A comprehensive evaluation of unmet treatment needs along the HIV care continuum among people living with HIV in Germany and Austria

INTRODUCTION Most people living with HIV (PLHIV) achieve viral suppression with antiretroviral therapy (ART), but may still have unmet needs with their medicine, involvement in care, and with psychological challenges such as stigma.We quantified these obstacles among PLHIV in Germany and Austria. METHODSIn a cross-sectional analysis, adult PLHIV from Germany (G) and Austria (A) who participated in the Positive Perspectives Survey -a multi-country, web-based study of self-reported needs and experiences -were evaluated.Wave 1 (PP1, 2016-2017; Germany: n=140, Austria: n=50) and Wave 2 (PP2, 2019-2020; Germany: n=120, Austria: n=50) data were analyzed using descriptive and multivariable techniques (p<0.05).RESULTS There were perceived unmet needs within the HIV care continuum.ART concerns included the belief among participants that taking HIV medicines daily, constantly reminded them of their HIV status (G 52%, A 66%), brought back sad memories (G 37%, A 28%), and raised the likelihood of unwanted disclosure (G 41%, A 34%).Numerous PLHIV exhibited inadequate treatment literacy, information asymmetry with their healthcare provider (HCP), limited treatment involvement, and low self-efficacy communicating treatment issues with their HCPs.Although most PP2 participants understood their HIV treatment (G 62% vs A 84%; p=0.004) and indicated that their HCP gave them sufficient information to make decisions (G 65% vs A 84%; p=0.028), still, 31% of participants in Germany and 50% in Austria were uninformed of the number of medications in their ART regimen.Many stated a desire to use non-daily HIV treatments with a longer duration of action (G 46%, A 52%) and the majority (G 68%, A 72%) indicated their provider regularly discusses new treatment choices.In a multivariable analysis of PP2 participants from Germany and Austria combined (n=170), those reporting that their HCP prioritizes their health issues were more likely to report good overall health (adjusted prevalence ratio, APR=2.58;95% CI: 2.45-2.72)and treatment satisfaction (APR=2.40;95% CI: 2.29-2.52)compared to those who did not.CONCLUSIONS In self-reported surveys, PLHIV encountered psychological and emotional issues.Enhanced ART delivery flexibility and choice may improve PLHIV's health-related outcomes.