Becoming adherent to a preventive treatment for HIV: a qualitative approach

The clinical trial ANRS-IPERGAY investigated the efficacy of sexual activity-based (i.e. on demand) HIV pre-exposure prophylaxis (PrEP). Using a qualitative method, we analysed the role of adherence as one of the main elements for PrEP effectiveness and its associated determinants. Data were collected in various French ANRS-IPERGAY sites during the double-blind (2012-2014) and open-label study (2015-2016) phases, through two individual interviews per participant, collective interviews and focus groups. A total of 83 participants participated in the present study. Our analysis included 32 individual interviews (with 16 participants), 13 collective interviews (n = 45) and 8 focus groups (n = 33). We investigated adherence to on-demand pill-intake schedule, focusing especially on PrEP integration into daily life. PrEP intake was regulated through coping strategies to simplify implementation and avoid stigmatizing reactions. We considered self-care and pharmaceuticalization of prevention as specific features of sexual activity-based PrEP. As PrEP is a prophylaxis for seronegative people, it is contributing to the emergence of a new identity in the HIV field. Health-care professionals should take into account the practical implementation of PrEP schedules into daily life, assist PrEP users in personal management of pill intake and, more generally, improve adherence to the prophylaxis.

Community-Based Care in the ANRS-IPERGAY Trial: The Challenges of Combination Prevention

ANRS-IPERGAY was a community-based randomized trial investigating the efficacy of sexual activity-based HIV pre-exposure prophylaxis (PrEP) in a population of males and transgender females who had sex with men and were at high risk of HIV infection. We qualitatively analyzed the support provided to participants by community-based health workers (CBHW) throughout the trial's double-blind and open-label extension phases. In particular, we showed that the relationship between participants and CBHW strongly influenced self-managed pill intake. The delicate construction of this relationship, balanced between trust and dependence, played an important role in PrEP adherence. CBHW had to deal with various issues surrounding participants' feelings of empowerment regarding their role in the trial, as well as related tensions between various logics and rationalities. They were essential to participants' continued involvement.

[Prevention and management of Lyme disease: On complexity and the need to take into consideration various psycho-social factors]

OBJECTIVE

This paper aims to present a psychosocial analysis on the scientific literature concerning Lyme disease prevention and care.

METHODS

We performed a literature review on Lyme disease, especially on prevention and care, both through physicians and patients' perspective.

RESULTS

A total of 31 documents were included in our literature review. Literature shows that the acceptability of preventive measures, which is relatively poor, has to be associated with the behavioral nature, and not medical one, of these interventions. Moreover, the Lyme disease care is characterized by a condition of uncertainty - especially because of the controversy about the existence of the chronical form and the treatment to adopt - provoking important consequences on patient's quality of life. That is why the acknowledgment of profane knowledge's legitimacy is strongly demanded by patients, especially through the research of an empowered condition in the relation with the physicians. In this sense, the construction of a solid relation between caregiver and patient seems to be essential.

CONCLUSIONS

The invisibility of most symptoms, the patient's subjective experience and the social representations about Lyme disease show the need and the contribution of a psychosocial approach, in order to better understand the life experience of this uncertain condition and, more in general, of this disease.

Taking empowerment into account: the response of community-based organisations to the HIV care needs of men who have sex with men in West Africa (CohMSM ANRS 12324 - Expertise France)

Empowerment is an ongoing process through which individuals and communities appropriate power and acquire the capability to function autonomously. Research on empowerment in men who have sex with men (MSM) is lacking in community-based contexts. We investigated the relationship between willingness to be empowered and HIV care needs in West African MSM accessing community-based organisations' (CBO) services. Fifty-three interviews were administered to HIV-negative MSM participating in the CohMSM study (Mali, Burkina Faso, Côte d'Ivoire, Togo). Five indicators of empowerment were identified from a discourse analysis: (i) motivation to access HIV services, (ii) willingness to improve HIV services, (iii) desire to be involved in new activities, (iv) desire to participate in such services, (v) willingness to collaborate in decision making. Based on these indicators, participants were classified into two profiles: high (19/53, 36%) and low (34/53, 64%) level of willingness to be empowered (HWE, LWE). Using a thematic analysis, HWE participants were focused on collective benefit (preventive follow-up, questions about MSM identity), while LWE participants were centred on individual benefit (medical care). CBOs should consider empowerment as a tool to advance collective health benefits for MSM. To improve empowerment in MSM, specific training on issues regarding sexual identity and stigma is needed for CBO providers.

[Representations of colorectal cancer screening: the GPs point of view]

OBJECTIVES

Various studies have shown that general practitioners (GPs) have a strong influence on adherence to organized screening for colorectal cancer. Faced with very low screening rates (29.8%), this study aims to apprehend the context of screening, the representations of GPs and the context of the arrival of new screening test in how to consider medical practice.

