shared decision making between WWH and their providers, and help women choose between oral and LAI HIV treatment. METHODS The study will occur in 3 phases. In phase 1, we will utilize a mixed methods approach to collect data from WWH and medical and social service providers to inform i.ARTs content. During phase 2, we will conduct focus groups with WWH and providers to refine i.ARTs content and develop the web-based decision aid. In phase 3, i.ARTs will be tested in a randomized controlled trial with 180 women in Miami, Florida, and assessed for feasibility, usability, and acceptability, as well as to evaluate the associations between receiving i.ARTs and viral suppression, ART pharmacy refills, and clinic attendance. RESULTS This study was funded in March 2021. Columbia University's IRB approved the study protocols (approval number IRB-AAAT5314). Protocols for phase 1 interviews have been developed and interviews with service providers started in September 2021. We will apply for Clinicaltrials.gov registration prior to phase 3, which is when our first participant will be enrolled in the randomized controlled trial. This is anticipated to occur in April 2023. CONCLUSIONS This study is the first to develop a web-based patient decision aid to support WWH choices between oral and LAI ART. Its strengths include the incorporation of both patient and provider perspectives, a mixed methods design, and implementation in a real-world clinical setting. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/35646.
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Affiliation(s)
| | - Tara McCrimmon
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Victoria A Shaffer
- Department of Health Sciences, University of Missouri, Columbia, MO, United States
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Margaret Pereyra
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Mardge H Cohen
- Department of Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, IL, United States
| | - Oluwakemi Sosanya
- Department of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Anandi N Sheth
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Adaora A Adimora
- Department of Medicine, Department of Epidemiology, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Elizabeth F Topper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Aadia Rana
- Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Bani Tamraz
- School of Pharmacy, University of California San Francisco, San Francisco, CA, United States
| | - Lakshmi Goparaju
- Department of Medicine, Georgetown University Medical Center, Washington, DC, United States
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York, Downstate Health Sciences University, Brooklyn, NY, United States
| | - Maria Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
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12
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Massaroni V, Delle Donne V, Borghetti A, Ciccullo A, Lombardi F, Giuliano G, Farinacci D, Visconti E, Tamburrini E, Di Giambenedetto S. Use of Long-Acting Therapies for HIV Care in Italy: Are People Living with HIV Prepared for Change? A Cross-Sectional Study. AIDS Patient Care STDS 2022; 36:178-185. [PMID: 35507326 DOI: 10.1089/apc.2022.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Two hundred two people living with HIV (PLWH) selected from outpatients at the Infectious Disease Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS, in Rome (Italy) were consecutively enrolled from May to July 2021. We used an anonymous telephone questionnaire to investigate opinions of PLWH about combined antiretroviral (ARV) therapy and long-acting (LA) formulations of ARVs. All invited participants completed the questionnaire (100%). We found that most PLWH evaluated taking HIV pills for the rest of their life as a continuous, but undemanding commitment (61.4%; n = 124), although they were willing to stop the daily intake of HIV drugs (78.2%, n = 158). Moreover, most PLWH were unaware of the existence of LA therapies at the time of the investigation (60.4%, n = 122). Almost half the PLWH evaluated the need for injections in the hospital as an obstacle (51.4%, n = 104). Regarding the preference between monthly injections and taking pills everyday, most PLWH (68.8%, n = 139) stated that the injection was more advantageous than pills even if they had some pain/swelling at the injection site. The concern about LA therapy indicated most by PLWH was the possible lower efficacy of the drug (83.7%, n = 169). Regarding the possible benefits of LA therapy, those reported most by PLWH were feeling freer because they did not have to remember to take pills everyday (68,8%, n = 139). In conclusion, to date, PLWH in our cohort seem willing to accept LA therapy, but still show some concern about the efficacy of the new therapy and the obligation to come to the hospital to receive it. Thus, clinicians must take into account the needs of their patients and help them overcome their concerns to facilitate the transition to this new therapeutic modality. Clinical Trial Registration Number ID: 2424.
