Enhancing HIV Care Continuity: Impact on Treatment Adherence

Between January 1, 2018, and November 1, 2021, a total of 139,085 people living with HIV (PLHIV) began antiretroviral therapy (ART). Among them, 36.2% met the criteria for multimonth dispensing (MMD) eligibility at 6 months and were included in subsequent analyses. Within 18 months of starting ART, 26% of individuals disengaged from treatment. Despite all being eligible for MMD, 19% did not receive it; within this group, 55% disengaged from treatment at 18 months, compared with 19% of those who received MMD.¹

The study's results are being reported at this week’s AIDS 2024, the 25th International AIDS Conference, in Munich, Germany, underscore significant rates of treatment disengagement, emphasizing the ongoing need to develop new strategies for improving retention in care. By focusing exclusively on individuals eligible for MMD researchers minimized potential selection biases.¹

This retrospective cohort study focused on individuals eligible for MMD and individuals aged 15 years and older who initiated ART between January 2018 and November 2021, meeting stringent criteria 6 months after starting treatment. Data from 372 health facilities in Tanzania's Kagera and Geita Regions revealed that receiving multi-month ART refills within the first 18 months significantly reduced disengagement from care, underscoring its potential as a strategy to enhance treatment retention among PLHIV.¹

This method ensured that any advantages linked with MMD were accurately attributed, rather than mistakenly to differences in ART adherence histories. Importantly, the study identified a marked decrease in treatment disengagement at the 18-month milestone among recipients of MMD, indicating the potential of this approach in bolstering treatment retention rates.¹

Addressing HIV Drug Resistance Concerns

According to the WHO, the emergence of acquired resistance to antiretroviral drugs poses a growing concern, particularly among individuals with extensive prior treatment histories. This resistance underscores the need for comprehensive surveys to assess its prevalence and patterns, along with identifying the clinical factors associated with its development.²

Resistance linked to PrEP, is generally low among individuals acquiring HIV while using these medications. The risk significantly rises if PrEP is initiated during undiagnosed acute HIV infection, highlighting the importance of timely diagnosis and regimen adjustments.²

Effective antiretroviral therapies generally achieve sustained viral suppression in a majority of adherent patients. Although, vigilance in preventing and monitoring HIV drug resistance remains crucial, especially as treatment programs scale up globally.²

For more information on retention challenges, HIV experts address issues by offering insights into switching therapies for patients with a history of resistance, highlighting methods to simplify and optimize treatment. ³

References
1. A Hazlett, J Kadota, R Ghosh, et. al. Association between multi-month ART dispensing and retention in care among people living with HIV in Tanzania. Presented at International AIDS Conference 2024. July 22-26, 2024. Munich, Germany. Poster 11987.
2. WHO. HIV drug resistance. Published May 21, 2024. Accessed July 25, 2024. https://www.who.int/news-room/fact-sheets/detail/hiv-drug-resistance 
3. Sax P, Applin S, Segal-Maurer S, Pitts L. Switching Therapies for Patients with HIV and History of Resistance. Published June 21, 2024. Accessed July 25, 2024. https://www.contagionlive.com/view/switching-therapies-for-patients-with-hiv-and-history-of-resistance