HIV treatment prescribing in London
Antiretroviral prescribing guidance issued in London in 2011 has not lead to poorer outcomes, has maintained patient satisfaction levels, and has saved over £7 million, it was reported at the annual conference of the British HIV Association (BHIVA).
Approximately a fifth of the entire London NHS drugs budget is spent on anti-HIV drugs every year. In an effort to reduce costs, new prescribing guidelines were issued in 2011 to HIV clinics in the capital.
The prescribing guidance stated that people starting HIV treatment should, where appropriate, be prescribed a combination of the NNRTI efavirenz (Sustiva) with Kivexa (3TC and abacavir).
The guidance recommended that people who were currently taking a protease inhibitor should be reviewed to see if they could switch to the protease inhibitor ritonavir-boosted atazanavir (Reyataz).
The guidance was controversial when it was released, as there was concern that people would be put on to less effective combinations or made to change drugs against their wishes. However, it is consistent with treatment guidelines from BHIVA.
Importantly, doctors should still consider individual people’s circumstances when selecting drugs. For instance, abacavir should be avoided for patients with a higher risk of cardiovascular disease.
Research presented at the BHIVA conference shows that the combinations recommended in the prescribing guidance are as effective in reducing viral load as other combinations recommended in the BHIVA guidelines.
The research also showed that doctors were explaining the guidance to their patients, and that the vast majority of people were happy with their care.
A total of £7.2 million has been saved since the prescribing guidance was introduced.
Adherence among African people in the UK
Adherence is one of the most important factors to the success of your HIV treatment. The best outcomes are seen in people who take all or nearly all of their doses at the right time and in the correct way.
But not everyone achieves such high levels of adherence. It’s important to understand why this is the case so the right support can be provided.
Researchers interviewed 52 black African or Caribbean people receiving HIV care in London about their treatment adherence.
Reasons for not taking treatment included:
- Associating taking HIV treatment with side-effects and being ill.
- HIV treatment being a constant reminder of their HIV status.
- A concern that taking treatment would cause unwanted disclosure of HIV status, leading to stigma and social rejection. This was probably the most important cause of people not adhering to their treatment.
For a few people, religious beliefs were a factor. Belief in the healing power of God, rather than the effects of antiretroviral medications, was cited as a reason for not taking treatment.
However, religious beliefs were not necessarily associated with poor adherence. Other people saw their HIV treatment as a gift from God, and that taking treatment was an individual responsibility in order to enact God’s will.
Other research published at the conference showed a small number of people were rejecting HIV therapy, relying on faith-based healing. This had catastrophic consequences, leading to the development of potentially life-threatening, AIDS-defining illnesses and even death.
Infant feeding
With the exception of one person, all the women reported that they had only used formula and had not breastfed. However, they felt it had been at some cost. They reported having to overcome a number of barriers in order to formula feed.
These included:
- A concern that formula feeding would disclose their HIV status, leading to stigma and social rejection.
- An expectation from friends, family and other members of their community that they would breastfeed their baby
- Concern that the use of formula wasn’t as good for their babies as breast milk (a message that’s often given to new mothers – they had heard the ‘breast is best’ message targeted at the general population).
- Missing out on the bonding that breastfeeding can achieve.
- The high cost of formula.
Knowing that they were protecting their babies from infection with HIV motivated the women to use formula. Support from the baby’s father was also helpful, as was the provision of free formula and feeding equipment.
Other research highlighted confusion among people about the risk of HIV transmission associated with breastfeeding. Much of the information found on the internet on this topic is about countries where formula feeding is not considered safe (because of the lack of clean water, for example). This is not the case in the UK.
Other news from BHIVA
The 19th Annual Conference of the British HIV Association (BHIVA) was held in Manchester, last week.
- An analysis of health and wellbeing boards, new NHS local planning bodies, has shown that in areas of high HIV prevalence in England, half the local authorities have not made HIV a public health priority.
- Research presented at the conference suggests that injection of image- and performance-enhancing drugs is rising in England and Wales – and that men may be acquiring bloodborne viruses, including HIV and hepatitis, through this route.
Read more about these stories in NAM's news reporting from the BHIVA conference.
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