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Affiliation(s)
- Valentina Massaroni
- Department of Safety and Bioethics, Infectious Diseases Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Valentina Delle Donne
- Department of Safety and Bioethics, Infectious Diseases Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Alberto Borghetti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Arturo Ciccullo
- UOC Infectious Diseases, Ospedale San Salvatore, L'Aquila, Italy
| | - Francesca Lombardi
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriele Giuliano
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Damiano Farinacci
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elena Visconti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrica Tamburrini
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simona Di Giambenedetto
- Department of Safety and Bioethics, Infectious Diseases Institute, Catholic University of Sacred Heart, Rome, Italy
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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13
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Philbin MM, Bergen S, Parish C, Kerrigan D, Kinnard EN, Reed S, Cohen MH, Sosanya O, Sheth AN, Adimora AA, Cocohoba J, Goparaju L, Golub ET, Vaughn M, Gutierrez JI, Fischl MA, Alcaide M, Metsch LR. Long-Acting Injectable ART and PrEP Among Women in Six Cities Across the United States: A Qualitative Analysis of Who Would Benefit the Most. AIDS Behav 2022; 26:1260-1269. [PMID: 34648131 DOI: 10.1007/s10461-021-03483-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 12/20/2022]
Abstract
Long-acting injectable (LAI) modalities have been developed for ART and PrEP. Women face unique barriers to LAI use yet little research has examined women's perceptions of potential LAI HIV therapy candidates. We conducted 89 in-depth interviews at six Women's Interagency HIV Study (WIHS) sites with women living with HIV (n = 59) and HIV-negative women (n = 30) from 2017 to 2018. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Participants identified specific sub-populations who could most benefit from LAI over daily pills: (1) young people; (2) women with childcare responsibilities; (3) people with adherence-related psychological distress; (4) individuals with multiple sex partners; and (5) people facing structural insecurities such as homelessness. Women are underserved by current HIV care options and their perspectives are imperative to ensure a successful scale-up of LAI PrEP and LAI ART that prioritizes equitable access and benefit for all individuals.
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Affiliation(s)
- Morgan M Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
- Mailman School of Public Health, 722 West 168th Street, Room 536, MSPH Box 15, New York, NY, 10032, USA.
| | - Sadie Bergen
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Carrigan Parish
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Deanna Kerrigan
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA
| | - Elizabeth N Kinnard
- Division of Epidemiology and Biostatistics, UC Berkeley School of Public Health, Berkeley, CA, USA
| | - Sarah Reed
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mardge H Cohen
- Department of Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, IL, USA
| | | | - Anandi N Sheth
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Adaora A Adimora
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Cocohoba
- Department of Clinical Pharmacy, University of California at San Francisco School of Pharmacy, San Francisco, CA, USA
| | - Lakshmi Goparaju
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael Vaughn
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - José I Gutierrez
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA
| | - Margaret A Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
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Khuroo T, Mohamed EM, Dharani S, Immadi S, Nutan MTH, Lu D, Ali HI, Khan MA, Rahman Z. In-Situ Implant Formulation of Laurate and Myristate Prodrugs of Dolutegravir for Ultra-Long Delivery. J Pharm Sci 2022; 111:2312-2321. [PMID: 35296412 DOI: 10.1016/j.xphs.2022.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 01/23/2023]
Abstract
The focus of present work was to synthesize prodrugs of dolutegravir (DTG) for ultra-long delivery purpose. The prodrug was synthesized by esterification of hydroxyl group with carboxyl group of fatty acid (lauric or myristic acid). The prodrugs were characterized by differential scanning calorimetry, X-ray powder diffraction, nuclear magnetic resonance, Fourier transformed infrared, near infrared-chemical imaging, pH-solubility, partition coefficient, and stability (solid and liquid). Stability studies were performed by exposing the powder drugs to 40°C/75% RH for three months and buffer solutions at room temperature for 72 h. The prodrugs and drug were formulated into in-situ implant using biodegradable polymer. Thermal, spectral, and diffractometric data indicated formation of new chemical and solid forms. Formation of prodrugs resulted in lowering of melting point of DTG from 191.1°C to 163.7 and 140.7°C for DTG-Laurate and DTG-Myristate prodrugs, respectively. A decrease in solubility of 18.2-115.9 and 124.5-1594.9 folds was observed for DTG-Laurate and DTG-Myristate, respectively compared to DTG. Similarly, the prodrugs were highly lipophilic compared to DTG. Solid-state and pH-stability profiles of DTG and prodrugs were comparable. Implant formulation released 60.1% in 77 days compared to 95.6% in 35 days in the case of DTG-Myristate and DTG, respectively. In summary, combining prodrug and drug delivery approaches can be utilized for delivering drug for ultra-long period.
