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Antiretroviral Therapy and Periarticular Osteonecrosis Development in Patients With HIV. J Am Acad Orthop Surg 2023; 31:e148-e156. [PMID: 36656276 DOI: 10.5435/jaaos-d-22-00619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/18/2022] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION With modern antiretroviral therapy (ART), HIV has become a chronic condition. Previous studies have not definitively assessed the risk of periarticular osteonecrosis (ON) that ART poses to the HIV population. METHODS A retrospective case-control study using the PearlDiver database was done using International Classification of Diseases codes. Patients were selected from 2010 to 2019 with a diagnosis of periarticular ON and HIV taking ART (HIV+/ART+) and not taking ART (HIV+/ART-). The control was patients HIV- and not on ART. Subcategorization, by International Classification of Diseases codes, was used for which joint was affected-hip, knee, or shoulder-excluding patients with ON of the jaw. Chi-squared univariate analysis was used to compare incidence rates and control for age, sex, Elixhauser comorbidities, and other known risk factors for developing ON in multivariable analysis. RESULTS In total, 219,853 patients had HIV between 2010 and 2019. Of those patients, 123,710 (56.27%) had a history of ART (HIV+/ART+), while 96,143 (43.74%) did not (HIV+/ART-). Difference in incidence rates for HIV+/ART+ was higher in any joint (+1.7%), as well as the hip (+1.31%), knee (+0.08%), and shoulder (+0.08%). All risk factors met inclusion criteria in the multivariate analysis except coagulopathy. Multivariate analysis found that patients in the HIV+/ART+ cohort had higher odds of developing periarticular ON when compared with the HIV+/ART- cohort in any joint (odds ratios = 1.40; 95% CI, 1.38 to 1.42), hip (OR:1.41; 95% CI, 1.38-1.43), knee (OR:2.56; 95% CI, 2.39 to 2.74), and shoulder (OR:1.05; 95% CI, 1.01-1.10). CONCLUSION Patients with HIV taking ART have well-established morbidity and mortality benefits. However, this study found that ART is associated with a higher risk of developing periarticular ON when compared with those not taking ART. Therefore, clinicians should be hypervigilant of patients on ART and their risk of ON, especially asymptomatic patients, and focus on modifiable risk factors and early surgical correction. LEVEL OF EVIDENCE III.
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Pulido Tarquino IA, Venables E, de Amaral Fidelis JM, Giuliani R, Decroo T. "I take my pills every day, but then it goes up, goes down. I don't know what's going on": Perceptions of HIV virological failure in a rural context in Mozambique. A qualitative research study. PLoS One 2019; 14:e0218364. [PMID: 31206540 PMCID: PMC6576769 DOI: 10.1371/journal.pone.0218364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/02/2019] [Indexed: 01/11/2023] Open
Abstract
Background HIV prevalence in Mozambique is estimated to be 13.2%. Routine viral load for HIV monitoring was first implemented in the rural area of Tete in 2014. Programmatic data showed an unexpected high proportion of high viral load results, with up to 40% of patients having a viral load above 1000 copies/ml. Objectives This qualitative study aimed to explore perceptions about virological failure and viral load monitoring from the perspective of HIV positive patients on first-line antiretroviral therapy (ART) and health-care workers. Methods The study was conducted in seven rural communities in Changara-Marara district, Tete province, Mozambique. A total of 91 participants took part in in-depth interviews (IDIs) and focus group discussions (FGDs), including health-care workers (n = 18), patients on ART in individual care or Community Adherence Groups (CAGs) who experienced virological failure and virological re-suppression (n = 39) and CAG focal points (n = 34). Purposive sampling was used to select participants. Interviews and FGDs were conducted in Nhuengue and Portuguese. IDIs and FGDs were translated and transcribed before being coded and thematically analysed. Results Emergent themes showed that patients and health-care workers attributed great importance to viral load monitoring. A supressed viral load was viewed by participants as a predictor of good health and good adherence. However, some patients were confused and appeared distressed when confronted with virological failure. Viral load results were often little understood, especially when virological failure was detected despite good adherence. Inadequate explanations of causes of virological failure, delayed follow-up viral load results, repeated blood tests and lack of access to second-line ART resulted in reduced confidence in the effectiveness of ART, challenged the patient-provider relationship and disempowered patients and providers. Conclusion In this rural context undetectable viral load is recognized as a predictor of good health by people living with HIV and health-care workers. However, a lack of knowledge and health system barriers caused different responses in patients and health-care workers. Adapted counselling strategies, accelerated viral load follow-up and second-line ART initiation in patients with virological failure need to be prioritized.
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Affiliation(s)
| | - Emilie Venables
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | - Tom Decroo
- Institute of Tropical Medicine, Department of Clinical Sciences, Unit of HIV/AIDS & Infectious Diseases, Antwerp, Belgium
- Research Foundation Flanders, Brussels, Belgium
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Hollingdrake O, Lui CW, Mutch A, Dean J, Howard C, Fitzgerald L. Factors affecting the decision to initiate antiretroviral therapy in the era of treatment-as-prevention: synthesis of evidence from qualitative research in high-income settings. AIDS Care 2018; 31:397-402. [PMID: 30311499 DOI: 10.1080/09540121.2018.1533235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The emergence of treatment-as-prevention has made early initiation of antiretroviral treatment (ART) a "universal" policy. This review synthesizes qualitative research findings on barriers and facilitators of ART initiation in Organization for Economic Co-operation and Development (OECD) countries published since 2010. Ten articles describing seven research studies were included in the review. Findings confirmed ART initiation as a complicated process involving careful deliberation of the personal risks and benefits of treatment within the broader contexts of everyday life for people living with HIV (PLHIV). They also highlight interpersonal dynamics and concern for the public as increasingly important factors in shaping the decision to initiate treatment. The review provides valuable information for understanding treatment behaviour and maximizing treatment options brought forth by new biomedical advances.
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Affiliation(s)
| | - Chi-Wai Lui
- a School of Public Health , University of Queensland , Brisbane , Australia
| | - Allyson Mutch
- a School of Public Health , University of Queensland , Brisbane , Australia
| | - Judith Dean
- a School of Public Health , University of Queensland , Brisbane , Australia
| | - Chris Howard
- b Department of Life and Program , Queensland Positive People , Brisbane , Australia
| | - Lisa Fitzgerald
- a School of Public Health , University of Queensland , Brisbane , Australia
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Drumhiller K, Nanín JE, Gaul Z, Sutton MY. The Influence of Religion and Spirituality on HIV Prevention Among Black and Latino Men Who Have Sex with Men, New York City. JOURNAL OF RELIGION AND HEALTH 2018; 57:1931-1947. [PMID: 29696488 DOI: 10.1007/s10943-018-0626-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The influence of religion and spirituality (R/S) on HIV prevention has been understudied, especially for Black and/or Latino men who have sex with men (BLMSM), who bear a disproportionate burden of HIV, and who are part of racial/ethnic communities with high engagement in R/S. The specific aim of this study was to explore perspectives about R/S among BLMSM to inform HIV prevention strategies and reduce HIV-related health disparities. Data from 105 qualitative interviews with BLMSM were analyzed; 58 (55%) stated that R/S had no personal influence on HIV prevention. For those reporting any R/S influence, main themes were: (1) R/S positively influenced decision-making and self-respect, (2) perceived judgment and stigma by religious communities, (3) belief in a higher power, and (4) altruism. These findings can inform faith-based HIV prevention interventions for BLMSM.
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Affiliation(s)
- Kathryn Drumhiller
- Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-45, Atlanta, GA, 30329, USA.
- Chenega Professional and Technical Services, Chesapeake, VA, USA.
| | - José E Nanín
- Community Health Program/Department of Health, Physical Education, and Recreation, Kingsborough Community College, Brooklyn, NY, USA
| | - Zaneta Gaul
- Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-45, Atlanta, GA, 30329, USA
- ICF, Atlanta, GA, USA
| | - Madeline Y Sutton
- Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-45, Atlanta, GA, 30329, USA
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Yelverton V, Ostermann J, Hobbie A, Madut D, Thielman N. A Mixed Methods Approach to Understanding Antiretroviral Treatment Preferences: What Do Patients Really Want? AIDS Patient Care STDS 2018; 32:340-348. [PMID: 30179532 DOI: 10.1089/apc.2018.0099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
As the number of effective antiretroviral therapy (ART) options increases, there is greater opportunity to involve HIV patients in ART selection. To establish the parameters for a shared ART decision-making process, we sought to identify ART characteristics that are important to patients and understand considerations in ART selection from both patient and provider perspectives. Using a mixed-methods approach, 16 patients and 12 healthcare providers were interviewed, and ranking tasks were conducted with 26 patients to identify ART characteristics that are relevant for shared decision making. Interviews were coded using direct content analysis and complemented by a quantitative analysis of references to specific attributes. Ranking data were analyzed through count analysis. Qualitative analysis of patient interviews identified four major categories of ART characteristics that are pertinent to shared decision making: side effects (14/16 patients), administration characteristics (14/16 patients), dosing (13/16 patients), and long-term effects (12/16 patients). Other considerations included expectations for patient involvement in ART decision making, relationship with provider, and efficacy. The degree of concordance between patients and providers differed across categories. Ranking exercises demonstrated differences in the ways providers and patients prioritize specific side effects and food requirements. Expectations for patient involvement in the selection process also varied greatly among and between patients and providers. We identify specific attributes of ART that are decision-relevant to patients and providers, describe heterogeneity of their relative importance, and note variable perceptions of shared decision making. Individualizing ART will require greater investment in understanding an individual patient's preferences, including her/his desire to participate in shared decision making.
