# Attitudes and Barriers Toward Antiretroviral Therapeutic Drug Monitoring Among Infectious Disease Providers

## TL;DR

This study explores how healthcare providers view therapeutic drug monitoring for HIV treatment and identifies barriers to its use, such as lack of evidence and guidelines.

## Contribution

The study provides insights into providers' attitudes and the main barriers preventing the adoption of TDM in HIV treatment.

## Key findings

- Most providers have positive attitudes toward TDM and believe it can improve drug efficacy and adherence.
- Over 90% of providers feel there is insufficient evidence to support TDM's effectiveness in HIV treatment.
- Lack of clinical guidelines is a major barrier to implementing TDM.

## 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. Materials and 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 Disease 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 five-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% were 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 will positively impact improving drug efficacy and medication adherence. The results revealed barriers to implementing TDM, including a lack of evidence supporting TDM’s impact on HIV outcomes, and the absence of clinical guidelines. The results indicated that >90% were ambivalent or agreed that there was not enough evidence to support the use of TDM, and nearly all recognized that the guidelines do not endorse it or did not know if they do not endorse it. Conclusions: This study highlighted positive attitudes and significant barriers to implementing therapeutic drug monitoring, including a lack of evidence supporting TDM’s impact on HIV outcomes and the absence of clinical guidelines supporting TDM’s 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.