Costs and acceptability of simplified monitoring in HIV-suppressed patients switching to dual therapy: the SIMPL’HIV open-label, factorial randomised controlled trial.  Swiss Medical Weekly
Personalized strategies are crucial to accommodating the diverse needs of people with HIV. These strategies are not limited to antiretroviral treatments (ART) but also include aspects related to consultations. In this study published in Swiss Medical Weekly, Marinosci et al. assessed the impact of simplifying the monitoring of people with HIV on costs and treatment satisfaction within the Swiss HIV Cohort Study.
SIMPL’HIV is a randomized trial with a factorial design, in which participants were randomized 1:1 to standard ART or dual treatment with dolutegravir and emtricitabine, and 1:1 to standard vs. simplified monitoring. In addition to HIV RNA measurements taken at baseline, weeks 6, and 3-monthly thereafter in all participants, individuals in the simplified monitoring arm had CD4 cell counts and other lab tests (e.g. full blood count) at baseline and week 48 only. In addition, these participants were given the possibility to (1) complete some of the visits with a phone call, (2) have their drugs delivered to a specific address, and (3) perform blood tests at the location of their choice (e.g. their general practitioner). The results confirming the efficacy and safety of dolutegravir and emtricitabine have been published previously.
The study included 188 individuals: 95 were randomized into the simplified and 92 into the standard monitoring arm. Overall, 83% were male, the mean age was 48 years, and the majority received an integrase inhibitor-based ART before randomization. Of the individuals in the simplified monitoring arm, 80% chose phone calls as a simplification option, followed by mail drug supply (50%), and laboratory tests at alternative locations (17%). In the 48 months, total healthcare-related costs, including ART, were similar in the patient-centred and the standard monitoring arm (median difference 50$, 95% confidence interval -1021 to 1059). No difference in treatment satisfaction was observed, but the satisfaction was very high in both groups at the end of the study (96.2 and 94 of 100 on a visual analog scale). When comparing ART-related costs, dual therapy with dolutegravir and emtricitabine was substantially cheaper than other guideline-recommended ART (-4643$, 95% CI -5128 to 3160).
In summary, simplified monitoring did not decrease healthcare costs but was associated with a very high level of treatment satisfaction. The present study nicely illustrates that ART remains the main driver of healthcare costs for people with HIV, and simplifying treatments may be the most effective way to decrease treatment-related costs.