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Abstract

Purpose: This study investigates how antiretroviral (ARV) tablet size affects medication adherence, particularly in individuals with dysphagia, pediatric populations, and the elderly. It highlights the role of tablet size in influencing adherence and its broader impact on virological control, drug resistance, and HIV-related morbidity.


Research Method: This research employed a constructivist paradigm, conducting a scoping literature review to explore existing studies. Systematic inclusion and exclusion criteria were applied to select relevant sources. Thematic analysis identified key patterns and refined central themes to ensure analytical consistency regarding ARV tablet size and associated adherence barriers.


Results and Discussion: The review reveals that smaller tablets, particularly in dolutegravir-based regimens, significantly enhance adherence by reducing the physical difficulty of swallowing. However, the visibility of medication continues to contribute to stigma, potentially undermining adherence. Emerging innovations, such as mini-tablets, nanotechnology, and long-acting injectables, show promise; however, their cost and limited availability hinder widespread adoption in low-resource settings.


Implications: The findings suggest a need for patient-centred ARV formulations that reduce stigma and improve access. Policymakers and pharmaceutical stakeholders are encouraged to develop smaller, affordable ARV options to support better adherence and long-term treatment success.

Keywords

adherence tablet size hiv treatment antiretroviral therapy medication burden stigma drug formulation long-acting injectables

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How to Cite
Willie, M. M. (2025). Addressing the Stigma and Size of Antiretroviral (ARV) Tablets: A Call for Innovation. Advances in Healthcare Research, 3(2), 69–79. https://doi.org/10.60079/ahr.v3i2.477
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References

