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One Pill, Once a Day: Simplified Treatment Regimens and Retention in HIV Care.

Authors:
Jacob Bor Sheryl A Kluberg Michael P LaValley Denise Evans Kamban Hirasen Mhairi Maskew Lawrence Long Matthew P Fox

Am J Epidemiol 2022 Jan 27. Epub 2022 Jan 27.

Department of Epidemiology, Boston University School of Public Health, Boston, MA USA.

Simplified drug regimens may improve retention in care for chronic diseases. In April 2013, South Africa adopted a once-daily single-pill HIV treatment regimen as standard-of-care, replacing a multiple-pill regimen. Because the regimens had similar biological efficacy, the shift to single-pill therapy offers a real-world test of the impact of simplified drug delivery mechanisms on patient behavior. Using a quasi-experimental regression discontinuity design, we assessed retention in care among patients starting HIV treatment just before and just after the guideline change. The study included 4484 patients starting treatment at a large public sector clinic in Johannesburg, South Africa. The share of patients prescribed a single-pill regimen increased by over 40 percentage points between March and April 2013. Initiating after the policy change was associated with 11.7 percentage points higher retention at 12 months (95% CI: -2.2, 29.4). Findings were robust to different measures of retention, different bandwidths, and different statistical models. Patients starting treatment early in HIV infection - a key population in the test-and-treat era - experienced the greatest improvements in retention from single-pill regimens.

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http://dx.doi.org/10.1093/aje/kwac006DOI Listing
January 2022

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