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Affiliation(s)
- Valerie Yelverton
- Department of Health, Nursing, Administration, Hochschule Neubrandenburg, Neubrandenburg, Germany
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Jan Ostermann
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Amy Hobbie
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Deng Madut
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Nathan Thielman
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
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Nabipour AR, Nakhaee N, Khanjani N, Soltani M, Moradlou HZ, Soltani Z. Psychometric Properties of the Persian Version of the God Locus of Health Control (GLHC): A Study on Muslim Pilgrims. JOURNAL OF RELIGION AND HEALTH 2018; 57:84-93. [PMID: 28032318 DOI: 10.1007/s10943-016-0350-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
God Locus of Health Control (GHLC) scale is an instrument for assessing to what extent one believes that God controls his/her health or disease. The aim of this study was to describe the cultural adaptation of this scale and to investigate the psychometric properties of Persian version. At first, the scale was forward-translated to Persian, and then, backward-translation was conducted. Finally, the synthesized back-translated version was prepared and compared to the draft Persian-language version of the GLHC. In the next step, in order to test cognitive debriefing, the Persian-language version of the questionnaire was completed by 20 pilgrims. Final version of Persian GHLC scale was answered by 600 pilgrims attending religious holy places. Mean age of respondents was 33.15 (±11.04) years. There was a positive correlation between six items of GLHC scale and inter-item correlation coefficients. The Cronbach's alpha coefficient was 0.84. Exploratory factor analysis showed that the G LHC scale had a one-factor structure. The factor loadings for all items ranged from 0.57 to 0.77. Residual correlations of all items were between -0.2 and +0.2. The people with lower income had significantly higher score of GLHC scale. GLHC scale score had a significant positive correlation with DUREL subscale and MHLC Chance Externality subscale score. There was no a significant correlation between GLHC scale score and Multidimensional Health Locus of Control (MHLC) Internality and Powerful subscales scores. The results of the present study showed that the Persian version of GHLC scale has acceptable factorial validity and internal consistency reliability.
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Affiliation(s)
- Amir Reza Nabipour
- Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran.
| | - Nouzar Nakhaee
- Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Narges Khanjani
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Soltani
- Tehran Education and Training Organization, Tehran, Iran
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Dalmida SG, McCoy K, Koenig HG, Miller A, Holstad MM, Thomas T, Clayton-Jones D, Grant M, Fleming T, Wirani MM, Mugoya G. Examination of the Role of Religious and Psychosocial Factors in HIV Medication Adherence Rates. JOURNAL OF RELIGION AND HEALTH 2017; 56:2144-2161. [PMID: 28285439 PMCID: PMC9897031 DOI: 10.1007/s10943-017-0377-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Optimal adherence to antiretroviral therapy (ART) is associated with favorable HIV outcomes, including higher CD4 cell counts, HIV virus suppression and a lower risk of HIV transmission. However, only 25% of people living with HIV/AIDS (PLWH) in the USA are virally suppressed. Sub-optimal adherence (<90-95%) contributes to antiretroviral resistance and worse medical outcomes, including more rapid progression to AIDS and death. Psychosocial factors and religion/spirituality (R/S) have a significant impact on ART adherence, but the findings are mixed. The purpose of this study was to examine religious and psychosocial correlates and predictors of ≥90% ART adherence in PLWH. A cross-sectional study was conducted with a sample of 292 outpatient PLWH in the Southeastern USA. Participants completed computerized surveys. The mean ART adherence percentage was 80.9% and only about half reported ≥90% adherence. There were statistically significant differences in ART adherence rates based on age, depressive symptom status and frequency of religious attendance and prayer. Praying at least once a day was significantly associated with ≥90% ART adherence (OR = 2.26, 95% CI [1.06-4.79], p < 0.05). Social support satisfaction was also significantly associated with ART adherence (OR = 1.52, 95% CI [1.11-2.08], p < 0.05) and energy/fatigue/vitality (OR = 1.03, 95% CI [1.00-1.05], p < 0.05).
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Affiliation(s)
- Safiya George Dalmida
- Capstone College of Nursing, The University of Alabama, 650 University Blvd, Tuscaloosa, AL, 35487, USA.
| | - Katryna McCoy
- School of Nursing and Health Studies, University of Washington, Bothell, WA, USA
| | - Harold G Koenig
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Aretha Miller
- College of Health Sciences, Walden University, Minneapolis, MN, USA
| | | | - Tami Thomas
- Nicole Werthiem College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
| | - Dora Clayton-Jones
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Terri Fleming
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | - George Mugoya
- College of Education, The University of Alabama, Tuscaloosa, AL, USA
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Medved Kendrick H. Are religion and spirituality barriers or facilitators to treatment for HIV: a systematic review of the literature. AIDS Care 2016; 29:1-13. [PMID: 27410058 DOI: 10.1080/09540121.2016.1201196] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Much attention has been given to the relationship between religion/spirituality (R/S) and HIV in recent years, but comparatively little has been explored in regard to R/S and HIV testing, retention in care, and adherence to medication. Religious views concerning HIV risk behavior pose challenges to communication and education about sexual health in religious communities and may serve as barriers to HIV treatment and care. Conversely, religious coping and spiritual well-being, as well as social support could serve as facilitators to HIV treatment and care. This study aims to fill a gap in the literature by addressing the following questions: (1) what dimensions of R/S have been found to be factors associated with HIV outcomes?; (2) which R/S factors function as barriers or facilitators to care among people living with HIV (PLWH)?; and (3) which R/S factors, if any, vary across socio-demographic groups? Thirty-three empirical articles were identified for systematic review. Of the 33 empirical studies included, 24 studies found that at least one measure of R/S was associated with better adherence and clinical health outcomes. Twelve studies found at least one measure of R/S to be associated with poorer adherence and clinical health outcomes. Seven of the studies found at least one R/S measure to have no significant association with outcomes. Though all of the studies included in this review focused on R/S experiences of PLWH, there was very little consistency in regard to measurement of R/S. Studies in this review included a wide range of R/S measures, including beliefs, religious/spiritual practices, R/S coping, organizational religion, and many more. Of the 33 studies reviewed, only 9 focused on unique populations such as women, people with histories of substance abuse, immigrants, etc. Findings from this review highlight opportunities for more studies in various populations using standardized R/S measures.
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Affiliation(s)
- Haley Medved Kendrick
- a Department of Sociology , University of Alabama at Birmingham , Birmingham , AL , USA
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Fiscella K, Boyd M, Brown J, Carroll J, Cassells A, Corales R, Cross W, El'Daher N, Farah S, Fine S, Fowler R, Hann A, Luque A, Rodriquez J, Sanders M, Tobin J. Activation of persons living with HIV for treatment, the great study. BMC Public Health 2015; 15:1056. [PMID: 26474979 PMCID: PMC4608105 DOI: 10.1186/s12889-015-2382-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/29/2015] [Indexed: 01/16/2023] Open
Abstract
Background Patient empowerment represents a potent tool for addressing racial, ethnic and socioeconomic disparities in health care, particularly for chronic conditions such as HIV infection that require active patient engagement. This multimodal intervention, developed in concert with HIV patients and clinicians, aims to provide HIV patients with the knowledge, skills, attitudes and tools to become more activated patients. Methods/Design Randomized controlled trial of a multimodal intervention designed to activate persons living with HIV. The intervention includes four components: 1) use of a web-enabled hand-held device (Apple iPod Touch) loaded with a Personal Health Record (ePHR) customized for HIV patients; 2) six 90-minute group-based training sessions in use of the device, internet and the ePHR; 3) a pre-visit coaching session; and 4) clinician education regarding how they can support activated patients. Outcome measures include pre- post changes in patient activation measure score (primary outcome), eHealth literacy, patient involvement in decision-making and care, medication adherence, preventive care, and HIV Viral Load. Discussion We hypothesize that participants receiving the intervention will show greater improvement in empowerment and the intervention will reduce disparities in study outcomes. Disparities in these measures will be smaller than those in the usual care group. Findings have implications for activating persons living with HIV and for other marginalized groups living with chronic illness. Trial registration ClinicalTrials.gov Identifier: NCT02165735, 6/13/2014.
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Affiliation(s)
- Kevin Fiscella
- Public Health Sciences and Community Health, Department of Family Medicine, University of Rochester Medical Center, 1381 South Ave, Rochester, NY, 14620, USA. .,Public Health Sciences, University of Rochester Medical Center, Rochester, USA.
| | - Michele Boyd
- Public Health Sciences and Community Health, Department of Family Medicine, University of Rochester Medical Center, 1381 South Ave, Rochester, NY, 14620, USA
| | | | - Jennifer Carroll
- Department of Family Medicine, University of Colorado, Denver, USA
| | | | | | - Wendi Cross
- Department of Psychiatry, University of Rochester Medical Center, Rochester, USA
| | - Nayef El'Daher
- Rochester Regional Health System, Unity Family Medicine at St. Mary's and Unity Infectious Disease, Rochester, USA
| | - Subrina Farah
- Public Health Sciences and Community Health, Department of Family Medicine, University of Rochester Medical Center, 1381 South Ave, Rochester, NY, 14620, USA
| | - Steven Fine
- Department of Medicine, Infectious Diseases (SMD), University of Rochester, Rochester, USA
| | | | - Ashley Hann
- Rochester Regional Health System, Unity Family Medicine at St. Mary's and Unity Infectious Disease, Rochester, USA
| | - Amneris Luque
- Department of Medicine, Infectious Diseases (SMD), University of Rochester, Rochester, USA
| | | | - Mechelle Sanders
- Public Health Sciences and Community Health, Department of Family Medicine, University of Rochester Medical Center, 1381 South Ave, Rochester, NY, 14620, USA.,Public Health Sciences, University of Rochester Medical Center, Rochester, USA
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Leyva-Moral JM, de Dios Sánchez R, Lluva-Castaño A, Mestres-Camps L. Living with constant suffering: a different life following the diagnosis of HIV. J Assoc Nurses AIDS Care 2015; 26:613-24. [PMID: 25998265 DOI: 10.1016/j.jana.2015.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/18/2015] [Indexed: 11/18/2022]
Abstract
We used grounded theory in semi-structured interviews with 32 persons living with HIV (PLWH) in Barcelona, Spain, and found that PLWH live with constant suffering, a core category combining four realities: I need help; My life is constantly controlled; I have a new imposed life; and I have an uncertain reality. Participants described being constantly controlled by health policies and medications. They thought their lives were in the hands of others and that a new life, characterized by the constant fear of stigma, had been imposed on them. They felt they were losing freedom and vitality, as many questions remained unanswered, causing uncertainty related to health and public life. Emotional help was obtained mainly from peers and social networks. Our emergent theory shows a disruptive experience, with serious consequences to individual and social development. Health care has to focus on the real needs of PLWH to reduce suffering and uncertainty.
