Researchers Address HIV Treatment Gap Among Underserved Population
By Jonathan Springston, Editor, Relias Media
Although long-acting antiretroviral treatment (LA-ART) is effective against HIV, there are some patients who cannot stick to a strict treatment schedule because of housing trouble, substance use disorders, mental illness, and other problems. However, a group of researchers in California is working to close this gap.
Backed by funding from the National Institutes of Health (NIH), a team from the University of California, San Francisco (UCSF) recruited 133 patients with HIV. These patients did not have to be virally suppressed or be taking daily ART; however, all participants were trying to manage substance use disorders, mental health issues, homelessness, and other social determinants of health challenges.
The median age of the study population was 45 years. Many (88%) identified as cisgender men, and 68% identified as non-white. More than half (58%) reported unstable housing, 38% reported living with a mental illness, 33% reported substance use, and 8% reported experiencing homelessness.
Between June 2021 and November 2022, investigators started participants on LA-ART (57 with untreated or unsuppressed HIV, 76 who were virologically suppressed on oral ART). Researchers reviewed health status biweekly. Pharmacists reminded participants about appointments.
After a median 33 days, 55 of 57 who entered the study as untreated achieved viral suppression. All patients who started virally suppressed remained in such condition.
This is ongoing work, led by Monica Gandhi, MD, MPH, professor of medicine and associate division chief at UCSF and medical director of the Ward 86 HIV clinic at San Francisco General Hospital. Gandhi discussed this work recently at the Conference on Retroviruses and Opportunistic Infections.
“Our patient population does not look like the patient population that got enrolled in the clinical trials to determine the approval criteria for long-acting ART,” Gandhi said in an NIH news release. “It is the role of researchers to help address disparities through intentionally and proactively including diverse groups in our studies, and for this population to have the same successful outcomes as those in the other clinical trials was very important and exciting. We want to have the ability to offer these drugs to patients who stand to benefit the most, including those who face challenges adhering to daily treatment.”
“The most effective treatments are those that fit into the lives of people who need them,” added Joshua A. Gordon, MD, PhD, director of the National Institute of Mental Health, a division of NIH. “These findings show that with the right support, long-acting ART can make it easier for people with HIV who face barriers in adhering to daily oral treatment to keep the virus under control.”
For more on this and related subjects, be sure to read the latest issues of Contraceptive Technology Update, Hospital Infection Control & Prevention, Infectious Disease Alert, and Medical Ethics Advisor.