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Affiliation(s)
- Tahir Khuroo
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Texas A&M University, College Station, TX 77843, USA
| | - Eman M Mohamed
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Texas A&M University, College Station, TX 77843, USA; Department of Pharmaceutics, Faculty of Pharmacy, Beni-Suef University, Egypt
| | - Sathish Dharani
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Texas A&M University, College Station, TX 77843, USA
| | - Sujana Immadi
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Texas A&M University, Kingsville, TX 78363, USA
| | - Mohammad T H Nutan
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Texas A&M University, Kingsville, TX 78363, USA
| | - Dai Lu
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Texas A&M University, Kingsville, TX 78363, USA
| | - Hamed I Ali
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Texas A&M University, College Station, TX 77843, USA
| | - Mansoor A Khan
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Texas A&M University, College Station, TX 77843, USA
| | - Ziyaur Rahman
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Texas A&M University, College Station, TX 77843, USA.
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15
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El-Halabi S, Cooper DH, Cha DS, Rosenblat JD, Gill B, Rodrigues NB, Lipsitz O, McIntyre RS, Gill H. The effects of antidepressant medications on antiretroviral treatment adherence in HIV-positive individuals with depression. J Affect Disord 2022; 300:219-225. [PMID: 34952118 DOI: 10.1016/j.jad.2021.12.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 09/05/2021] [Accepted: 12/19/2021] [Indexed: 11/26/2022]
Abstract
Background Extant literature has identified Major Depressive Disorder (MDD) as a comorbid disorder in individuals with seropositive human immunodeficiency disorder (HIV), and this may affect HIV-treatment efficacy. However, there is a paucity of literature evaluating the effects of antidepressant use on antiretroviral therapies (ART) in HIV-positive individuals. Herein, the following review assesses the effects of antidepressant medications on ART adherence in HIV-positive individuals with diagnosed MDD. Methods A systematic search on PubMed, Scopus, Web of Science, and Google Scholar search engines were conducted between database inception to June 12th, 2020 using the search and MeSH terms: (HIV) AND (antiretroviral or treatment) AND (depress*) AND (antidepressants) AND (adherence). Results We identified nine articles that evaluated ART adherence in HIV-positive individuals using antidepressants. Of the nine included articles, eight articles evaluated participants undergoing ART, and one article evaluated participants undergoing highly active antiretroviral therapy (HAART). Our primary findings suggest that patients who took antidepressant treatment for depression demonstrated greater adherence to HIV treatments and a reduction in missed HIV medication dosage. Limitations The heterogeneity of study design between the included studies was high. Conclusion The current review suggests that response to antidepressant medication may improve adherence to HIV treatments in HIV-positive individuals with comorbid depression. Further studies should expand the findings to explore the effects of disparate psychotropic agents on adherence behaviors among patients with HIV to identify the benefits of these agents on long-term health outcomes in this vulnerable clinical population.
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Affiliation(s)
- Sabine El-Halabi
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Daniel H Cooper
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Joshua Daniel Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Barjot Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Nelson B Rodrigues
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Orly Lipsitz
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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Abstract
PURPOSE OF REVIEW This paper provides a critical review of recent therapeutic advances in long-acting (LA) modalities for human immunodeficiency virus (HIV) treatment and prevention. RECENT FINDINGS LA injectable antiretroviral therapy (ART) has been approved in the United States, Canada and Europe; the United States also has approved LA injectable preexposure prophylaxis (PrEP) and the World Health Organization has recommended the vaginal PrEP ring. Current LA PrEP modalities in clinical trials include injections, films, rings, and implants; LA ART modalities in trials include subcutaneous injections and long-term oral pills. Although LA modalities hold incredible promise, global availability is inhibited by long-standing multilevel perils including declining multilateral funding, patent protections and lack of political will. Once available, access and uptake are limited by factors such as insurance coverage, clinic access, labor markets, stigma, and structural racism and sexism. These must be addressed to facilitate equitable access for all. SUMMARY There have been tremendous recent advances in the efficacy of LA ART and PrEP modalities, providing renewed hope that 'ending the HIV epidemic' is within reach. However, pervasive socio-structural inequities limit the promise of LA modalities, highlighting the need for cautious optimism in light of the embedded inequities in the trajectory of research, development, and population-level implementation.