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Ketema AK, Shewangizaw Weret Z. Assessment of adherence to highly active antiretroviral therapy and associated factors among people living with HIV at Debrebrihan Referral Hospital and Health Center, Northeast Ethiopia: a cross-sectional study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2015; 7:75-81. [PMID: 25792856 PMCID: PMC4362904 DOI: 10.2147/hiv.s79328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Patient adherence to antiretroviral combination therapy is a critical component to successful treatment outcome. Nonadherence to antiretroviral therapy (ART) is a major challenge to AIDS care, and the risks associated with it are extensive. The intention of this study was to determine prevalence and associated factors with adherence to highly active ART among people living with HIV/AIDS (PLWHA) at the Debrebrihan Referral Hospital and Health Center, Northeast Ethiopia. A cross-sectional study design with systematic random sampling conducted by the use of a structured, pretested self-rating adherence questionnaire was used to conduct the study among 422 respondents from the Debrebrihan Referral Hospital and Health Center. A single population proportion formula at 95% CI with 5% of marginal error at 50% of prevalence of occurrence was used to determine sample size. Adherence was defined as not missing a single ART dose during the 30-day period prior to filling out the self-report. Adherence was measured by self-reports by the patients. These results were then used in binary logistic regression analysis. Covariates were analyzed by bivariate and multivariate logistic regression with SPSS statistical software. The total number of respondents in this study was 422; their median age was 35 years. Among the participants, 95.5% were taking their medication without missing a dose. Factors such as having emotional or practical support positively encouraged ART adherence (adjusted odds ratio 0.16 [95% CI 0.05–0.49]). However, users of traditional, complementary, and alternative medicine (TCAM) (adjusted odds ratio 4.7 [95% CI 1.06–21.22]) had nearly a five times higher risk for ART nonadherence (P<0.05) than those not using TCAM. Adherence to ART among PLWA is imperative and standard. But, there is still a need to boost psychological support and practical support for the clients, and there is also a need to create a more integrative approach with TCAM in order to increase adherence to ART. Strengthening emotional and practical support for PLWHA and integrating TCAM with the proper use of ART are mandatory to enhance ART adherence.
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Affiliation(s)
- Abush Kebede Ketema
- Regional Monitoring and Evaluation Advisor, Management Sciences for Health, Addis Ababa, Ethiopia
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Beer L, Valverde EE, Raiford JL, Weiser J, White BL, Skarbinski J. Clinician Perspectives on Delaying Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients. J Int Assoc Provid AIDS Care 2014; 14:245-54. [PMID: 25394912 PMCID: PMC4426141 DOI: 10.1177/2325957414557267] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: Guidelines for antiretroviral therapy (ART) initiation have evolved, but consistently note that adherence problems should be considered and addressed. Little is known regarding the reasons providers delay ART initiation in clinically eligible patients. Methods: In 2009, we surveyed a probability sample of HIV care providers in 582 outpatient facilities in the United States and Puerto Rico with an open-ended question about nonclinical reasons for delaying ART initiation in otherwise clinically eligible patients. Results: Very few providers (2%) reported never delaying ART. Reasons for delaying ART were concerns about patient adherence (68%), patient acceptance (60%), and structural barriers (33%). Provider and practice characteristics were associated with reasons for delaying ART. Conclusion: Reasons for delaying ART were consistent with clinical guidelines and were both patient level and structural. Providers may benefit from training and access to referrals for ancillary services to enhance their ability to monitor and address these issues with their patients.
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Affiliation(s)
- Linda Beer
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eduardo E Valverde
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jerris L Raiford
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Weiser
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Becky L White
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Jacek Skarbinski
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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13
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Kremer H, Ironson G, Kaplan L, Stuetzele R, Baker N, Fletcher MA. Spiritual coping predicts CD4-cell preservation and undetectable viral load over four years. AIDS Care 2014; 27:71-9. [PMID: 25297848 DOI: 10.1080/09540121.2014.952220] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this study of 177 people living with HIV, we examined if spiritual coping leads to slower HIV disease progression (CD4 cells, viral load [VL]), and more positive health behaviors (adherence, safer sex, less substance use). Prior research suggests that physicians' assessment of spiritual coping can be an interventional aid in promoting positive spiritual coping. Longitudinal spiritual coping was rated using qualitative content analysis of six-monthly interviews/essays. Positive spiritual coping (65%) was predominant over negative (7%), whereas 28% did not make significant use of spirituality as a means to cope. Spiritual coping was associated with less substance use disorder but not with less sexual risk behavior. Hierarchical linear modeling demonstrated that spiritual coping predicted sustained undetectable VL and CD4-cell preservation over four years, independent of sociodemographics, baseline disease status, and substance use disorder. Achieving undetectable VL significantly increased over time in participants with positive spiritual coping but decreased among those with negative spiritual coping. For every participant with positive spiritual coping achieving undetectable VL, four with negative spiritual coping reported with detectable/transmittable HIV. Notably, even when controlling for the effect of VL suppression, CD4-cell decline was 2.25 times faster among those engaged in negative versus positive spiritual coping. In conclusion, spiritual coping is associated with positive health behaviors, such as maintaining long-term VL suppression and less onset/relapse of substance use disorder over time. Among those who are sexually active, positive spiritual coping reduces the risk of HIV transmission via VL suppression but may not prevent the transmission of other STDs because spiritual coping is not related to safer sexual behavior. Notably, the association between spiritual coping and immune preservation was direct (i.e., not explained by VL suppression), suggesting potential psychoneuroimmunological pathways. Thus, assessment of spiritual coping may be an important area of intervention to achieve undetectable VL, reduce HIV disease progression, and prevent substance use onset/relapse.
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Affiliation(s)
- Heidemarie Kremer
- a Department of Psychology , University of Miami , Coral Gables , FL , USA
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Kremer H, Ironson G. Longitudinal spiritual coping with trauma in people with HIV: implications for health care. AIDS Patient Care STDS 2014; 28:144-54. [PMID: 24601735 DOI: 10.1089/apc.2013.0280] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
This 10-year study (N=177) examines how people with HIV use spirituality to cope with life's trauma on top of HIV-related stress (e.g., facing death, stigma, poverty, limited healthcare) usual events. Spirituality, defined as a connection to a higher presence, is independent from religion (institutionalized spirituality). As a dynamic adaptive process, coping requires longitudinal studying. Qualitative content-analysis of interviews/essays yielded a coding of specific aspects and a longitudinal rating of overall spiritual coping. Most participants were rated as spiritual, using spiritual practices, about half experienced comfort, empowerment, growth/transformation, gratitude, less than one-third meaning, community, and positive reframing. Up to one-fifth perceived spiritual conflict, struggle, or anger, triggering post-traumatic stress, which sometimes converted into positive growth/transformation later. Over time, 65% used spiritual coping positively, 7% negatively, and 28% had no significant use. Spirituality was mainly beneficial for women, heterosexuals, and African Americans (p<0.05). Results suggest that spirituality is a major source of positive and occasionally negative coping (e.g., viewing HIV as sin). We discuss how clinicians can recognize and prevent when spirituality is creating distress and barriers to HIV treatment, adding a literature review on ways of effective spiritual assessment. Spirituality may be a beneficial component of coping with trauma, considering socio-cultural contexts.
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Affiliation(s)
| | - Gail Ironson
- Department of Psychology, University of Miami, Miami, Florida
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15
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Down I, Prestage G, Triffitt K, Brown G, Bradley J, Ellard J. Recently diagnosed gay men talk about HIV treatment decisions. Sex Health 2014; 11:200-6. [DOI: 10.1071/sh13100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/30/2013] [Indexed: 11/23/2022]
Abstract
Background
In recent years, there has been increasing evidence that early initiation of antiretroviral therapy (ART) may provide health benefits for those infected with HIV. There has also been significant discussion about the role of HIV treatment in preventing onward transmission of the virus. Early provision and uptake of ART to people recently diagnosed with HIV could achieve both individual and public health outcomes. The success of such an initiative relies, in part, on the preparedness of those recently diagnosed with HIV to engage with the therapy. Methods: The HIV Seroconversion Study collects both quantitative and qualitative data from people in Australia who have recently been diagnosed with HIV. During 2011–2012, 53 gay or bisexual men recruited across Australia took part in semistructured interviews as part of the study. The men were asked about their knowledge and experience of, and their decisions about whether or not to commence, HIV treatment. Results: The interviews identified differing levels of knowledge about HIV treatments and divergent views about the health and prevention benefits of ART. For some, treatments provided a sense of control over the virus; others were apprehensive and distrustful, and preferred to resist commencing treatments for as long as possible. Conclusions: If early initiation of treatment is to be encouraged, appropriate measures must be in place to ensure recently diagnosed individuals have access to the appropriate information and the support they need to enable them to make informed choices and, if necessary, to address their fears.
