Preference for Non-Daily ART is Associated with Perceived Extent of ART-related Emotional, Psychosocial, Physical, and Adherence Challenges among People Living with HIV in the Netherlands and Other European Countries

Introduction Daily antiretroviral treatment (ART) can be challenging for some people living with HIV (PLHIV). Longacting injectable regimens (LAR) allow for non-daily dosing. We explored unmet needs associated with daily ART dosing and examined PLHIV’s preference for LAR in the Netherlands, a country that has made enormous strides in improving HIV care; and 11 other European countries. Methods Data were from the second wave of the Positive Perspectives survey of PLHIV on ART conducted in 2019 (Europe-wide, n=969 including Netherlands, n=51). Within four domains of ART-related challenges (emotional, psychosocial/stigma, physical, adherence), we used multivariable logistic regression to examine the relationship between the extent of unmet needs (tertiles) and LAR preference (p<0.05). Results In pooled Europe-wide analysis, within each domain of unmet need, LAR preference increased with an increasing number of challenges. By the extent of ART-related emotional challenges, LAR preference odds were 1.76 (95% CI: 1.45–2.13) among those with a ‘moderate’ burden, and 4.05 (95% CI: 3.26–5.03) among those with a ‘high’ burden, compared to those with a ‘low’ burden. For anticipated stigma, LAR preference odds were 1.50 (95% CI: 1.11–2.04) for moderate and 2.33 (95% CI: 1.68–3.21) for high versus low. For adherence barriers, LAR preference odds were 1.53 (95% CI: 1.14–2.04) and 2.06 (95% CI: 1.45–2.91) among those with moderate and high levels of adherence barriers, respectively, compared to low. LAR preference odds were 1.71 (95% CI: 1.25–2.34) higher among PLHIV with 2+ non-HIV comorbidities versus HIV only, and 1.57 (95% CI: 1.12–2.34) higher among those on 2+ co-medications versus on ART exclusively. Of Dutch participants, 58.8% (30/51) indicated LAR preference, and 32.2% ranked LAR as the single most important ART improvement. Regarding daily oral ART dosing, 11.8% (6/51) of Dutch participants felt that it limited their daily life; 3.9% (2/51) were stressed by it, and 35.3% (18/51) said that it reminded them of HIV. Furthermore, 23.5% (12/51) hid/disguised their HIV medication to prevent unwanted disclosure of their HIV status. Also, 13.7% (7/51) reported adherence anxiety, 37.2% (19/51) missed ART 1+ times during the past month, and 13.7% (7/51) had difficulty swallowing pills. Conclusions PLHIV’s preference for LAR can be for a variety of reasons other than clinical indications. LAR preference was associated with different domains of unmet needs, including emotional, psychosocial, physical, and adherencerelated challenges.