Attitudes and Barriers Toward Antiretroviral Therapeutic Drug Monitoring Among Infectious Disease Providers
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background/Objectives: Effective HIV treatment and prevention rely heavily on patient adherence to the prescribed regimen. Therapeutic drug monitoring (TDM), which involves measuring medication concentrations in blood circulation, offers an objective method to evaluate toxic or ineffective drug levels. TDM is not routinely used in HIV treatment in clinical practice. Therefore, the purpose of this study is to survey infectious disease providers' attitudes and barriers toward therapeutic drug monitoring for antiretroviral therapy in people living with HIV. Methods: A 15-item online survey was distributed to infectious disease providers in the Greater Houston Area, including physicians, pharmacists, and mid-level practitioners involved in HIV patient care. The survey was disseminated via the Houston Citywide Infectious Diseases Provider Network and the Houston AIDS Education and Training Center. The survey employed close-ended questions to evaluate providers' attitudes, perceptions, practices, and barriers toward antiretroviral drug level monitoring. Responses were recorded using a 5-point Likert scale. Demographic characteristics and information regarding research involvement were collected to contextualize the findings. The survey results were analyzed using descriptive statistics, with categorical variables expressed as frequencies and percentages using SAS software. Results: A total of 139 responses were received, with 89 participants meeting the inclusion criteria; the majority were female (62.9%), nearly half were aged 34 or younger (53.4%), 50% physicians and 36.3% pharmacists, and most worked in hospitals (52.3%) or clinics (35.2%). The findings demonstrate participants' predominantly positive attitudes toward TDM. Nearly 70% agree (agree or strongly agree) that TDM will be helpful and positively impact improving drug efficacy and medication adherence. The results revealed sbarriers to implementing TDM, lack of evidence supporting TDM's impact on HIV outcomes, and the absence of clinical guidelines. With <10% disagreed, the results indicated that >90% were ambivalent or agreed that there wasn't enough evidence to support use of TDM and nearly all recognize that the guidelines do not endorse it or don't know if they don't endorse it. Conclusions: The study highlighted positive attitudes and significant barriers to implementing therapeutic drug monitoring, including lack of evidence supporting TDM's impact on HIV outcomes and the absence of clinical guidelines supporting TDM widespread use. The findings emphasize the need for clinical trials and longitudinal studies to establish definitive evidence on the effectiveness of TDM in improving HIV treatment outcomes.
Source: Medicina
Authors: Hongmei Wang, Cecilia M. Torres, Thomas P. Giordano, Bich N. Dang, Dong Liang
Institutions: Texas Southern University, Baylor College of Medicine
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,654
OpenAlex ID: W4408660642