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Complementary therapy provision in a London community clinic for people living with HIV/AIDS: a case study. Complement Ther Clin Pract 2013; 20:65-9. [PMID: 24439648 DOI: 10.1016/j.ctcp.2013.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/06/2013] [Accepted: 10/03/2013] [Indexed: 11/22/2022]
Abstract
AIM To present a case study of complementary therapy (CT) provision within a community HIV multi-agency service in a Northwest London deprived area. METHODS Anonymised routine service data were provided for all clients (n = 1030) August 2010 to October 2012. Face-to-face meetings provided feedback from volunteers (9 CT-using clients and 9 staff). RESULTS CT-users were demographically similar to other clients. Support for coping with HIV was commonly cited as a service benefit. Over 26 months 1416 CT sessions were provided; 875 aromatherapy and 471 shiatsu. CT-users' most common concerns were pain (48%), stress (15%) and insomnia (13%), few had heard of or used CT before. Perceived mental and emotional benefits included relaxation,stress relief, relieving musculoskeletal aches and pains. Service challenges included time and funding, though staff felt CT may be cost-effective. CONCLUSIONS CT may provide important support and treatment options for HIV disease, but cost effectiveness requires further evaluation.
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17
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Lorenc A, Robinson N. A review of the use of complementary and alternative medicine and HIV: issues for patient care. AIDS Patient Care STDS 2013; 27:503-10. [PMID: 23991688 DOI: 10.1089/apc.2013.0175] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV/AIDS is a chronic illness, with a range of physical symptoms and psychosocial issues. The complex health and social issues associated with living with HIV mean that people living with HIV/AIDS (PLWHA) have historically often turned to complementary and alternative medicine (CAM). This article provides an overview of the literature on HIV and CAM. Databases were searched using keywords for CAM and HIV from inception to December 2012. Articles in English and in Western countries were included; letters, commentaries, news articles, articles on specific therapies and basic science studies were excluded. Of the 282 articles identified, 94 were included. Over half reported prevalence and determinants of CAM use. Lifetime use of CAM by PLWHA ranged from 30% to 90%, with national studies suggesting CAM is used by around 55% of PLWHA, practitioner-based CAM by 15%. Vitamins, herbs, and supplements were most common, followed by prayer, meditation, and spiritual approaches. CAM use was predicted by length of time since HIV diagnosis, and a greater number of medications/symptoms, with CAM often used to address limitations or problems with antiretroviral therapy. CAM users rarely rejected conventional medicine, but a number of CAM can have potentially serious side effects or interactions with ART. CAM was used as a self-management approach, providing PLWHA with an active role in their healthcare and sense of control. Clinicians, particularly nurses, should consider discussing CAM with patients as part of patient-centered care, to encourage valuable self-management and ensure patient safety.
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Affiliation(s)
- Ava Lorenc
- London South Bank University, London, United Kingdom
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18
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Ahmedani BK, Peterson EL, Wells KE, Rand CS, Williams LK. Asthma medication adherence: the role of God and other health locus of control factors. Ann Allergy Asthma Immunol 2012; 110:75-9.e2. [PMID: 23352524 DOI: 10.1016/j.anai.2012.11.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 10/09/2012] [Accepted: 11/12/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND Medication adherence is an important determinant of disease outcomes, yet medication use on average tends to be low among patients with chronic conditions, including asthma. Although several predictors of non-adherence have been assessed, more research is needed on patients' beliefs about God and how these relate to medication use. OBJECTIVE To examine the relationship between perceptions about "God's" role in health and other locus of control factors with inhaled corticosteroid (ICS) adherence among asthma patients. METHODS Participants were from a clinical trial to improve ICS adherence and were 5-56 years old, had a diagnosis of asthma, and were receiving ICS medication. Baseline adherence was estimated from electronic prescription and pharmacy fill records. Patients were considered to be adherent if ICS use was ≥80% of prescribed. A baseline survey with the Multidimensional Health Locus of Control scale was used to assess five sources (God, doctors, other people, chance, and internal). RESULTS Medication adherence was low (36%). Patients' who had a stronger belief that God determined asthma control were less likely to be adherent (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.70-0.96). This relationship was stronger among African American (OR 0.68, 95% CI0.47-0.99) compared to white patients (OR 0.89, 95% CI 0.75-1.04), and among adults (OR 0.81, 95% CI 0.69-0.96) compared to children (OR 0.84, 95% CI 0.58-1.22). CONCLUSION Patients' belief in God's control of health appears to be a factor in asthma controller use, and therefore should be considered in physician-patient discussions concerning course of treatment. TRIAL REGISTRATION ClinicalTrials.gov: NCT00459368.
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Affiliation(s)
- Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan 48202, USA.
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19
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Muñoz FA, Servin AE, Kozo J, Lam M, Zúñiga ML. A binational comparison of HIV provider attitudes towards the use of complementary and alternative medicine among HIV-positive Latino patients receiving care in the US-Mexico border region. AIDS Care 2012; 25:990-7. [PMID: 23088506 DOI: 10.1080/09540121.2012.729806] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Use of complementary and alternative medicine (CAM) is common among Latinos living with HIV in the United States (US)-Mexico border region. Health providers may vary in their approach to communicating acceptance or non acceptance of CAM use, which can undermine patient confidence in disclosing CAM use. Patient-provider communication about CAM is important because certain types of CAM can affect antiretroviral therapy (ART) adherence. We undertook the present binational study to understand US and Mexican provider beliefs, and perceptions surrounding CAM use among Latino patients, and to learn if and how CAM communication occurs. Between July and December 2010, we conducted in-depth, qualitative interviews in Tijuana and San Diego. Analysis procedures drew upon principles of Grounded Theory. The sample was comprised of 19 HIV-health care providers, including 7 women and 12 men. Emerging CAM-related themes were: Provider's perceptions, attitudes and knowledge about CAM; CAM types and modalities; and patient-provider CAM communication. Many clinicians were uncomfortable supporting CAM use with their patients. San Diego providers reported more frequent instances of CAM use among Latino patients than Tijuana providers. Providers from both cities reported that patients infrequently disclose CAM use and almost half do not routinely ask patients about CAM practices. Most of the providers acknowledged that they lack information about CAM, and are concerned about the drug interaction as well as the effects of CAM on adherence. Our findings have important implications for understanding provider communication surrounding CAM use in a highly transnational population and context. Because CAM use may undermine ART adherence and is highly prevalent among Latinos, provider communication about CAM is critical to improved health outcomes among HIV-positive Latinos. Considering the significant growth of US Latinos, especially in the US-Mexico border region, assessment of Mexican and US provider training and communication needs surrounding Latino patient CAM use is warranted.
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Affiliation(s)
- Fátima A Muñoz
- Division of Global Public Health, Department of Medicine, University of California, San Diego, la Jolla, CA, USA
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20
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Beer L, Heffelfinger J, Frazier E, Mattson C, Roter B, Barash E, Buskin S, Rime T, Valverde E. Use of and Adherence to Antiretroviral Therapy in a Large U.S. Sample of HIV-infected Adults in Care, 2007-2008. Open AIDS J 2012; 6:213-23. [PMID: 23056163 PMCID: PMC3465862 DOI: 10.2174/1874613601206010213] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/24/2011] [Accepted: 07/21/2011] [Indexed: 11/22/2022] Open
Abstract
Background: Antiretroviral therapy (ART) is the cornerstone of HIV clinical care and is increasingly recognized as a key component of HIV prevention. However, the benefits of ART can be realized only if HIV-infected persons maintain high levels of adherence. Methods: We present interview data (collected from June 2007 through September 2008) from a national HIV surveillance system in the United States—the Medical Monitoring Project (MMP)—to describe persons taking ART. We used multivariate logistic regression to assess behavioral, sociodemographic, and medication regimen factors associated with three measures that capture different dimensions of nonadherence to ART: dose, schedule, and instruction. Results: The use of ART among HIV-infected adults in care was high (85%), but adherence to ART was suboptimal and varied across the three measures of nonadherence. Of MMP participants currently taking ART, the following reported nonadherence during the past 48 hours: 13% to dose, 27% to schedule, and 30% to instruction. The determinants of the three measures also varied, although younger age and binge drinking were associated with all aspects of nonadherence. Conclusion: Our results support the measurement of multiple dimensions of medication-taking behavior in order to avoid overestimating adherence to ART.
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Affiliation(s)
- Linda Beer
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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21
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Tumwine C, Neema S, Wagner G. Reasons Why High Religiosity Can Co-exist with and Precipitate Discontinuation of Anti-retroviral Therapy among Different HIV Clients in Uganda: An Exploratory Study. RELIGIONS 2012; 3:817-832. [PMID: 24432189 PMCID: PMC3890424 DOI: 10.3390/rel3030817] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In-depth interviews were conducted with 39 very religious people living with HIV (16 had ever and 23 had never discontinued antiretroviral therapy-ART) to assess the role of religion in these treatment decisions and in coping with HIV. Participants who had ever discontinued ART gave reasons such as: teachings and prophecies from religious leaders, and supporting Biblical scriptures all of which led them to feel that God and their faith, not ART, would help them; and testimonies by their "already healed" peers who had stopped ART. Participants who had never discontinued ART gave reasons such as continuous adherence counseling from multiple sources, improvement in physical health as a result of ART, and beliefs that God heals in different ways and that non-adherence is equal to putting God to a test. High religiosity was reported to help participants cope with HIV through engagement in personal and or community protective behaviours, "taking care of other illness", and reducing worries. When high religiosity among people living with HIV (PHAs) becomes a barrier to ART adherence, the adherence counseling provided can draw on experiences of PHAs with high religiosity who have sustained good adherence to ART and achieved good health outcomes.
