title: Switching from a two-tablet regimen of tenofovir/emtricitabine and efavirenz to a one-tablet regimen may affect patients' perceptions and drug management.
abstract: OBJECTIVE
  Simplification of antiretroviral therapy enhances a patient's adherence but a new formulation could also lead to new adverse events and changes in daily routine. This study compared medication adherence, tolerance and satisfaction among subjects switching from a two-tablet tenofovir/emtricitabine/efavirenz regimen to a one-tablet regimen.
  
  
  METHODS
  Clinical and sociodemographic data were collected and three surveys were administered at month 0 (=switch), and then 1 and 4-6 months after the switch: the Beliefs about Medicines Questionnaire, the HIV-symptom index questionnaire, the Short HIV Treatment Satisfaction Questionnaire, the Swiss HIV Cohort Study (SHCS) two-item adherence questionnaire, and a questionnaire on daily combination antiretroviral therapy (cART) management. Medication adherence of a subgroup of subjects was routinely monitored using an electronic device (MEMS(™) ).
  
  
  RESULTS
  Eighty-eight subjects gave informed consent to participate in the study. The subjects' back-switch rate was 7% (six of 88). Subjects who did not back-switch preferred the one-tablet regimen (median = 2; IQR = 1.3-2.5; on a -3 to 3 scale), but no change in adherence was found (10 of 46 nonadherent subjects; P = 1.00). The perception of treatment necessity score decreased (P = 0.004), the efavirenz blood level increased (14%; P = 0.04), and association/dissociation of cART with food intake evolved (P = 0.01) after the switch. Subjects listed equivalent numbers of symptoms during the three visits.
  
  
  CONCLUSIONS
  The one-tablet regimen was preferred but the number of back-switches was not negligible. The perception of treatment necessity score decreased with the simplification of the regimen from a two-tablet to a one-tablet formulation, which could negatively impact adherence. Switching is a sensitive time in a patient's treatment life and professionals should pay particular attention to patient's perceptions of treatment during such a transition.
authors.affiliation: Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.|Commuity Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Rotzinger
authors.affiliation: Institute for Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: I
authors.initials: I
authors.lastname: Locatelli
authors.affiliation: Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.|Commuity Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: O
authors.initials: O
authors.lastname: Bugnon
authors.affiliation: Division of Clinical Pharmacology, Service of Biomedicine, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Fayet Mello
authors.affiliation: Department of Biostatistics and Clinical Research, Côte de Nacre University Hospital Center, Caen, France.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Parienti
authors.affiliation: Infectious Disease Service, CHUV, University of Lausanne, Lausanne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Cavassini
authors.affiliation: Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.|Commuity Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: M P
authors.initials: MP
authors.lastname: Schneider
mesh_terms: D000328:Adult; D000480:Alkynes; D048588:Benzoxazines / Q000008:administration & dosage* / Q000627:therapeutic use; D015331:Cohort Studies; D003521:Cyclopropanes; D004334:Drug Administration Schedule; D004338:Drug Combinations; D000068679:Emtricitabine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D013607:Tablets; D000068698:Tenofovir / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; D004338:Drug Combinations; D013607:Tablets; D000068698:Tenofovir; D000068679:Emtricitabine; C098320:efavirenz
keywords: HIV; combination; drug therapy; efavirenz; medication adherence; medication therapy management; patient beliefs; regimen simplification; tenofovir