1570. Exploring Antiretroviral Therapy (ART) Switch Decisions in Clinical Setting: Trio Health Mixed Methods Study
Authors: Elion Rick A , Dunbar Megan , Amico K Rivet , Gruber Joshua , Harrison Lauren , McComsey Grace A , Shalit Peter , Radtchenko Janna 
Published: November 2023

Abstract

Background
This study describes clinical decisions on switching to B/F/TAF or DTG/3TC.

Methods
Sequential explanatory design was used in this mixed methods study. Retrospective EMR analysis of Trio HIV Network data characterized people living with HIV (PWH) ≥18 yrs prescribed B/F/TAF or DTG/3TC (4/2019-6/2022). Informed by retrospective analyses, interviews among selected clinicians were summarized through thematic analyses. Qualitative responses were then quantified to describe regimen choice.

Results
In EMR analysis, of 6996 eligible PWH, 84% were prescribed B/F/TAF, 16% DTG/3TC. B/F/TAF prescription was associated with HIV clinical parameters (detectable viral load [VL], CD4&lt; 200 cells/μL) and substance use, while prescribing DTG/3TC was associated with renal toxicity and obesity.
In qualitative analysis, 27 clinicians (44% MDs, 33% NPs, 22% PAs) participated in interviews. Factors influencing regimen switch endorsed by ≥50% of providers included resistance, HBV coinfection, eGFR, PWH views, VL, mental health, and weight [Figure 1]; only 22% felt CD4 count was relevant in decisions to switch.
Over 89% of providers reported B/F/TAF or DTG/3TC switch discussions were related to development/anticipation of new symptoms or comorbidities. All providers had patient-initiated switch discussions motivated by individual concerns, advertisements, or social influences [Table 1].
In differential choice analysis, PWH were more likely to be prescribed B/F/TAF if they were viremic, had HBV co-infection, inconsistent clinic attendance, non-adherence, or substance use; providers were more likely to prescribe DTG/3TC when there were concerns about weight or eGFR &lt; 30 [Table 2].Figure 1.Factors influencing switch to either B/F/TAF or DTG/3TC regimen.Table 1.Themes in decisions to consider a switch to B/F/TAF or DTG/3TC.Table 2.Differential choice based on individual profile.

Conclusion
This mixed methods approach highlights discordance between beliefs and evidence in clinical decision making. CD4 count was not a consideration for ≥75% of providers in interviews, although CD4 &lt; 200 cells/μL was significantly associated with prescribing B/F/TAF in EMR analysis. Provider beliefs surrounding B/F/TAF and DTG/3TC suggested general preferences for B/F/TAF for a broader population, including those with possible adherence challenges, substance use, or resistance, while DTG/3TC was preferred when weight gain or eGFR was a concern.

Disclosures
Rick A. Elion, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Proteus: Grant/Research Support|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support Megan Dunbar, PhD, Gilead: Employment Joshua Gruber, PhD, Gilead Sciences, Inc: Employee|Gilead Sciences, Inc: Stocks/Bonds Grace A. McComsey, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Janssen: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support Peter Shalit, MD, PhD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support Janna Radtchenko, MBA, Trio Health: Employee