METHODS

On the basis of a qualitative methodology, semi-structured interviews were conducted with 17 general practitioners in 2014-2015. A thematic content analysis was then performed.

RESULTS

The doctors interviewed said that they discussed colorectal cancer screening quickly at the end of the consultation, along with other screening tests (mammography), due to lack of time and management of several reasons for consultation. GPs had very little information about the new test, so they had no specific expectations for the new test. The analysis revealed an inconsistency between the role that GPs feel they should play with patients in prevention and screening and the reality of their practice that leaves them little time to devote to it.

CONCLUSIONS

A lack of information regarding the arrival of the new test and the difficulties associated with the organization of care has an impact on the representations of screening management. Setting up a consultation dedicated to prevention could be a prospect of improvement.

Digital health interventions to help living with cancer: A systematic review of participants' engagement and psychosocial effects

OBJECTIVE

Digital health interventions (DI) open the possibility for cancer patients and survivors to manage the disease and its side effects when they return home after treatment. This study aims to highlight the components of DI, investigate patient engagement with DI, and explore the effects of DI on psychosocial variables.

METHODS

In September 2017, we performed a systematic review of studies focusing on DI which target cancer patients or survivors.

RESULTS

A total of 29 articles (24 studies) were reviewed. There was considerable heterogeneity in study methods, in outcome definitions, in measures for engagement with DI and in psychosocial variables assessed. Results from the studies showed a high level of engagement. Self-efficacy, psychological symptoms, and quality of life were the most commonly assessed psychosocial variables. However, results for the effect of DI on psychosocial variables were inconsistent. Regarding pain management, results were in line with what one would expect.

CONCLUSIONS

The present review showed that despite the heterogeneity in the studies assessed and inconsistent results, DI may constitute an excellent means to help cancer patients and survivors cope better with the disease and with treatment side effects, as they can improve self-management and wellbeing. In order to acquire a greater understanding of the mechanisms underlying cancer patients'/survivors' psychological and behavioral changes in terms of adopting DI, direct comparison between studies is needed. However, this can only come about if methodological and conceptual standardization of DI is implemented.

SFSPM 2018 — Congrès de la Société Française de Sénologie et de Pathologie Mammaire (Avignon, 7-9/11-2018)

Les 40es Journées de la SFSPM se sont tenues à Avignon du 7 au 9 novembre 2018. Le thème abordé—Cancer du sein : optimisation du parcours de soins — a réuni plus de 1 200 participants sous les voûtes du Palais des Papes. La fluidité de chaque segment du parcours a été analysée en termes de risques de rupture de continuité des soins tant au sein du segment lui-même qu’en amont et en aval. Dans un parcours par essence pluridisciplinaire et plurimétiers, la nécessité d’une réflexion globale et d’une coordination active réalisées par des professionnels formés a été rappelée à chaque session. Chacun des intervenants a esquissé de potentiels indicateurs de qualité tenant compte à la fois de son implication dans son segment d’intervention, mais tenant compte aussi d’une vision plus globale de ce que devrait être le parcours au travers de la maladie et des soins. La parole a été très largement partagée entre soignants et associations de malades, entre paramédicaux et acteurs en sciences humaines et sociales, entre responsables de la santé publique HAS, ARS, CNAM–CPAM 84 et représentants des différents modes d’hospitalisation publique/privée et ESPIC. La session grand public a été l’occasion d’échanges fructueux et instructifs sur la perception des difficultés comme des satisfactions rencontrées que nous ont fait partager les malades, leurs proches et les représentantes des associations. Au total, un congrès de réflexion partagé par de nombreux acteurs qui cherchent tous à améliorer le parcours de soins des malades atteintes de cancer du sein. La publication le 21 janvier par l’INCa de dix indicateurs de qualité du parcours de soins pour les malades atteints de cancer du sein est une étape importante qu’attendaient tous les participants d’Avignon — SFSPM 2018.

Empowering Malian women living with HIV regarding serostatus disclosure management: Short-term effects of a community-based intervention

OBJECTIVE

The objective of this study was to assess the short-term effects of Gundo-So-a program aimed at empowering Malian women living with HIV (WLHIV) regarding serostatus disclosure management.

METHODS

A pre-experimental study with two measures (one week before and four weeks after Gundo-So) was carried out. A 35-item questionnaire was administered to a convenience sample of 210 WLHIV. Six outcomes were considered: ability to decide whether or not to disclose HIV status, self-efficacy to keep HIV status a secret, self-efficacy to disclose HIV status, feeling crushed by the weight of secrecy, perceived physical health, and perceived psychological health. For each outcome, temporal changes associated with the intervention were assessed using linear regressions with random intercepts.

RESULTS

Statistically significant change was observed for all six outcomes between the pre- and post-intervention measures. Furthermore, several variables were associated with the baseline levels of the outcomes and the intervention effect.