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Affiliation(s)
- Morgan M. Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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17
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Chandiwana NC, Serenata CM, Owen A, Rannard S, Pérez Casas C, Scott C, Hill A, Clayden P, Flexner C. Impact of long-acting therapies on the global HIV epidemic. AIDS 2021; 35:S137-S143. [PMID: 34848580 DOI: 10.1097/qad.0000000000003102] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Long-acting antiretroviral drugs have emerged as exciting treatment and preexposure prophylaxis (PrEP) options for people with HIV and at risk of HIV. Long-acting regimens may improve dosing convenience, tolerability and cost compared with current daily-based oral therapy. They can also circumvent stigma associated with oral therapy for both treatment and PrEP, thereby improving adherence and outcomes. Yet, multiple challenges remain, many specific to low-income and middle-income countries (LMICs), where the epidemic is most concentrated and HIV prevention and treatment options are limited. To optimize the use of long-acting formulations, key outstanding questions must be addressed. Uncertain costing, scale-up manufacturing, complex delivery systems and implementation challenges are potential barriers when considering the scalability of long-acting ARVs for global use.
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Affiliation(s)
- Nomathemba C Chandiwana
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Celicia M Serenata
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Owen
- Department of Molecular and Clinical Pharmacology
| | - Steve Rannard
- Department of Chemistry, Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool, United Kingdom
| | | | | | - Andrew Hill
- Department of Translational Medicine, Liverpool University, Liverpool
| | | | - Charles Flexner
- Divisions of Clinical Pharmacology and Infectious Diseases, School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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18
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Kanazawa JT, Saberi P, Sauceda JA, Dubé K. The LAIs Are Coming! Implementation Science Considerations for Long-Acting Injectable Antiretroviral Therapy in the United States: A Scoping Review. AIDS Res Hum Retroviruses 2021; 37:75-88. [PMID: 33176429 PMCID: PMC8020525 DOI: 10.1089/aid.2020.0126] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Long-acting injectable antiretroviral therapy (LAI-ART) is one of the latest advancements in HIV control with the potential to overcome oral ART barriers to adherence. The objective of this article is to anticipate and examine implementation considerations for LAI-ART using components of the PRISM model, a Practical, Robust Implementation and Sustainability Model for integrating research findings into practice. We conducted a scoping review from January to August 2020 of the growing literature on LAI-ART implementation and other fields using LAI therapies. Key considerations regarding LAI-ART were parsed from the searches and entered into the PRISM implementation science framework. The PRISM framework posed multiple questions for consideration in the development of an optimal implementation strategy for LAI-ART in the United States. These questions revealed the necessity for more data, including acceptability of LAI-ART among many different subgroups of people living with HIV (PLWH), cost effectiveness, patient satisfaction, and patient-reported outcomes, as well as more detailed information related to the external environment for optimal LAI-ART implementation. Ethical considerations of LAI-ART will also need to be considered. The anticipation of, and excitement for, LAI-ART represent the hope for a new direction for HIV treatment that reduces adherence barriers and improves prognoses for PLWH. We have a unique window of opportunity to anticipate implementation considerations for LAI-ART, so this new therapy can be used to its fullest potential. Outstanding questions remain, however, that need to be addressed to help achieve HIV suppression goals in diverse populations.