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Affiliation(s)
- Christopher Tumwine
- Infectious Diseases Institute, Makerere University, P.O. Box 22184, Kampala, Uganda
- Author to whom correspondence should be addressed;
| | - Stella Neema
- Department of Sociology and Anthropology, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Glenn Wagner
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA
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22
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Beer L, Fagan JL, Garland P, Valverde EE, Bolden B, Brady KA, Courogen M, Hillman D, Neaigus A, Bertolli, for the Never in Care Pro J. Medication-related barriers to entering HIV care. AIDS Patient Care STDS 2012; 26:214-21. [PMID: 22320266 DOI: 10.1089/apc.2011.0407] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Early entry to HIV care and receipt of antiretroviral therapy improve the health of the individual and decrease the risk of transmission in the community. To increase the limited information on prospective decisions to enter care and how these decisions relate to beliefs about HIV medications, we analyzed interview data from the Never in Care Project, a multisite project conducted in Indiana, New Jersey, New York City, Philadelphia, and Washington State. From March 2008 through August 2010, we completed structured interviews with 134 persons with no evidence of HIV care entry, 48 of whom also completed qualitative interviews. Many respondents believed that HIV care entails the passive receipt of medications that may be harmful or unnecessary, resulting in reluctance to enter care. Respondents voiced concerns about prescription practices and preserving future treatment options, mistrust of medications and medical care providers, and ambivalence about the life-preserving properties of medications in light of an assumed negative impact on quality of life. Our results support the provision of information on other benefits of care (beyond medications), elicitation of concerns about medications, and assessment of psychosocial barriers to entering care. These tasks should begin at the time a positive test result is delivered and continue throughout the linkage-to-care process; for persons unwilling to enter care immediately, support should be provided in nonmedical settings.
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Affiliation(s)
- Linda Beer
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer L. Fagan
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pamela Garland
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
- P3S Corporation, San Antonio, Texas
| | - Eduardo E. Valverde
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barbara Bolden
- New Jersey Department of Health and Senior Services, Trenton, New Jersey
| | - Kathleen A. Brady
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Maria Courogen
- Washington State Department of Health, Olympia, Washington
| | - Daniel Hillman
- Indiana State Department of Health, Indianapolis, Indiana
| | - Alan Neaigus
- New York City Department of Health and Mental Hygiene, New York, New York
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23
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Ironson G, Stuetzle R, Ironson D, Balbin E, Kremer H, George A, Schneiderman N, Fletcher MA. View of God as benevolent and forgiving or punishing and judgmental predicts HIV disease progression. J Behav Med 2011; 34:414-25. [PMID: 21340531 DOI: 10.1007/s10865-011-9314-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 01/06/2011] [Indexed: 11/28/2022]
Abstract
This study assessed the predictive relationship between View of God beliefs and change in CD4-cell and Viral Load (VL) in HIV positive people over an extended period. A diverse sample of HIVseropositive participants (N = 101) undergoing comprehensive psychological assessment and blood draws over the course of 4 years completed the View of God Inventory with subscales measuring Positive View (benevolent/forgiving) and Negative View of God (harsh/judgmental/punishing). Adjusting for initial disease status, age, gender, ethnicity, education, and antiretroviral medication (at every 6-month visit), a Positive View of God predicted significantly slower disease-progression (better preservation of CD4-cells, better control of VL), whereas a Negative View of God predicted faster disease-progression over 4 years. Effect sizes were greater than those previously demonstrated for psychosocial variables known to predict HIV-disease-progression, such as depression and coping. Results remained significant even after adjusting for church attendance and psychosocial variables (health behaviors, mood, and coping). These results provide good initial evidence that spiritual beliefs may predict health outcomes.
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Affiliation(s)
- Gail Ironson
- Department of Psychology, University of Miami, Coral Gables, FL 33146, USA.
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24
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Hoogbruin A. Complementary and alternative therapy (CAT) use and highly active antiretroviral therapy (HAART): current evidence in the literature, 2000-2009. J Clin Nurs 2011; 20:925-39. [PMID: 21306453 DOI: 10.1111/j.1365-2702.2010.03322.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM AND OBJECTIVE To determine current evidence about the use of complementary and alternative medicine in the context of highly active antiretroviral therapy. The following objectives included identifying the risks and benefits of using complementary and alternative medicine when living with the human immunodeficiency virus (HIV) and taking such medications. BACKGROUND In Canada and the USA, HIV/AIDS service organisations recognise that people affected or infected by HIV are increasingly choosing to use complementary and alternative medicine to cope with this disease. These same organisations advocate for increased access to complementary and alternative medicine and more information about the safe use of complementary and alternative medicine to make informed decisions. Based on the increased integral use of complementary and alternative medicine and conventional medicine in Canada and the USA, the literature review was limited to these two countries. DESIGN Systematic review. METHOD Available full-text abstracts published in English from 2000-2009 were retrieved by electronic searches of selected databases, including the websites of Health Canada and American National Center for Complementary and Alternate Medicine (NCCAM). Forty studies were examined and were categorised by referring to the NCCAM (2007) four types of complementary and alternative medicine. RESULTS Insufficient evidence exists to support the use of a particular complementary and alternate therapy to enhance the management of HIV disease. CONCLUSION Decisions about using complementary and alternative medicine in conjunction with highly active antiretroviral therapy are often poorly informed. Safety risks and potential drug interactions are frequently ignored as people who use highly active antiretroviral therapy prefer to focus on the physical and mental benefits of using selected complementary and alternate therapies to promote their quality of life. RELEVANCE TO CLINICAL PRACTICE As life expectancy increases, from the use of highly active antiretroviral therapy, it is important for health professionals like nurses to be knowledgeable about the prevention, assessment and treatment of HIV symptoms and treatment side effects. Given the increased trend of using complementary and alternative medicine by the general population, it is also important to understand the appropriate use of complementary and alternative medicine for symptom management in HIV/AIDS care.
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Affiliation(s)
- Amandah Hoogbruin
- Faculty of Community & Health Studies, Kwantlen Polytechnic University, Surrey, BC, Canada.
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25
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Abstract
HIV treatment guidelines state that patients' readiness should be assessed before initiating highly active antiretroviral therapy (HAART) to assure adherence. None of the guidelines provide a way to measure readiness. Therefore, this article sought to review the literature on readiness to determine if there was a viable predictor of adherence. Twenty-seven articles were reviewed. Nine described studies that examined the relationship between a measure of readiness and HAART adherence. No readiness measure demonstrated clinical utility as a predictor of adherence. Study flaws included small sample sizes (only one study >100 patients), short follow-up periods (all ≤1 year and six were ≤5 months, four ≤1 month), measures of readiness that related poorly to adherence, and inconsistent adherence measures (eight different measures were used by the researchers). Neither the guidelines nor the literature will help clinicians judge who should initiate HAART and who should delay treatment.
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Affiliation(s)
- Richard M Grimes
- Division of General Medicine, Department of Medicine, Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin, Houston, TX 77030, USA.
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26
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Mohammadpour A, Yekta ZP, Nikbakht Nasrabadi AR. HIV-infected patients' adherence to highly active antiretroviral therapy: a phenomenological study. Nurs Health Sci 2010; 12:464-9. [PMID: 21210925 DOI: 10.1111/j.1442-2018.2010.00560.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Adherence to the treatment regimen is essential to the success of highly active antiretroviral therapy for patients who are infected with HIV. The evidence suggests that poor adherence to antiretroviral drug therapy is a major problem that has the potential to diminish effective viral suppression, promote viral resistance, and place patients at risk for hospitalization, opportunistic infections, and an increased risk of HIV transmission. The primary aim of this study was to understand patients' experiences regarding their adherence to antiretroviral drug therapy. Thus, 19 participants were recruited for in-depth interviews regarding their adherence to drug regimens. All the interviews were transcribed verbatim and analyzed by using Benner's phenomenological analysis approach. Four main themes emerged from the data: (i) choosing to live and the decision to start taking medications; (ii) strategies for adhering to the regimen and managing the side-effects; (iii) relationships with healthcare providers; and (iv) advantages of the medications as a motivator to continue one's adherence to the regimen. Studying and understanding the experiences of patients can provide new insights and strategies in order to enhance patients' adherence to highly active antiretroviral therapy.
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Affiliation(s)
- Ali Mohammadpour
- Department of Nursing, Gonabad University of Medical Sciences, Gonabad, Iran.
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27
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Rahmati-Najarkolaei F, Niknami S, Aminshokravi F, Bazargan M, Ahmadi F, Hadjizadeh E, Tavafian SS. Experiences of stigma in healthcare settings among adults living with HIV in the Islamic Republic of Iran. J Int AIDS Soc 2010; 13:27. [PMID: 20649967 PMCID: PMC2919446 DOI: 10.1186/1758-2652-13-27] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 07/22/2010] [Indexed: 11/10/2022] Open
Abstract
Background People living with HIV (PLHIV) sometimes experience discrimination. There is little understanding of the causes, forms and consequences of this stigma in Islamic countries. This qualitative study explored perceptions and experiences of PLHIV regarding both the quality of healthcare and the attitudes and behaviours of their healthcare providers in the Islamic Republic of Iran. Methods In-depth, semi-structured interviews were held with a purposively selected group of 69 PLHIV recruited from two HIV care clinics in Tehran. Data were analyzed using the content analysis approach. Results and discussion Nearly all participants reported experiencing stigma and discrimination by their healthcare providers in a variety of contexts. Participants perceived that their healthcare providers' fear of being infected with HIV, coupled with religious and negative value-based assumptions about PLHIV, led to high levels of stigma. Participants mentioned at least four major forms of stigma: (1) refusal of care; (2) sub-optimal care; (3) excessive precautions and physical distancing; and (4) humiliation and blaming. The participants' healthcare-seeking behavioural reactions to perceived stigma and discrimination included avoiding or delaying seeking care, not disclosing HIV status when seeking healthcare, and using spiritual healing. In addition, emotional responses to perceived acts of stigma included feeling undeserving of care, diminished motivation to stay healthy, feeling angry and vengeful, and experiencing emotional stress. Conclusions While previous studies demonstrate that most Iranian healthcare providers report fairly positive attitudes towards PLHIV, our participants' experiences tell a different story. Therefore, it is imperative to engage both healthcare providers and PLHIV in designing interventions targeting stigma in healthcare settings. Additionally, specialized training programmes in universal precautions for health providers will lead to stigma reduction. National policies to strengthen medical training and to provide funding for stigma-reduction programming are strongly recommended. Investigating Islamic literature and instruction, as well as requesting official public statements from religious leaders regarding stigma and discrimination in healthcare settings, should be used in educational intervention programmes targeting healthcare providers. Finally, further studies are needed to investigate the role of the physician and religion in the local context.
