Individual Variability in Barriers Affecting People's Decision to Take HAART: A Qualitative Study Identifying Barriers to Being on HAART

Alfonso, Victoria; Bermbach, Nicole; Geller, Josie; Montaner, Julio S. G.

doi:10.1089/apc.2006.20.848

Cited by 27 publications

(19 citation statements)

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“…Others equated readiness with adherence to treatment or care [34–36•, 37•, 38]. For example, Wagner and colleagues [36•, 37•] measured readiness by which participants achieved >90% adherence as measured by an electronic monitoring device in a placebo trial.…”

Section: Resultsmentioning

confidence: 99%

Readiness: The State of the Science (or the Lack Thereof)

Grimes

2010

Curr HIV/AIDS Rep

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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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Section: Resultsmentioning

confidence: 99%

Readiness: The State of the Science (or the Lack Thereof)

Grimes

2010

Curr HIV/AIDS Rep

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“…Among patients who have entered HIV care, fear of side effects, mistrust of medications and health care workers, concerns about the effects of medications on quality of life, and a preference for alternative medicine and self-care have been associated with lower acceptance of ART, 11,[13][14][15][16][17][24][25][26] although at least one study found no association between conspiracy beliefs and access to care. 27 However, research on the role of mistrust of medications and health care workers as barriers to entering care has been limited.…”

Section: Discussionmentioning

confidence: 99%

“…14 These discussions should include a full assessment of the patient's values and sociocultural context as they relate to HIV care. 17 Although information about care and medications may be most accurately communicated by a medical provider, persons with negative perceptions of HIV medications may never enter a care relationship and therefore never have the opportunity to receive this information. In addition, as the experiences of NIC respondents indicate, they may not trust medical providers and thus prefer alternative therapies to information from the medical establishment.…”

Section: Discussionmentioning

confidence: 99%

“…For example, studies have documented reluctance to take ART and fears about medication side effects. [10][11][12][13][14][15][16][17] However, because almost all studies have focused on HIV-infected persons already engaged in medical care, little is known about how medication-related factors influence prospective decisions to enter care. 18,19 An important exception is a recent study by Pollini and colleagues 20 who found that, compared to those in care, persons who had never initiated HIV care were more likely to mistrust HIV medications and health care providers.…”

Section: Introductionmentioning

confidence: 99%

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Medication-Related Barriers to Entering HIV Care

Beer

Fagan²,

Garland³

et al. 2012

AIDS Patient Care and STDs

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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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“…At the individual level of influence primary barriers to HIV care/ART for AABH-PLWH include negative health beliefs such as medical distrust, negative outcome expectancies, low levels of “readiness” [48–52], and negative emotions about care/ART, including fear [53–55]. Indeed, the primacy of fear as a barrier; namely, fear of being pressured to take ART in health care settings, of ART’s side effects and toxicities, and possible negative effects on relationships if on ART, cannot be over-stated [56, 57].…”

Section: Methodsmentioning

confidence: 99%

Using the multiphase optimization strategy (MOST) to optimize an HIV care continuum intervention for vulnerable populations: a study protocol

et al. 2017

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BackgroundMore than half of persons living with HIV (PLWH) in the United States are insufficiently engaged in HIV primary care and not taking antiretroviral therapy (ART), mainly African Americans/Blacks and Hispanics. In the proposed project, a potent and innovative research methodology, the multiphase optimization strategy (MOST), will be employed to develop a highly efficacious, efficient, scalable, and cost-effective intervention to increase engagement along the HIV care continuum. Whereas randomized controlled trials are valuable for evaluating the efficacy of multi-component interventions as a package, they are not designed to evaluate which specific components contribute to efficacy. MOST, a pioneering, engineering-inspired framework, addresses this problem through highly efficient randomized experimentation to assess the performance of individual intervention components and their interactions. We propose to use MOST to engineer an intervention to increase engagement along the HIV care continuum for African American/Black and Hispanic PLWH not well engaged in care and not taking ART. Further, the intervention will be optimized for cost-effectiveness. A similar set of multi-level factors impede both HIV care and ART initiation for African American/Black and Hispanic PLWH, primary among them individual- (e.g., substance use, distrust, fear), social- (e.g., stigma), and structural-level barriers (e.g., difficulties accessing ancillary services). Guided by a multi-level social cognitive theory, and using the motivational interviewing approach, the study will evaluate five distinct culturally based intervention components (i.e., counseling sessions, pre-adherence preparation, support groups, peer mentorship, and patient navigation), each designed to address a specific barrier to HIV care and ART initiation. These components are well-grounded in the empirical literature and were found acceptable, feasible, and promising with respect to efficacy in a preliminary study.Methods/designStudy aims are: 1) using a highly efficient fractional factorial experimental design, identify which of five intervention components contribute meaningfully to improvement in HIV viral suppression, and secondary outcomes of ART adherence and engagement in HIV primary care; 2) identify mediators and moderators of intervention component efficacy; and 3) using a mathematical modeling approach, build the most cost-effective and efficient intervention package from the efficacious components. A heterogeneous sample of African American/Black and Hispanic PLWH (with respect to age, substance use, and sexual minority status) will be recruited with a proven hybrid sampling method using targeted sampling in community settings and peer recruitment (N = 512).DiscussionThis is the first study to apply the MOST framework in the field of HIV prevention and treatment. This innovative study will produce a culturally based HIV care continuum intervention for the nation’s most vulnerable PLWH, optimized for cost-effectiveness, and with exceptional levels ...

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Individual Variability in Barriers Affecting People's Decision to Take HAART: A Qualitative Study Identifying Barriers to Being on HAART

Cited by 27 publications

References 18 publications

Readiness: The State of the Science (or the Lack Thereof)

Readiness: The State of the Science (or the Lack Thereof)

Medication-Related Barriers to Entering HIV Care

Using the multiphase optimization strategy (MOST) to optimize an HIV care continuum intervention for vulnerable populations: a study protocol

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