AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #266 - The impact of patient and doctor concerns on commencing and changing antiretroviral treatment
Authors: Presenting Author: Dr Jeffrey Grierson - La Trobe University
Additional Authors: Prof. Marian Pitts, Ms. Rachel Koelmeyer,
Aim: Advances in the development of antiretroviral therapies for the management of HIV infection have provided clinicians and patients with many treatment choices. In this study, we investigated the experiences of people living with HIV in commencing and changing antiretroviral therapy from the perspective of their doctors.
Method / Issue: As part of a larger study of treatment decisions, we conducted thirteen structured interviews with medical specialists and general practitioners registered to prescribe antiretroviral medications in Australia. The interviews centred on the antecedents of commencing and changing treatment, what information was discussed, and the critical factors that led to decision making from the clinician’s perspective. We conducted simple thematic analysis to identify key themes in the processes of commencing and changing antiretroviral therapy.
Results / Comments: The interviewees included sexual health specialists, infectious disease specialists and general practitioners; the majority were male. The interviewees worked in primary care, hospital-based practices and community sexual health centres. Half of the respondents worked in urban locations and the remainder worked in regional settings. Besides clinical indicators, the main considerations in decisions to commence or change treatment were the patients’ and doctors’ hesitation and resistance to change. The patient’s perceived readiness to start or change treatments was one of the most common considerations; patient perception of the benefits or otherwise of ARV, resistance to taking medication for life and doctors’ concern about patient lifestyle and risk factors for non-adherence were also important. The major barrier to changing treatment was patients’ resistance to change and a perceived ‘fear of the unknown’. Doctors indicated a desire on their part and on behalf of patients not to ‘rock the boat’.
Discussion: As antiretroviral treatments continue to improve in tolerability and efficacy, consideration of patients’ psychological characteristics are likely to play an important role in achieving optimal outcomes for PLHIV.
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