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Affiliation(s)
| | - Shamsaddin Niknami
- Department of Family Medicine, Charles Drew University of Medicine and Science, Los Angeles, California, USA
| | | | - Mohsen Bazargan
- Health Education Department, Tarbiat Modares University, Tehran, Iran
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Shacham E, Nurutdinova D, Onen N, Stamm K, Overton ET. The interplay of sociodemographic factors on virologic suppression among a U.S. outpatient HIV clinic population. AIDS Patient Care STDS 2010; 24:229-35. [PMID: 20397898 DOI: 10.1089/apc.2009.0275] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Understanding challenges to virologic suppression is essential to optimizing health outcomes among individuals with HIV. This cross-sectional behavioral assessment was conducted among 514 individuals presenting at an urban U.S. HIV clinic between June and September 2007. The majority of the sample was African American and male, with a mean age of 42 years. Most of the sample was receiving highly active antiretroviral therapy (HAART), and the majority of those had suppressed viral loads (HIV viral loads less than 400 copies per milliliter). By logistic regression analyses, African American/other minorities had 2.9 increased odds, those less than high school degree had 2.3 increased odds, those who were receiving ritonavir-boosted protease inhibitor therapy had 1.4 increased odds, and those who had expressed symptoms indicative of depressive disorders had 2.5 increased odds of having unsuppressed viremia as compared to Caucasians, those with more education, receiving non-nucleoside reverse transcriptase inhibitor-based therapy, and who had minimal depressive symptoms, respectively. These findings signify the importance of individualized interventions to enhance virologic suppression, both based on medication choices and individual characteristics.
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Affiliation(s)
- Enbal Shacham
- Health Communication Research Laboratory, George Warren Brown School of Social Work, Washington University, St. Louis, Missouri
| | - Diana Nurutdinova
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- St. Louis Veterans Administration, St. Louis, Missouri
| | - Nur Onen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Katelin Stamm
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - E. Turner Overton
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Ironson G, Kremer H. Spiritual transformation, psychological well-being, health, and survival in people with HIV. Int J Psychiatry Med 2010; 39:263-81. [PMID: 19967899 DOI: 10.2190/pm.39.3.d] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Although Spiritual Transformation (ST) occurs in a sizable proportion of people with HIV (about 39%), there is little research on the potential benefits of ST with respect to psychological well-being, health, and survival in this population. Our study attempts to fill this gap. METHOD Using a mixed method approach, we related interviews of 147 people with HIV (identifying the presence/absence of ST) to questionnaires measuring demographics, medical history, treatment adherence, physical symptoms, and psychological well-being (i.e., stress, coping, life attitude, and spirituality), and assessments of CD4-counts and viral load and survival 3 to 5 years later. RESULTS At comparable times since HIV-diagnosis and antiretroviral medications prescribed, the presence of ST was significantly associated with better treatment success (undetectable viral loads, higher CD4 counts), better medication adherence, fewer symptoms, less distress, more positive coping, different life attitudes (i.e., existential transcendence, meaning/purpose in life, optimism, death acceptance), more spiritual practices, and increased spirituality. ST was also associated with substance-use recovery and with being African American. Survival up to 5 years was 5.35 times more likely among participants with ST (p(f) = .044). According to a Cox-regression adjusted for baseline CD4-counts, age, race-ethnicity, gender, education, years since HIV-diagnosis, and a history of substance-use problems, ST still reduced the risk of death (HR = 0.07, 95% CI = 0.01-0.53, p = .010). CONCLUSIONS ST has associated benefits for psychological well-being, health, and survival.
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Affiliation(s)
- Gail Ironson
- Department of Psychology, University of Miami, Coral Gables, Florida 33124, USA.
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Kremer H, Ironson G, Kaplan L. The fork in the road: HIV as a potential positive turning point and the role of spirituality. AIDS Care 2009; 21:368-77. [DOI: 10.1080/09540120802183479] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- H. Kremer
- a Department of Psychology , University of Miami , Coral Gables , FL , USA
| | - G. Ironson
- a Department of Psychology , University of Miami , Coral Gables , FL , USA
| | - L. Kaplan
- a Department of Psychology , University of Miami , Coral Gables , FL , USA
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Cauldbeck MB, O'Connor C, O'Connor MB, Saunders JA, Rao B, Mallesh VG, Praveen Kumar NK, Mamtha G, McGoldrick C, Laing RBS, Satish KS. Adherence to anti-retroviral therapy among HIV patients in Bangalore, India. AIDS Res Ther 2009; 6:7. [PMID: 19400929 PMCID: PMC2681471 DOI: 10.1186/1742-6405-6-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 04/28/2009] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Human Immunodeficiency Virus (HIV) has an estimated prevalence of 0.9% in India (5.2 million). Anti-retroviral drugs (ARV) are the treatments of choice and non-adherence is an important factor in treatment failure and development of resistance, as well as being a powerful predictor of survival. This study assesses adherence to ARV in HIV positive patients in Bangalore, India, a country where only 10% of those who need therapy are receiving it. METHODS A cross-sectional anonymous questionnaire survey of 60 HIV antibody positive patients was carried out with patients attending HIV outpatient services at two centres: The Chest and Maternity Centre, Rajajinagar, and Wockhardt Hospital and Heart Institute, Bangalore. Consent was obtained. Translation was done by a translator and doctors where required. Data was analysed using SPSS statistical analysis. RESULTS A response rate of 88% (53/60) was achieved. The mean patient age was 39.98 years, with 50% aged 30-40, and 73.6% of participants being male. Mean family size was 4.8 (1-13). 21% lived less than 50 kms and 21% greater than 400 kms from clinic.60% reported they were fully adherent. Adherence was statistically significantly linked to regular follow-up attendance (70.5%, p = 0.002). No other results were statistically significant but trends were found. "100% adherence" trends were seen in older patients, male gender, those from larger families, those who had a previous AIDS defining illness, those taking fewer tablets, and without food restrictions. Commonest side-effects causing non-adherence were metabolic reasons (66%) and GI symptoms (50%). No trends were seen for education level, family income, distance travelled to clinic, time since diagnosis, or time on ART. CONCLUSION Regular attendance for follow up was statistically significant for 100% lifetime adherence. Positive trends were seen in those in larger families, older, those who had AIDS defining illness, simple regimes, and without side-effects. Education, income, distance travelled and length of time diagnosed or treated had no effect on adherence.
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Affiliation(s)
- Mary B Cauldbeck
- The School of Medicine, University of Aberdeen, Aberdeen, Scotland, UK
| | - Catherine O'Connor
- GU/STD Clinics, Department of GU/STD Medicine, Mid-Western Regional Hospital, Limerick, Ireland
| | - Mortimer B O'Connor
- Department of Medicine, South Infirmary – Victoria University Hospital, Cork, Ireland
- The School of Medicine, University College Cork, Cork, Ireland
| | - Jean A Saunders
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Bhimasena Rao
- Department of Respiratory and HIV Medicine, Rajajinagar and Wockhardt Hospital and Heart Institute, Bangalore, India
| | - V G Mallesh
- Department of Respiratory and HIV Medicine, Rajajinagar and Wockhardt Hospital and Heart Institute, Bangalore, India
| | | | - Gurushanthappa Mamtha
- Department of Respiratory and HIV Medicine, Rajajinagar and Wockhardt Hospital and Heart Institute, Bangalore, India
| | - Claire McGoldrick
- Infection Unit, Department of Infectious Diseases, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | - Robert BS Laing
- Infection Unit, Department of Infectious Diseases, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | - Kadappa Shivappa Satish
- Department of Respiratory and HIV Medicine, Rajajinagar and Wockhardt Hospital and Heart Institute, Bangalore, India
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Kremer H, Sonnenberg-Schwan U, Arendt G, Brockmeyer NH, Potthoff A, Ulmer A, Graefe K, Lorenzen T, Starke W, Walker UA. HIV or HIV-therapy? Causal attributions of symptoms and their impact on treatment decisions among women and men with HIV. Eur J Med Res 2009; 14:139-46. [PMID: 19380286 PMCID: PMC3401004 DOI: 10.1186/2047-783x-14-4-139] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 03/04/2009] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Among people with HIV, we examined symptom attribution to HIV or HIV-therapy, awareness of potential side effects and discontinuation of treatment, as well as sex/gender differences. METHODS HIV-patients (N=168, 46% female) completed a comprehensive symptom checklist (attributing each endorsed symptom to HIV, HIV-therapy, or other causes), reported reasons for treatment discontinuations and potential ART-related laboratory abnormalities. RESULTS Main symptom areas were fatigue/sleep/energy, depression/mood, lipodystrophy, and gastrointestinal, dermatological, and neurological problems. Top HIV-attributed symptoms were lack of stamina/energy in both genders, night sweats, depression, mood swings in women; and fatigue, lethargy, difficulties concentrating in men. Women attributed symptoms less frequently to HIV than men, particularly fatigue (p<.01). Top treatment-attributed symptoms were lipodystrophy and gastrointestinal problems in both genders. Symptom attribution to HIV-therapy did not differ between genders. Over the past six months, 22% switched/interrupted ART due to side effects. In women, side effect-related treatment decisions were more complex, involving more side effects and substances. Remarkably, women took predominantly protease inhibitor-sparing regimens (p=.05). Both genders reported only 15% of potential ART-related laboratory abnormalities but more than 50% had laboratory abnormalities. Notably, women had fewer elevated renal parameters (p<.01). CONCLUSIONS Men may attribute symptoms more often to HIV and maintain a treatment-regimen despite side effects, whereas women may be more prudent in avoiding treatment side effects. Lacking awareness of laboratory abnormalities in both genders potentially indicates gaps in physician-patient communication. Gender differences in causal attributions of symptoms/side effects may influence treatment decisions.
