O28 ‘Is less good?’: experiences on dual-drug antiretroviral treatment (ART) regimens among people living with HIV (PLWH) (the PEDAL Study)

Introduction The PEDAL Study is a qualitative study exploring patients’ experiences and perceptions on the safety, effectiveness, and tolerability of two-drug (2DR) and triple-drug regimens (3DR), particularly targeting the 2DR dolutegravir/lamivudine. Methods A purposive sample of 118 adults on ART (see Table) participated in online and in-person cultural domain analysis sessions whereby participants were interviewed and shared positive and negative aspects regarding their treatments. Thematic analysis was used to analyse the data. Results Emerging themes include: • Safety: maintaining a low viral level, the absence of drug-drug interactions, and the existence of research on treatment efficacy. Some felt unsafe taking generic instead of branded drugs. • Tolerability of ART: physical aspects of the tablets (size, colour), food restrictions, and side effects. • Effectiveness: relating to HIV remaining ‘untransmittable’ and participants’ general wellbeing. Treatments were considered ineffective in the presence of side effects or of a detectable virus. Many participants were unaware of the number of the ART components, possibly suggesting that their priority was to reduce the number of tablets taken each day. Benefits participants on dolutegravir/lamivudine stated included less side effects, lower toxicity, reduced organ impact, and research demonstrating safety and effectiveness. Participants on 3DRs expressed concerns regarding switching to 2DRs due to fears around effectiveness and safety. Discussion LWH perceive ART safety, tolerability, and effectiveness as their priority in ensuring their wellbeing. Although benefits and concerns of 2DRs were discussed, patients were often unaware of exactly how many components were in their regimens. Accessible resources could improve knowledge and approval of 2DRs.