CONCLUSION

The results suggest that Gundo-So empowers Malian WLHIV with regard to serostatus disclosure management, thus improving their perceived physical and psychological health.

PRACTICAL IMPLICATIONS

These results highlight the need for programs to empower WLHIV regarding serostatus disclosure, so that WLHIV can make free and informed decisions regarding serostatus disclosure.

[The Seintinelles: an innovative approach to promoting Community-Based Research and sustaining health democracy in oncology]

Community-based research drives innovation in major fields of public health, HIV/AIDS being the most emblematic example (Demange, Henry & Préau, 2012), and hepatitis. However, this type of research appears to be more difficult to develop in certain specific diseases, such as cancer (Shankand, Saïas & Friboulet, 2009). This article proposes various approaches concerning current citizen mobilization in relation to cancer research, including potential new levers to the development of participative and community-based research based on the recent creation of the Seintinelles platform, designed to federate researchers and citizens concerned by the problem of cancer. This reflection will be supported by more global issues concerning health democracy.

Patterns of patient and healthcare provider viewpoints regarding participation in HIV cure-related clinical trials. Findings from a multicentre French survey using Q methodology (ANRS-APSEC)

Context

Despite huge advances in the fight against HIV concerning diagnosis, clinical efficacy of antiretroviral treatments (ART), patient survival and quality of life, there is still no cure. Recent developments in HIV cure research have opened the way for clinical trials which could lead to a temporary or definitive end to ART. However, ethical questions exist about related trial-participation risks. The main goal of the ANRS-APSEC survey was, using Q-methodology, to investigate the viewpoints of people living with HIV (PLWH) and HIV healthcare providers (HHP) regarding motivations for and barriers to participation in HIV Cure-related clinical trials (HCRCT).

Materials and methods

Thirty-three statements were defined encompassing seven dimensions: treatment and follow-up; risks; benefits; patient-physician relationship; beliefs and attitudes; information; target population. Forty-one PLWH and 41 HHP from five French HIV services were asked to rank-order the statements.

Results

Five main viewpoints were elicited from “the most motivated” to “the most reluctant” vis-à-vis HCRCT participation. All placed importance on the wish to participate in HIV research. This result is in line with the HIV-specific culture of joint mobilization. For some viewpoints, the motivation to participate in/propose HCRCT was primarily conditioned by side-effects and/or by constraints, which overall were more accepted by PLWH than HHP. Some viewpoints placed particular importance on HCRCT recruitment strategies. Finally, some expressed a high acceptance of risks and constraints but emphasized the need for information.

Conclusion

HIV cure research clinical trials (HCRCT) constitute a risky yet unavoidable step towards the goal of finding a cure. To improve future HCRCT and informed consent designs, based on PLWH and HHP preferences and expectations, we need greater knowledge about how these populations perceive the risks and the benefits of HCRCT. Our results confirmed the importance of careful, studied HCRCT design, management and communication, to ensure PLWH and HHP acceptability and convergence of their expectations.

[Dispensing of oral anticancer drugs by retail pharmacies: professional requirements and recommendations]

Objectives: As a result of organizational and therapeutic progress in the management of cancer, retail pharmacies are faced with numerous challenges in the follow-up of cancer patients. This study was designed to provide a better understanding of the way in which retail pharmacists define their role in the management of cancer patients and to identify actions that would promote more efficient coordination with other oncology professionals.Methods: Semi-structured qualitative interviews were conducted with retail pharmacists and data were analysed by thematic analysis.Results: The majority (53%) of retail pharmacists provide patients with explanations concerning their treatments. Participants in this study described in detail patients’ questions concerning adverse effects (79%) as well as certain forms of alternative medicine (37%). Difficulties with an impact on patient follow-up were also reported, such as the lack of medical information concerning cancer treatments (21%) and their relationship with the hospital (26%).Conclusion: The availability of information tools shared by all healthcare professionals therefore appears to be essential to address the difficulties of follow-up of cancer patients by retail pharmacists.

Suicide risk in a representative sample of people receiving HIV care: Time to target most-at-risk populations (ANRS VESPA2 French national survey)

BACKGROUND

Suicide risk is high among people living with HIV (PLHIV). This study aimed to identify major correlates of suicide risk in a representative sample of PLHIV in France, in order to help target individuals who would benefit from suicide risk screening and psychiatric care.

METHODS

The ANRS VESPA2 cross-sectional survey (April 2011-January 2012) collected socio-demographic, medical and behavioral data from 3,022 PLHIV recruited in 73 French HIV hospital departments. The study sample comprised the 2,973 participants with available self-reported data on suicide risk (defined as having either thought about and planned to commit suicide during the previous 12 months or attempted suicide during the same period of time) and medical data on comorbidities. Weighted Poisson models adjusted for HCV co-infection and significant clinical variables were used to estimate the relationship between suicide risk and HIV transmission groups, experience with HIV disease and other psychosocial factors.