  1. Arksey, H., & O'Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19-32. https://doi.org/10.1080/1364557032000119616
  2. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.
  3. Champion, V. L., & Skinner, C. S. (2008). The health belief model. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research, and practice (4th ed., pp. 189-193). Jossey-Bass.
  4. Clotet, B., Feinberg, J., van Lunzen, J., et al. (2014). ING114915 Study Team. Once-daily dolutegravir vs darunavir plus ritonavir in antiretroviral-naive adults with HIV-1 infection (FLAMINGO): 48-week results from the randomised open-label phase 3b study. The Lancet, 383(9936), 2222–2231. https://doi.org/10.1016/S0140-6736(14)60084-2
  5. Cohen, A., Seedat, J., & Sawasawa, C. (2023). Dysphagia and pill swallowing in HIV/AIDS in South Africa: Results of a scoping review. The South African Journal of Communication Disorders, 70(1), 955. https://doi.org/10.4102/sajcd.v70i1.955
  6. Cresswell, F. V., & Lamorde, M. (2022). Implementation of long-acting antiretroviral therapy in low-income and middle-income countries. Current Opinion in HIV & AIDS, 17(3), 127-134. https://doi.org/10.1097/COH.0000000000000732
  7. Creswell , J. W., & Plano Clark, V. L. (2018). Designing and conducting mixed methods research (3rd ed.). SAGE Publications.
  8. Earnshaw, V. A., & Chaudoir, S. R. (2009). From conceptualising to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS and Behavior, 13(6), 1160. https://doi.org/10.1007/s10461-009-9593-3
  9. Günthard, H. F., Saag, M. S., Benson, C. A., Eron, J. J., Gallant, J. E., Hoy, J. F., Mugavero, M. J., Sax, P. E., Thompson, M. A., Gandhi, R. T., Landovitz, R. J., Smith, D. M., Jacobsen, D. M., & Volberding, P. A. (2016). Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2016 recommendations of the International Antiviral Society–USA Panel. JAMA, 316(2), 191. https://doi.org/10.1001/jama.2016.8900
  10. Hayakawa, Y., Uchida, S., & Namiki, N. (2015). Evaluation of the ease of taking mini-tablets compared with other tablet formulations in healthy volunteers. European Journal of Pharmaceutical Sciences, 84, 1-6. https://doi.org/10.1016/j.ejps.2015.12.029
  11. Hejduk, A., & Lulek, J. (2022). Dispensing of minitablets – Has the problem been resolved? International Journal of Pharmaceutics, 619, 121666. https://doi.org/10.1016/j.ijpharm.2022.121666
  12. Home Guides. (2024). Introduction to ART: Antiretroviral drugs: Illustrated pill chart. Retriever from https://i-base.info/guides/starting/arvs
  13. Hummler, H., Stillhart, C., Meilicke, L., Grimm, M., Krause, E., Mannaa, M., Gollasch, M., Weitschies, W., & Page, S. (2023). Impact of tablet size and shape on the swallowability in older adults. Pharmaceutics, 15(4), 1042. https://doi.org/10.3390/pharmaceutics15041042
  14. Jaiswal, J., Francis, M., Singer, S., Dunlap, K., Cox, A., & Greene, R. (2020). "Worn out": Coping strategies for managing antiretroviral treatment fatigue among urban people of color living with HIV who were recently disengaged from outpatient HIV care. Journal of HIV/AIDS & Social Services, 19(2), 173. https://doi.org/10.1080/15381501.2020.1767749
  15. Luthuli, M. Q., & John-Langba, J. (2024). Interaction of social support and depressive symptoms on antiretroviral therapy adherence among people living with HIV in South Africa. Health SA Gesondheid, 29(0), a2271. https://doi.org/10.4102/hsag.v29i0.2271
  16. Madiba, S., & Josiah, U. (2019). Perceived stigma and fear of unintended disclosure are barriers in medication adherence in adolescents with perinatal HIV in Botswana: A qualitative study. BioMed Research International, 2019, 9623159. https://doi.org/10.1155/2019/9623159
  17. Martinez, J., Harper, G., Carleton, R. A., Hosek, S., Bojan, K., Glum, G., Ellen, J., & Trials Network, A. M. (2012). The impact of stigma on medication adherence among HIV-positive adolescent and young adult females and the moderating effects of coping and satisfaction with health care. AIDS Patient Care and STDs, 26(2), 108. https://doi.org/10.1089/apc.2011.0178
  18. Mate, K. K., Engler, K., Lessard, D., & Lebouché, B. (2023). Barriers to adherence to antiretroviral therapy: Identifying priority areas for people with HIV and healthcare professionals. International Journal of STD & AIDS, 34(10), 677. https://doi.org/10.1177/09564624231169329
  19. Mellins, C. A., Havens, J. F., McDonnell, C., Lichtenstein, C., Uldall, K., Chesney, M., Santamaria, E. K., & Bell, J. (2009). Adherence to antiretroviral medications and medical care in HIV-infected adults diagnosed with mental and substance abuse disorders. AIDS Care, 21(2), 168. https://doi.org/10.1080/09540120802001705
