Quantifying unmet treatment needs among people living with HIV in Australia and other countries

Introduction We examined unmet needs among persons living with HIV (PLHIV) in Australia and compared them with other countries. Methods The 2019 Positive Perspectives web-based survey of PLHIV on antiretroviral therapy (ART) was conducted in 25 countries and included 120 participants from Australia. Descriptive analyses were used to explore treatment-related attitudes and behaviors among participants in Australia versus other countries. Results Despite most Australian participants reporting viral suppression (96.7%; 116/120) and treatment satisfaction (83.3%; 100/120), unmet needs existed, with 35.0% (42/120) reporting suboptimal mental health and 42.5% (51/120) perceiving gaps in their HIV management. Side effects were the most common reason for switching ART among Australian participants who ever switched (54.4%; 56/103) alongside reducing the number of pills (33.0%; 34/103) and medicines (25.2%; 26/103). Australian participants with polypharmacy reported a higher prevalence of being worried about taking more and more medicines with age, than those without polypharmacy [58.1% (36/62) vs 37.7% (22/58), p=0.027]; they were also more open to ART with fewer medicines [91.9% (57/62) vs 77.6% (45/58), p=0.028]. Participants fully informed and involved in treatment planning generally reported better health outcomes than those with less engagement with their providers. For example, within the Australian sample, compared to those neither informed nor involved in care, those fully involved reported significantly higher treatment satisfaction [89.0% (81/91) vs 57.9% (11/19), p=0.032], greater sentiment that their personal needs were met by their provider [94.5% (86/91) vs 52.6% (10/19), p=0.012], and higher optimal overall health [70.3% (64/91) vs 36.8% (7/19), p=0.032]; they were also less likely to report being stressed by their daily dosing schedule [11.0% (10/91) vs 47.4% (9/19), p=0.001]. Australian participants reported the highest percentage (93.3%; 42/45) of those reporting that they discussed with their provider a treatment they wanted, among those indicating they ever wanted a new treatment. Conclusions Holistic care addressing salient treatmentrelated issues, as well as patient preferences and concerns can help improve PLHIV’s health-related quality of life, the fourth ‘90’ target.