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Affiliation(s)
- John T. Kanazawa
- Gillings School of Global Public Health, University of North Carolina (UNC) at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Parya Saberi
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - John A. Sauceda
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina (UNC) at Chapel Hill, Chapel Hill, North Carolina, USA
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Philbin MM, Parish C, Bergen S, Kerrigan D, Kinnard EN, Reed SE, Cohen MH, Sosanya O, Sheth AN, Adimora AA, Cocohoba J, Goparaju L, Golub ET, Fischl M, Alcaide ML, Metsch LR. A Qualitative Exploration of Women's Interest in Long-Acting Injectable Antiretroviral Therapy Across Six Cities in the Women's Interagency HIV Study: Intersections with Current and Past Injectable Medication and Substance Use. AIDS Patient Care STDS 2021; 35:23-30. [PMID: 33400587 PMCID: PMC7826427 DOI: 10.1089/apc.2020.0164] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Medications for antiretroviral therapy (ART) and preexposure prophylaxis (PrEP) are currently daily pill regimens, which pose barriers to long-term adherence. Long-acting injectable (LAI) modalities have been developed for ART and PrEP, but minimal LAI-focused research has occurred among women. Thus, little is known about how women's history of injection for medical or nonmedical purposes may influence their interest in LAI. We conducted 89 in-depth interviews at 6 sites (New York, NY; Chicago, IL; San Francisco, CA; Atlanta, GA; Chapel Hill, NC; Washington, DC) of the Women's Interagency HIV study. Interviews occurred with women living with HIV (n = 59) and HIV-negative women (n = 30) from November 2017 to October 2018. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Women's prior experiences with injections occurred primarily through substance use, physical comorbidities, birth control, or flu vaccines. Four primary categories of women emerged; those who (1) received episodic injections and had few LAI-related concerns; (2) required frequent injections and would refuse additional injections; (3) had a history of injection drug use, of whom some feared LAI might trigger a recurrence, while others had few LAI-related concerns; and (4) were currently injecting drugs and had few LAI-related concerns. Most women with a history of injectable medication would prefer LAI, but those with other frequent injections and history of injection drug use might not. Future research needs to address injection-related concerns, and develop patient-centered approaches to help providers best identify which women could benefit from LAI use.
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Affiliation(s)
- Morgan M. Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
- Address correspondence to: Morgan M. Philbin, PhD, MHS, Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
| | - Carrigan Parish
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Sadie Bergen
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, District of Columbia, USA
| | - Elizabeth N. Kinnard
- Division of Epidemiology, UC Berkeley School of Public Health, Berkeley, California, USA
| | - Sarah E. Reed
- Teachers College, Columbia University, New York, New York, USA
| | - Mardge H. Cohen
- Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Oluwakemi Sosanya
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Anandi N. Sheth
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Adaora A. Adimora
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer Cocohoba
- Department of Clinical Pharmacy, University of California at San Francisco School of Pharmacy, San Francisco, California, USA
| | - Lakshmi Goparaju
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Margaret Fischl
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Maria L. Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
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Sang Y, Ding L, Zhuang C, Chen F. Design strategies for long-acting anti-HIV pharmaceuticals. Curr Opin Pharmacol 2020; 54:158-165. [PMID: 33176247 DOI: 10.1016/j.coph.2020.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/27/2022]
Abstract
Current combination antiretroviral therapy (cART) for human immunodeficiency virus (HIV) is limited by the frequent dosing and unfavorable adherence, and the rapid appearance of resistant mutants. Thus, there is a continuous need to improve and optimize the present therapies. The clinical phase III trials of FLAIR and ATLAS, showed two-drug injectable cabotegravir (CAB) and rilpivirine (RPV) formulation is potent, safe, and tolerable in HIV-infected patients. The recent approval of cabenuva (CAB+RPV) by Health Canada is a milestone in the development of long-term therapies for HIV infection. Broadly neutralizing antibodies (bNAbs) with excellent breath and efficiency against HIV have been investigated as LA antiviral weapons. Several modern modalities capable of sustained drug release for long-term treatment and prevention of HIV infection are also in development, such as implants, vaginal rings, and nanotherapies.
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Affiliation(s)
- Yali Sang
- School of Science, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China; Green Pharmaceutical Engineering Research Center, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China
| | - Li Ding
- Engineering Center of Catalysis and Synthesis for Chiral Molecules, Department of Chemistry, Fudan University, Shanghai 200433, China
| | - Chunlin Zhuang
- Engineering Center of Catalysis and Synthesis for Chiral Molecules, Department of Chemistry, Fudan University, Shanghai 200433, China.
| | - Fener Chen
- School of Science, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China; Green Pharmaceutical Engineering Research Center, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China; Engineering Center of Catalysis and Synthesis for Chiral Molecules, Department of Chemistry, Fudan University, Shanghai 200433, China.
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