1570. Exploring Antiretroviral Therapy (ART) Switch Decisions in Clinical Setting: Trio Health Mixed Methods Study

BACKGROUND: This study describes clinical decisions on switching to B/F/TAF or DTG/3TC. METHODS: Sequential explanatory design was used in this mixed methods study. Retrospective EMR analysis of Trio HIV Network data characterized people living with HIV (PWH) ≥18 yrs prescribed B/F/TAF or DTG/3TC (4/2019-6/2022). Informed by retrospective analyses, interviews among selected clinicians were summarized through thematic analyses. Qualitative responses were then quantified to describe regimen choice. RESULTS: In EMR analysis, of 6996 eligible PWH, 84% were prescribed B/F/TAF, 16% DTG/3TC. B/F/TAF prescription was associated with HIV clinical parameters (detectable viral load [VL], CD4< 200 cells/μL) and substance use, while prescribing DTG/3TC was associated with renal toxicity and obesity. In qualitative analysis, 27 clinicians (44% MDs, 33% NPs, 22% PAs) participated in interviews. Factors influencing regimen switch endorsed by ≥50% of providers included resistance, HBV coinfection, eGFR, PWH views, VL, mental health, and weight [Figure 1]; only 22% felt CD4 count was relevant in decisions to switch. Over 89% of providers reported B/F/TAF or DTG/3TC switch discussions were related to development/anticipation of new symptoms or comorbidities. All providers had patient-initiated switch discussions motivated by individual concerns, advertisements, or social influences [Table 1]. In differential choice analysis, PWH were more likely to be prescribed B/F/TAF if they were viremic, had HBV co-infection, inconsistent clinic attendance, non-adherence, or substance use; providers were more likely to prescribe DTG/3TC when there were concerns about weight or eGFR < 30 [Table 2]. [Figure: see text] [Figure: see text] [Figure: see text] CONCLUSION: This mixed methods approach highlights discordance between beliefs and evidence in clinical decision making. CD4 count was not a consideration for ≥75% of providers in interviews, although CD4 < 200 cells/μL was significantly associated with prescribing B/F/TAF in EMR analysis. Provider beliefs surrounding B/F/TAF and DTG/3TC suggested general preferences for B/F/TAF for a broader population, including those with possible adherence challenges, substance use, or resistance, while DTG/3TC was preferred when weight gain or eGFR was a concern. DISCLOSURES: Rick A. Elion, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Proteus: Grant/Research Support|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support Megan Dunbar, PhD, Gilead: Employment Joshua Gruber, PhD, Gilead Sciences, Inc: Employee|Gilead Sciences, Inc: Stocks/Bonds Grace A. McComsey, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Janssen: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support Peter Shalit, MD, PhD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support Janna Radtchenko, MBA, Trio Health: Employee