Lamivudine (3TC) Plus Dolutegravir (DTG) Dual Therapy: a Study on Patients' Experiences and Perceptions

The investigators propose a three-phase comparative study with a control population (i.e., people living with HIV on other dual therapy regimens and triple ART) and the target population (i.e., people living with HIV on dual DTG/3TC regimen). The control population will include a group on dual regimens other than DTG/3TC and a group on triple therapy. In the control group of patients receiving dual therapies, the investigators will include patients (i) on Juluca (DTG/rilpivirine[RPV]), (ii) on boosted darunavir plus lamivudine (DRV/r or DRV/c + 3TC), and (iii) on boosted darunavir plus raltegravir (DRV/r or DRV/c + RAL). The target population will include patients on DTG/3TC. The addition of the control group of patients on other dual therapies will allow the investigators to tease out the particular characteristics of the dual DTG/3TC beyond the mere reduction of molecules employed for the treatment.

The investigators suggest that a comparative study including the target and control populations will allow to better understand patient perceptions and needs as related to the variables of (i) safety, (ii) effectiveness, (iii) tolerability, and (iv) unmet needs. This is because DTG/3TC will not be experienced and perceived in isolation from the patients' previous drug regimens or from other patients on different drug regimens. When a participant on DTG/3TC describes their experiences and perceptions, they will be making a comparison to a 'time before' or to 'an other'. For example, the investigators anticipate patients to describe current experiences of DTG/3TC effectiveness in comparison to a time they were on another drug regimen or in comparison to a friend/known person on another drug regimen (e.g. 'DTG/3TC is more effective than my previous treatment' or 'DTG/3TC seems to be less tolerable because my friend is on a different regimen and has fewer side-effects'). This supports the need to explore other drug regimens through a control group so that comparisons that arise in the data will have a reference point rooted in the data. In short, if a patient says 'DTG/3TC is safer than my previous treatment' the investigators can understand not only experiences on DTG/3TC, but also how it compares to other treatments.

Additionally, the subjective nature of these variables means that each person will have a different understanding, meaning, perception, and experience of the study variables. ViiV Healthcare, the researchers, and health care providers will have one, or more, ways of defining the variables, but there is added value in exploring what they mean to patients. By widening our participant population to not just include the target population, but to also include the control groups the investigators will gain a more in-depth understanding of what these variables mean to patients. This will ensure conceptual and operational alignment of the variables between patients and researchers.

This study's 'phases' refer to the order in which specific methods will be deployed and findings preliminarily analysed. In Phase I the investigators will deploy Cultural Domain Analysis (CDA), a type of structured interview aimed at understanding how people in a group think about lists of things that somehow go together. CDA will help the investigators to better understand patient unmet needs. After data collection, the investigators will conduct a preliminary analysis to refine and improve our Focus Group Discussion (FGD) questions and approach. In Phase II the investigators will conduct FGDs to gain a deeper knowledge of patient unmet needs and to begin exploring the variables safety, efficacy, and tolerability. The investigators will conduct a preliminary analysis of the FGDs to refine the questions and approach the subsequent In-Depth Interviews (IDI). In Phase III the investigators will conduct IDIs to gain expert knowledge and understanding of the variables safety, efficacy, and tolerability. The investigators will conduct a preliminary analysis of the data. Finally, the investigators will analyse all data sets, prepare journal articles, conference papers, and share findings through public engagement with both the Brighton and Sussex Medical School and the Sussex Beacon.

The investigators will ask the control population to draw on their knowledge of the DTG/3TC regimen, and the target population to share their experiences on DTG/3TC; both in relation to the above-mentioned variables. By asking the control population about the DTG/3TC regimen (as opposed to their current care plan) the investigators will illuminate potential gaps in knowledge and understanding about the DTG/3TC regimen, as well as potential misconceptions among HIV patients in treatment about the 2-drug therapy.