Health care provider- and patient-reported outcomes for bictegravir/emtricitabine/tenofovir alafenamide versus other antiretroviral regimens: an observational survey in the United States (July 2021-March 2022).

Abstract

Objective: Given the chronic nature of HIV infection and the evolving treatment landscape, it is important to reexamine the impact of HIV medication choice on adherence, treatment satisfaction, and quality of life (QoL) for people with HIV (PWH). While bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) is commonly prescribed, there are few observational data comparing treatment outcomes with other regimens. This study aimed to compare health care provider (HCP)- and PWH-reported outcomes for individuals prescribed B/F/TAF versus other antiretroviral therapy (ART) regimens.

Methods: Data were from the Adelphi Real World HIV Disease Specific Programme, an observational, cross-sectional survey of HCPs and PWH conducted from July 2021-March 2022 in the United States. PWH were aged ≥18 years with confirmed HIV diagnosis and a current ART prescription. Outcomes included HCP- and PWH-reported adherence, treatment satisfaction, QoL, and health care resource utilization (HCRU). Subgroups were based on ART regimen and treatment experience. Comparisons between subgroups were performed using the t test, chi-square test, Fisher's exact test, and Mann-Whitney test, as appropriate.

Results: Sixty HCPs provided data for 600 PWH, and 249 PWH reported their experiences. Overall, 264 PWH were prescribed B/F/TAF, 281 were prescribed other single-tablet regimens (STRs) or a long-acting injectable (LAI), and 55 were prescribed a multi-tablet regimen. The two most common HCP-reported reasons for choice of ART were viral potency and tolerability. High treatment satisfaction was reported for B/F/TAF by both HCPs (61% "very satisfied" with B/F/TAF vs 53% with other STRs or an LAI; P = 0.0223) and PWH (57% vs 52%, respectively; P = 0.3170). PWH receiving B/F/TAF reported significantly higher QoL scores (PozQoL and EQ-5D-5L) and lower activity impairment versus PWH receiving other STRs or an LAI. Adherence rates and HCRU were generally similar between groups. PWH receiving B/F/TAF as their first ART regimen were significantly more likely to be "completely adherent" according to HCPs (P = 0.0098) and had significantly less testing-related HCRU (P < 0.0001) than treatment-experienced PWH receiving B/F/TAF. PWH who switched to B/F/TAF had less HCP-reported weight gain (P = 0.0266) and had lower testing-related HCRU (P = 0.0498) compared with those who switched to other ART.

Conclusion: Positive HCP- and PWH-reported outcomes were seen across ART regimens. However, differences observed, including HCP-reported treatment satisfaction and PWH-reported QoL, favored B/F/TAF compared with other STRs or an LAI. These findings support continued use of B/F/TAF for HIV treatment in the United States. More patient-focused research with disease-specific outcome measures should be performed to further optimize treatment outcomes for PWH.