  20. Mitzel, L. D., Vanable, P. A., & Carey, M. P. (2018). HIV-related stigmatisation and medication adherence: Indirect effects of disclosure concerns and depression. Stigma and Health, 4(3), 282. https://doi.org/10.1037/sah0000144
  21. Nachega, J. B., Hislop, M., Nguyen, H., Dowdy, D. W., Chaisson, R. E., Regensberg, L., Cotton, M., & Maartens, G. (2009). Antiretroviral therapy adherence, virologic and immunologic outcomes in adolescents compared with adults in Southern Africa. Journal of Acquired Immune Deficiency Syndromes (1999), 51(1), 65. https://doi.org/10.1097/QAI.0b013e318199072e
  22. Naeem, M., Ozuem, W., Howell, K., & Ranfagni, S. (2023). A step-by-step process of thematic analysis to develop a conceptual model in qualitative research. International Journal of Qualitative Methods. https://doi.org/10.1177_16094069231205789
  23. Oguntibeju, O. O. (2012). Quality of life of people living with HIV and AIDS and antiretroviral therapy. HIV/AIDS (Auckland, N.Z.), 4, 117–124. https://doi.org/10.2147/HIV.S32321
  24. Okoli, C., Castellanos, E., Allan, B., Young, B., Brough, G., Muchenje, M., Eremin, A., Corbelli, G. M., McBritton, M., & Hardy, W. D. (2020). Physical, emotional, and psychosocial challenges associated with daily dosing of HIV medications and their impact on indicators of quality of life: Findings from the Positive Perspectives Study. AIDS and Behavior, 25(3), 961. https://doi.org/10.1007/s10461-020-03055-1
  25. Perger, T., Davtyan, M., Foster, C., Evangeli, M., Berman, C., Kacanek, D., Puga, A. M., Sekidde, S., & Bhopal, S. (2025). Impact of HIV-related stigma on antiretroviral therapy adherence, engagement and retention in HIV care, and transition to adult HIV care in pediatric and young adult populations living with HIV: A literature review. AIDS and Behavior, 29(2), 497-516. https://doi.org/10.1007/s10461-024-04534-5
  26. Priyanka, Kumar, K., Teotia, D., & Teotia, D. (2018). A comprehensive review on pharmaceutical mini tablets. Journal of Drug Delivery and Therapeutics, 8(6), 382-390. https://doi.org/10.22270/jddt.v8i6.2060
  27. Rodés, B., Cadiñanos, J., Esteban-Cantos, A., Rodríguez-Centeno, J., & Arribas, J. R. (2022). Ageing with HIV: Challenges and biomarkers. EBioMedicine, 77, 103896. https://doi.org/10.1016/j.ebiom.2022.103896
  28. Rodríguez-Pombo, L., Awad, A., Basit, A. W., Alvarez-Lorenzo, C., & Goyanes, A. (2022). Innovations in chewable formulations: The novelty and applications of 3D printing in drug product design. Pharmaceutics, 14(8), 1732. https://doi.org/10.3390/pharmaceutics14081732
  29. Rosenstock, I. M. (1974). The Health Belief Model and Preventive Health Behavior. Health Education Monographs. https://doi.org/10.1177/109019817400200405
  30. Salleh, N. M., Richardson, L., Kerr, T., Shoveller, J., Montaner, J., Kamarulzaman, A., & Milloy, J. (2018). A longitudinal analysis of daily pill burden and likelihood of optimal adherence to antiretroviral therapy among people living with HIV who use drugs. Journal of Addiction Medicine, 12(4), 308. https://doi.org/10.1097/ADM.0000000000000403
  31. SeyedAlinaghi, S., Afsahi, A. M., Moradi, A., Parmoon, Z., Habibi, P., Mirzapour, P., Dashti, M., Ghasemzadeh, A., Karimi, E., Sanaati, F., Hamedi, Z., Molla, A., Mehraeen, E., & Dadras, O. (2023). Current ART, determinants for virologic failure and implications for HIV drug resistance: An umbrella review. AIDS Research and Therapy, 20, 74. https://doi.org/10.1186/s12981-023-00572-6
  32. Shailesh, K., & Vaishali, L. (2020). Review on: Alternatives to large dosage forms for ease of swallowing. Journal of Drug Delivery Science and Technology, 57, 101712. https://doi.org/10.1016/j.jddst.2020.101712
  33. Slama, L., Porcher, R., Linard, F., Chakvetadze, C., Cros, A., Carillon, S., Gallardo, L., Viard, P., & Molina, M. (2023). Injectable long-acting antiretroviral for HIV treatment and prevention: Perspectives of potential users. BMC Infectious Diseases, 23, 98. https://doi.org/10.1186/s12879-023-08071-9
  34. Sweeney, S. M., Mitzel, L. D., & Vanable, P. A. (2015). Impact of HIV-related stigma on medication adherence among persons living with HIV. Current Opinion in Psychology, 5, 96-100. https://doi.org/10.1016/j.copsyc.2015.06.002
  35. Thornhill, J., & Orkin, C. (2021). Long-acting injectable HIV therapies: The next frontier. Current Opinion in Infectious Diseases, 34(1), 8-15. https://doi.org/10.1097/QCO.0000000000000701
  36. Tseng, A., Seet, J., & Phillips, E. J. (2015). The evolution of three decades of antiretroviral therapy: Challenges, triumphs, and the promise of the future. British Journal of Clinical Pharmacology, 79(2), 182. https://doi.org/10.1111/bcp.12403
  37. Walmsley, S. L., Antela, A., Clumeck, N., et al. (2013). Dolutegravir plus abacavir-lamivudine for the treatment of HIV-1 infection. New England Journal of Medicine, 369(19), 1807–1818. https://doi.org/10.1056/NEJMoa1215541