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Affiliation(s)
- H Kremer
- All Around Women Special, German AIDS Society, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
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Kremer H, Ironson G, Porr M. Spiritual and mind-body beliefs as barriers and motivators to HIV-treatment decision-making and medication adherence? A qualitative study. AIDS Patient Care STDS 2009; 23:127-34. [PMID: 19133751 DOI: 10.1089/apc.2008.0131] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
We examined spiritual/mind-body beliefs related to treatment decision-making and adherence in 79 HIV-positive people (35% female, 41% African American, 22% Latino, 24% White) who had been offered antiretroviral treatment by their physicians. Interviews (performed in 2003) identified spiritual/mind-body beliefs; the Adult AIDS Clinical Trials Group (ACTG) questionnaire assessed adherence and symptoms/side effects. Decision-making was influenced by health-related spiritual beliefs (e.g., calling on God/Higher Power for help/protection, God/Higher Power controls health) and mind-body beliefs (e.g., mind controls body, body tells when medication is needed). Participants believing God/Higher Power controls health were 4.75 times more likely to refuse, and participants with mind-body beliefs related to decision-making were 5.31 times more likely to defer antiretrovirals than those without those beliefs. Participants believing spirituality helps coping with side effects reported significantly better adherence and fewer symptoms/side effects. Fewer symptoms/side effects were significantly associated with the beliefs mind controls body, calling on God/Higher Power for help/protection, and spirituality helps adherence. Spiritual/mind-body beliefs as barriers or motivators to taking or adhering to treatment are important, since they may affect survival and quality of life of HIV-positive people.
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Affiliation(s)
- Heidemarie Kremer
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Gail Ironson
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Martina Porr
- Department of Psychology, University of Miami, Coral Gables, Florida
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Littlewood RA, Vanable PA. Complementary and alternative medicine use among HIV-positive people: research synthesis and implications for HIV care. AIDS Care 2008; 20:1002-18. [PMID: 18608078 DOI: 10.1080/09540120701767216] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Use of complementary and alternative medicine (CAM) is prevalent among HIV-positive individuals despite the success of antiretroviral treatments and limited evidence of CAM's safety and efficacy. To characterize the potential impact of CAM use on HIV care, we conducted a systematic review of 40 studies of CAM use among HIV-positive people. The goals of this review are to: (1) describe the demographic, biomedical, psychosocial and health behavior correlates of CAM use; (2) characterize patient-reported reasons for CAM use; and (3) identify methodological and conceptual limitations of the reviewed studies. Findings confirm that a high proportion of HIV-positive individuals report CAM use (M=60%). Overall, CAM use is more common among HIV-positive individuals who are men who have sex with men (MSM), non-minority, better educated and less impoverished. The use of CAM is also associated with greater HIV-symptom severity and longer disease duration. HIV-positive CAM users commonly report that they use CAM to prevent or alleviate HIV-related symptoms, reduce treatment side-effects and improve quality of life. Findings regarding the association between CAM use, psychosocial adjustment and adherence to conventional HIV medications are mixed. While the reviewed studies are instrumental in describing the characteristics of HIV-positive CAM users, this literature lacks a conceptual framework to identify causal factors involved in the decision to use CAM or explain implications of CAM use for conventional HIV care. To address this concern, we propose the use of health behavior theory and discuss implications of review findings for HIV care providers.
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Affiliation(s)
- Rae A Littlewood
- Department of Psychology and Center for Health and Behavior, Syracuse University, Syracuse, US.
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Sordo del Castillo L, Ruiz Pérez I, Olry Labry de Lima A, Soto Blanco JM, Antón Basanta JJ, Girela López E, Castro Recio JM. [Factors related to refuse antiretroviral therapy in prison]. GACETA SANITARIA 2008; 22:120-7. [PMID: 18420009 DOI: 10.1157/13119319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Despite the benefits of highly-active antiretroviral therapy (HAART) on morbidity and mortality, some seropositive patients refuse to accept this treatment. Prisons provide easier access to this population. OBJECTIVE To determine the psychosocial characteristics of prisoners who refuse HAART. METHODS We performed a cross-sectional study in 580 seropositive prisoners in 3 hospitals in Andalusia (Spain). The dependent variable was being under treatment or refusal to be so. The independent variables were sociodemographic and psychosocial factors related to the prison environment and clinical factors related to health status and drug addiction. A logistic regression analysis was performed to determine which factors were related with refusal to accept HAART. RESULTS HAART was recommended to 73.1% of seropositive prisoners. This treatment was refused by 23.1% of these prisoners and was accepted by 76.9%. The factors related to refusal to accept HAART were high viral load, worse self-perceived health status, a greater number of stays in prison, and being visited by persons other than relatives. CONCLUSIONS There is a group of prisoners with specific characteristics that refuse HAART. Specific interventions should be performed in these prisoners to make them aware of the effects of their decision on the course of their disease.
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Affiliation(s)
- Luis Sordo del Castillo
- Servicio de Medicina Preventiva, Hospital Universitario Virgen de las Nieves de Granada, Granada, Spain
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Mascolini M, Zuniga JM. Perceptions of health, HIV disease, and HIV treatment by patients in 6 regions: analysis of the 2555-person AIDS treatment for life international survey. ACTA ACUST UNITED AC 2008; 7:160-77. [PMID: 18626118 DOI: 10.1177/1545109708322728] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART) has reached millions of HIV-infected patients worldwide, however very little is known about their perceptions about HIV disease and its treatment. The AIDS Treatment for Life International Survey (ATLIS) is the largest sampling of patient perceptions about HIV disease and its treatment, as well as their behaviors, including HIV status disclosure and ART adherence. METHODS The International Association of Physicians in AIDS Care (IAPAC) and its survey vendor, Ipsos Insight Health, conducted a convenience-sample survey of 2555 treated and untreated HIV-infected adults recruited by diverse means from 6 regions: North America, Latin America, the Caribbean, Europe, Asia/Pacific, and sub-Saharan Africa. FINDINGS Nearly three quarters of respondents were taking prescription medications for HIV infection or related diseases. Participants reported generally good overall health and high degrees of satisfaction with current antiretroviral drugs, though approximately half of respondents voiced concern about potential ART toxicity and 39.4% reported switching their antiretroviral regimen specifically because of treatment-associated side effects. About 1 in 5 respondents never took medications for HIV and AIDS. Among the three quarters of respondents currently taking medications, 37% are taking their first prescribed antiretroviral regimen, and 24% have switched from a first-line antiretroviral regimen. Three quarters of respondents believe ART will help them live a long life, and treatment-experienced respondents expressed this view significantly more often than untreated respondents. Large majorities of respondents in Latin America, Asia, and South Africa want to know more about ART, while half or fewer in these countries correctly explained the meaning of undetectable HIV RNA (defined as <50 HIV RNA copies/mL of plasma) or knew their CD4 cell count.
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Affiliation(s)
- Mark Mascolini
- International Association of Physicians in AIDS Care (IAPAC), Chicago, IL, USA
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Abstract
Adding to a traditional stress perspective, behavioral medicine has been focusing increasingly on investigating the potential impact of positive psychosocial factors on disease course in HIV. Dispositional optimism, active coping, and spirituality show the most evidence for predicting slower disease progression, although the data are not entirely consistent. Findings for the role of social support are mixed, although indications are that it may be particularly helpful at later stages of illness. Many of the other constructs (positive affect, finding meaning, emotional expression/processing, openness, extraversion, conscientiousness, altruism, and self-efficacy) have only been examined in one or two studies; results are preliminary but suggestive of protective effects. Plausible behavioral and biological mechanisms are discussed (including health behaviors, neurohormones, and immune measures) as well as suggestions for clinicians, limitations, future directions, and a discussion of whether these constructs can be changed. In conclusion, investigating the importance and usefulness of positive psychosocial factors in predicting disease progression in HIV is in its beginning scientific stages and shows good initial evidence and future promise.
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Moyle G, Gatell J, Perno CF, Ratanasuwan W, Schechter M, Tsoukas C. Potential for new antiretrovirals to address unmet needs in the management of HIV-1 infection. AIDS Patient Care STDS 2008; 22:459-71. [PMID: 18479200 DOI: 10.1089/apc.2007.0136] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Despite the myriad advances in antiretroviral therapy since the original highly active antiretroviral therapy regimens were developed, there remain numerous important and pressing unmet needs that, if addressed, would substantially improve the quality of life and longevity of HIV-infected patients. The most achievable goals of antiretroviral (ARV) therapy in the near future are likely to be continued reduction in HIV-related morbidity and mortality; improved quality of life; and restoration and preservation of immune function: all of which are most effectively achieved through sustained suppression of HIV-1 RNA. The ability to achieve long-term viral load reduction will require new ARVs with few, manageable toxicities, and medications that are convenient to adhere to, with few drug interactions. This is particularly true for the large number of highly treatment-experienced patients in whom HIV has developed resistance to one or more ARVs. Development of therapies that allow convenient dosing schedules, that do not necessitate strict adherence to meal-related timing restrictions, and that remain active in the face of resistance mutations is paramount, and remains a significant unmet need. Of the large number of ARVs currently in development, this article focuses on three agents recently approved that have shown particular promise in addressing some of these unmet needs: the novel non-nucleoside reverse transcriptase inhibitor etravirine; the CCR5 antagonist maraviroc; and the integrase inhibitor raltegravir.
