Financial instability strongly linked to poor ART adherence in young people with HIV

Treatment adherence to antiretrovirals is strongly associated with financial stability for young people with HIV, independent of other factors such as demographics, according to a new paper published in AIDS and Behavior.

This discovery was made by a group of researchers, including corresponding author Marie C. D. Stoner, Ph.D., RTI International, who studied the effects of financial instability in people ages 18 to 29 with an HIV diagnosis taking antiretroviral therapy.

Participants who were classified as nonadherent were significantly more likely to report that they could not get by financially compared with adherent participants (37.3% vs. 13.3%), according to the study. Researchers also found nonadherent participants had greater unmet subsistence needs, including difficulty obtaining food and clothing. Consistent adherence to ART is essential because missed doses can allow the virus to rebound, increase the risk of transmission and contribute to drug resistance.

“Financial instability may contribute to difficulties in maintaining regular clinic appointments, affording transportation and managing competing survival priorities, such as housing and food security,” Stoner and her colleagues write. “In our study, a substantial proportion of participants had experienced homelessness or shelter stays, reinforcing the link between structural vulnerabilities and health disparities.”

Study authors enrolled 201 young people with HIV using data from the intervention for virologic suppression study, 135 of whom lived in California and 66 in Florida.

Of these individuals, 92 reported they could barely get by on the money they had, and 42 said they could not get by at all.

Almost all (99%) of participants were on a form of ART, oral ART being the most common, taken by 89% of patients. This was followed by 10% of patients on a long-acting injectable form of ART.

Nearly three-quarters of participants were adherent to their chosen ART regimen at least 80% of the time, with those on long-acting injectable ART reporting more adherence despite being a smaller group (70% vs. 90%).

Researchers noted that long-acting injectable ART has emerged as a promising alternative to daily oral medication because it reduces the burden of daily pill management. The study found 90% adherence among injectable ART users compared with 69.8% among oral ART users, although investigators cautioned the injectable group was much smaller.

Long-acting injectable ART must be administered by a healthcare provider at least every two months, with some forms only requiring an injection twice a year.

However, this form is often more expensive than ART because it is a newer advancement, and patients who already struggle to make ends meet will likely be unable to afford it.

For example, the list price for Cabenuva, given every two months, is approximately $6,000 per injection for uninsured individuals. Lenacapavir, given twice yearly, carries a list price of $28,218 per year without insurance.

Comparatively, oral, daily generic ART can cost around $100 for a 30-day prescription, with insurance.

The authors said the findings suggest HIV treatment outcomes are closely tied to broader economic and social conditions, not just medication availability alone. They wrote that interventions such as transportation support, housing assistance, food vouchers and financial support programs may help improve adherence among vulnerable young adults with HIV.