Psychosocial Issues Influencing Treatment Adherence in Patients on Multidrug Rescue Therapy: Perspectives from Patients and Their Health Care Providers

Abstract

Multi-drug rescue therapy (MDRT) is often used for the treatment of highly experienced patients who harbor HIV variants with decreased susceptibility to multiple antiretrovirals. Patients on MDRT typically have limited treatment options, and without treatment, their prognosis can be poor. Yet the decision to go on MDRT is not always straightforward as MDRT can be associated with significant challenges including multiple daily doses, higher pill burden, emerging toxicities, and drug interactions. All of these may compromise adherence, which is often a major reason why patients may need MDRT in the first place. Little is known about how patients and health care providers (HCPs) experience MDRT. This study sought to explore areas of convergence and divergence between patients and HCPs in order to identify gaps in treatment and factors that may impact adherence to MDRT. A qualitative interview method based on grounded theory was used. Twelve patients and seven HCPs completed a 60-minute semistructured interview. Patients were asked about challenges, facilitative aspects of staying on MDRT, the decision to initiate treatment, their role, and the role of HCPs in their health care. HCPs were asked about their experience working with MDRT patients, their role, and the role of the patient. Congruent themes emerged from the two groups: developing a working relationship, treatment factors, information requirements, and readiness for treatment. There were no discrepancies in role perspectives. Patients and HCPs agreed on the need to optimize patients' readiness, willingness, and ability to embark on MDRT to maximize adherence. HCPs assumptions about beginning MDRT based solely on medical indications must be checked and discussed to ensure patients' motivation. In conclusion, adherence to MDRT demands a substantial behavior change, recognized as a major challenge by patients. Allocating the time to make a commitment to treatment can optimize adherence. It is therefore crucial that patients be provided with time to make informed decisions, explore and resolve their willingness and readiness to commit to treatment, and maintain supportive relationships with their HCPs, all of which can optimize adherence to MDRT.

Factors Influencing Oral Adherence: Qualitative Metasummary and Triangulation With Quantitative Evidence

“…The amount of information a patient knows about his or her medication and regimen requirements where an increase in knowledge has a positive effect 25% Alfonso et al, 2009;Beusterien et al, 2008;Curioso et al, 2010;Durante et al, 2003;Frank & Duncan, 2009;Gallagher et al, 2011;Garavalia et al, 2011;Henriques et al 2012;Iversen et al, 2011;Lau et al, 2008;Oggins, 2003;van den Boogaard et al, 2012;Van Dyk, 2011 One study shows no effect: Lihara et al, 2004 Five studies agree: Gater et al, 2012;Munro et al, 2007;Puts et al, 2014;Sawesi et al, 2014; Eight studies agree: Duggan et al, 2009;Khdour et al, 2012;Mann et al, 2009;Schoenthaler et al, 2013;…”

“…An increase in the number of pills has a negative effect. 25% Alfonso et al, 2009;Badahdah & Pedersen, 2011;Beusterien et al, 2008;Cooper et al, 2010;Durante et al, 2003;Frank & Duncan, 2009;Gariga Popa-Lisseanu et al, 2005;Golub et al, 2006;Henriques et al, 2012;Lihara et al, 2004;Ogedegbe et al, 2004;Streeter et al, 2011;Vaughan et al, 2011;Wai et al, 2010;Wood et al, 2004 Three studies show conflicting results: Gater et al, 2012;Sawesi et al, 2014;Verburgghe et al, 2013 Two studies agree: Coleman et al, 2012;Puts et al, 2014 Three studies show no effect: Briesacher et al, 2010;Jamous et al, 2011;…”

‘Not Until I'm Absolutely Half-Dead and Have To:’ Accounting for Non-Use of Antiretroviral Therapy in Semi-Structured Interviews with People Living with HIV in Australia

“…Similar reasons for non-use have been reported in research conducted in relatively comparable settings including the UK, 28 Germany, 29 Poland, 30 the USA, [31][32][33] and Canada. 34,35 Preference for alternative medicines were observed in a number of these studies, but particularly in the German and US research, 29,36 and mistrust of medications and medical care providers was particularly stressed in research from the USA, as was the role of stigma and perceived cost of treatment. 31,[37][38][39] Other factors that influence the uptake of ART in Australia and comparable settings include an individual's capacity to make informed treatment decisions, such as health literacy and decision making ability.…”

Is patient satisfaction the key to promote compliance in health care sector?

“…In particular, some authors emphasize the significance of such factors as the quality of the doctor-patient communication, the physician's attitude towards the patient, allowing the patient to take over control of their own health (health locus of control), or the patient empowerment strategy. The value of the doctor-patient relationship has been described as being characterized by such variables as understanding the patient's needs, empathy, openness, fairness, and respect for the patient's concerns (Alfonso et al, 2009).…”