RESULTS

Suicide risk was reported by 6.3% of PLHIV in the study sample. After adjustment for HIV immunological status and HCV co-infection, women (IRR [95%CI]:1.93 [1.17; 3.19]) and men who have sex with men (MSM) (1.97 [1.22; 3.19]) had a higher suicide risk than the rest of the sample. Moreover, the number of discrimination-related social contexts reported (1.39 [1.19; 1.61]), homelessness (4.87 [1.82; 13.02]), and reporting a feeling of loneliness (4.62 [3.06; 6.97]) were major predictors of suicide risk.

CONCLUSIONS

Reducing the burden of precarious social conditions and discrimination is an important lever for preventing suicide risk among PLHIV in France. Comprehensive care models involving peer/community social interventions targeted at women and MSM need to be implemented to lower the risk of suicide in these specific subgroups of PLHIV.

Discussing HIV Status: Is It Easier After 10 Years of Antiretroviral Treatment? The ANRS CO8 APROCO-COPILOTE Cohort

This study's objective was to explore the factors associated with the belief (or not) by people living with HIV that it is easier to talk about their seropositivity 10 years after initiating a protease inhibitor-containing ART. All patients in the ANRS CO8 APROCO-COPILOTE cohort who completed a self-administered questionnaire at 10 years of follow-up were included in this study. Forty-four percent of patients declared that discussing their seropositivity with their family was easier 10 years later, while 28 % declared this was true for discussing their status with a new sexual partner. Having a low socioeconomic status, not receiving social support from a steady partner and declaring a low number of discomforting symptoms 12 months after PI initiation were all independently associated with less difficulty in discussing seropositivity. This study highlights the difficulties in disclosing HIV 10 years after PI initiation, and the important influence of psychosocial factors and patients' daily-life experience on disclosure.

[Barriers and levers to HIV post-exposure prophylaxis]

Two challenges were identified to improve the place of PEP in combined prevention: (1)&#160;improvement of healthcare professionals&#8217; knowledge, practices and attitudes; and (2)&#160;revision of the guidelines concerning first-line prescription, the conditions for access to PEP, and sexual health support.</ce:para>.

Identity, Representations, and Beliefs: HIV Controllers Living on the Frontier of Good Health and Illness

Some people living with HIV spontaneously control the virus without antiretroviral treatment. They are called HIV controllers, and their status places them at the limits of bio-clinical normality. The objective of this study was to investigate HIV controllers' beliefs and representations of their individual trajectories using a qualitative approach. Fourteen HIV controllers were interviewed. Vertical analysis focused on examining how interviewees' specific beliefs and representational processes help these patients adapt to their particular situation. Horizontal analysis focused on how patients' biographic trajectories and identity positioning help them make sense of their situation. Results highlighted that perceiving oneself to be healthy or ill was linked to change or a lack of change in terms of disease perception, beliefs, and representations, when seropositivity was announced. This study of social representations and the processes involved provide crucial elements for health professionals caring for HIV controllers.

HIV seropositivity and sexuality: cessation of sexual relations among men and women living with HIV in five countries

The sexuality of people living with HIV (PLHIV) is a key issue in the fight against HIV, as it influences both the dynamic of the epidemic and the quality of life of PLHIV. The present study examined the factors associated with cessation of sexual relations after HIV diagnosis among men and women in five countries: Mali, Morocco, Democratic Republic of the Congo, Romania and Ecuador. A community-based cross-sectional study was implemented by a mixed consortium [researchers/community-based organizations (CBO)]. Trained CBO members interviewed 1500 PLHIV in contact with CBOs using a 125-item questionnaire. A weighted multivariate logistic regression and a separate gender analysis were performed. Among the 1413 participants, 471 (33%) declared that they stopped having sexual relations after their HIV diagnosis, including 318 women (42%) and 153 men (23%) (p < .001). Concerning women, variables associated with the cessation of sexual relations in the final multivariate model were mainly related with relational factors and the possibility of getting social support (e.g., needing help to disclose HIV serostatus, feeling lonely every day, not finding support in CBOs, not being in a couple). Men's sexual activity was more associated with their representations and their perception of the infection (e.g., thinking they will have their HIV infection for the rest of their life, perceiving the HIV infection as a mystery, perceiving the infection as serious). Furthermore, the following variables were associated with both men and women sexual behaviours: being older, having suffered from serious social consequences after serostatus disclosure and not being able to regularly discuss about HIV with their steady partner. Results suggested clear differences between men and women regarding cessation of sexual relations and highlighted the importance of implementing gender-based tailored interventions that promote safe and satisfying sexuality, as it is known to have a positive impact on the overall well-being of PLHIV.