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Affiliation(s)
- Graeme Moyle
- HIV Research Chelsea & Westminster Hospital, London, United Kingdom
| | - Jose Gatell
- Infectious Diseases & AIDS Unit, University of Barcelona, Barcelona, Spain
| | - Carlo-Federico Perno
- Department of Experimental Medicine, University of Rome, “Tor Vergata,” Rome, Italy
| | - Winai Ratanasuwan
- Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Mauro Schechter
- AIDS Research Laboratory, Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Christos Tsoukas
- Division of Clinical Immunology, Immune Deficiency Treatment Centre, McGill University, Montreal, Quebec, Canada
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Beliefs about HIV disease and medication adherence in persons living with HIV/AIDS in rural southeastern North Carolina. J Assoc Nurses AIDS Care 2008; 19:127-36. [PMID: 18328963 DOI: 10.1016/j.jana.2007.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2007] [Accepted: 08/31/2007] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to assess personal beliefs about the causes and meaning of having HIV disease and personal beliefs about medication adherence in persons living in rural southeastern North Carolina. Of the total sample of 34 participants, 29 (85%) were African American. The sample included 21 men (62%) and 13 women (38%), with a self-reported mean CD4 count of 499.38 (SD = 377.69) and a mean duration of HIV of 8.0 years. The majority of participants held beliefs that HIV was a serious and chronic condition and that the disease could be controlled by HIV therapies. Participants offered disparate views about whether or not the course of HIV disease was amenable to personal control. The persons who held the belief that the cause of HIV/AIDS was because of chance/bad luck (p = .03) or God's will (p < .001) were also most likely to believe that the progression of their HIV disease depended on chance or fate. The respondents currently taking HIV medication were also more likely to believe that HIV was caused by chance or bad luck (p = .038) or God's will (p = .016). The results reflect the important role of spirituality on self- regulation of illness and treatment in the rural southern culture.
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Munoz-Plaza CE, Strauss S, Astone-Twerell J, Jarlais DD, Gwadz M, Hagan H, Osborne A, Rosenblum A. Exploring drug users' attitudes and decisions regarding hepatitis C (HCV) treatment in the U.S. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19:71-8. [PMID: 18312822 PMCID: PMC2698452 DOI: 10.1016/j.drugpo.2007.02.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Revised: 01/09/2007] [Accepted: 02/12/2007] [Indexed: 02/09/2023]
Abstract
Individuals with a history of injecting drugs are at the highest risk of becoming infected with the hepatitis C virus (HCV), with studies of patients in methadone maintenance treatment programmes (MMTPs) reporting that 60-90 percent of intravenous drug users (IDUs) have the virus. Fortunately, HCV therapy has been shown to be effective in 42-82 percent of all patients with chronic HCV infection, including IDUs. While the decision to start HCV therapy requires significant consideration, little research exists that explores the attitudes of drug users toward HCV therapy. Therefore, this paper examines how drug users perceive the treatment, as well as the processes by which HCV-positive individuals examined the advantages and disadvantages of starting the HCV medications. Interviews were conducted with 164 patients from 14 drug treatment programmes throughout the United States, and both uninfected and HCV-positive drug users described a pipeline of communication among their peers that conveys largely negative messages about the medications that are available to treat HCV. Although many of the HCV-positive individuals said that these messages heightened their anxiety about the side effects and difficulties of treatment, some patients said that their peers helped them to consider, initiate HCV treatment or both. Gaining a better understanding of drug users' perceptions of HCV treatment is important, because so many of them, particularly IDUs, are already infected with HCV and may benefit from support in addressing their HCV treatment needs. In addition, currently uninfected drug users will likely remain at high risk for contracting HCV and may need to make decisions about whether or not to start the HCV medical regimen in the future.
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Affiliation(s)
- Corrine E. Munoz-Plaza
- National Development and Research Institutes, Inc., 71 West 23 Street, 8 Floor, New York, NY 10010; tel. 212.845.4537; fax 917.438.0894; email, respectively: ; ; ; ; ; ;
| | - Shiela Strauss
- National Development and Research Institutes, Inc., 71 West 23 Street, 8 Floor, New York, NY 10010; tel. 212.845.4537; fax 917.438.0894; email, respectively: ; ; ; ; ; ;
| | - Janetta Astone-Twerell
- National Development and Research Institutes, Inc., 71 West 23 Street, 8 Floor, New York, NY 10010; tel. 212.845.4537; fax 917.438.0894; email, respectively: ; ; ; ; ; ;
| | - Don Des Jarlais
- Beth Israel Medical Center, First Avenue at 16 Street, New York, NY 10003; tel. 212.523.8390; fax 212.256.2570; email
| | - Marya Gwadz
- National Development and Research Institutes, Inc., 71 West 23 Street, 8 Floor, New York, NY 10010; tel. 212.845.4537; fax 917.438.0894; email, respectively: ; ; ; ; ; ;
| | - Holly Hagan
- National Development and Research Institutes, Inc., 71 West 23 Street, 8 Floor, New York, NY 10010; tel. 212.845.4537; fax 917.438.0894; email, respectively: ; ; ; ; ; ;
| | - Andrew Osborne
- National Development and Research Institutes, Inc., 71 West 23 Street, 8 Floor, New York, NY 10010; tel. 212.845.4537; fax 917.438.0894; email, respectively: ; ; ; ; ; ;
| | - Andrew Rosenblum
- National Development and Research Institutes, Inc., 71 West 23 Street, 8 Floor, New York, NY 10010; tel. 212.845.4537; fax 917.438.0894; email, respectively: ; ; ; ; ; ;
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Sidat M, Fairley C, Grierson J. Experiences and perceptions of patients with 100% adherence to highly active antiretroviral therapy: a qualitative study. AIDS Patient Care STDS 2007; 21:509-20. [PMID: 17651032 DOI: 10.1089/apc.2006.0201] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A decade has passed since the introduction of highly active antiretroviral therapy (HAART) as standard of care for HIV/AIDS patients. The success of HAART is largely dependent on almost 100% adherence to it. In this study our primary aim was to understand from patients' own perspectives and experiences what resulted in them having 100% adherence to HAART. Thus, we purposefully recruited for in-depth interviews 10 participants (7 men and 3 women) with 100% adherence to HAART (>/=6 months previous to the interviews). All interviews were transcribed verbatim and analyzed by using Giorgi's phenomenological analysis approach. The following issues emerged from the analysis: readiness to go on HAART; HAART viewed as a life-line; maintenance of 100% adherence related with willingness to live longer and healthier; optimal ongoing patient-physician relationship, better coping and/or lack of perceived side effects; and improvements in clinical condition as well as in CD4 T-cells count and viral load reinforced the motivation to continue 100% adherence. The study findings should be helpful for health professionals caring for HIV-infected individuals on HAART.
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Affiliation(s)
- Mohsin Sidat
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia.
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Conway B. The Role of Adherence to Antiretroviral Therapy in the Management of HIV Infection. J Acquir Immune Defic Syndr 2007; 45 Suppl 1:S14-8. [PMID: 17525686 DOI: 10.1097/qai.0b013e3180600766] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite multiple studies demonstrating the relation between the success of highly active antiretroviral therapy (HAART) and adherence, inadequate adherence continues to be one of the most frequent reasons for poor treatment outcomes and/or lack of sustained treatment benefits. Interventions targeting patient-related social and psychologic barriers to adherence and issues related to mental health and substance abuse and access to health care may ameliorate their negative impact on adherence. Specific drug-related factors that influence adherence such as pill burden, dosing frequency, food requirements, and acute tolerability and safety concerns, however, are further issues that must be considered to optimize adherence. Fortunately, the availability of once-daily and coformulated agents with simple dosing requirements may help to improve adherence, and thereby make the difference between success and failure of HAART for some patients. A better understanding of adherence and its determinants and how to define specific goals in a given clinical setting are keys for clinicians to become more effective partners with patients in the achievement and maintenance of long-term virologic suppression and, more importantly, long-term health.
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Affiliation(s)
- Brian Conway
- Department of Pharmacology and Therapeutics, University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.
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Kremer H, Ironson G. To tell or not to tell: why people with HIV share or don't share with their physicians whether they are taking their medications as prescribed. AIDS Care 2006; 18:520-8. [PMID: 16777646 PMCID: PMC2614865 DOI: 10.1080/09540120600766020] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This qualitative study examines whether HIV-positive people (N = 79) tell their physicians whether they take antiretroviral treatment (ART) as prescribed and why. Interviews, analyzed with qualitative content-analysis, asked about taking/not taking ART and, if taking, whether they shared their reasons for non-adherence with their physician. Patients are more likely to inform physicians why they take than why they do not take ART (p<0.01). Only half of those not taking ART shared the reasons for their decision with their physician. The six motives were: anticipation that physicians will not support the decision, cannot discuss feelings, lack of trust in physician's opinion, unable to discuss spiritual/moral issues, no need for physician to know, and not seen physician yet. Of those taking ART, 21% did not tell their physician why they missed doses. The five motives were: not viewed as important, physician not asking, not seen physician yet, rarely non-adherent, no indications in surrogate markers. A significant proportion of patients are not taking their medications as prescribed and are not telling their physicians. To facilitate the chance that patients communicate with their physicians, physicians need to ask no need for and, while giving the patients medical information, create a non-judgmental, respectful atmosphere where patients feel comfortable sharing their personal view.
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Affiliation(s)
- H Kremer
- Department of Psychology, University of Miami, Coral Gables, FL 3324-2070, USA.
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