Clinical reasons for starting MDRT not enough. not enough is done in terms of facilitating readiness and commitment to treatment. Important to allow enough time to prepare for treatment Altice et al., (2001) Report on correlates of ART acceptance and adherence US: Four prison clinics Quantitative Cross-sectional survey (in English & Spanish) Validated, standardized measures assessing depression, locus of control, trust in physician, medical institutions, society HIV+ prisoners (N=205), most IUDs, 52% male, 48% female. Generally, high level of trust in current physician. Approximately 1/3 had negative experience with health care provider in past. Women more trust in DR: 82% of women said they trusted Dr a lot or completely; significantly lower (65% ) amongst men. Those with less trust in Dr reported less discussion of emotional issues. ART acceptance strongly associated with trust in physician and medication; trust in medication also associated with ART adherence. Men and non-whites less trust in medical institutions. Majority feels ‘there is a cure for AIDS but government is keeping it from me’. Significant minority (31% ) felt that ‘they had been experimented on in public hospitals without being told’. Discussion in physician and medicine, and therapeutic relationship central in ART initiation process. Interventions should target health care delivery system and both patient and physician. Findings point to importance and fragility of trust. Authors acknowledge this but do not indicate how providers may practically foster trust. Relationship between and communication, and between trust and ART acceptance and adherence. Difference between trust in medication and provider. Certain groups (men, minorities) less trust in medical institutions Ammassari et al. (2002). Examine studies of barriers to optimal HAART adherence and summarize results High income settings Quantitative Systematic review of studies reporting correlates of adherence Studies published between 1998-2002. Reporting on adult human subjects Used adherence as Found to be consistently associated: Symptoms, side effects, negative life events, stress, family/social support, regimen complexity, treatment –points to need to tailor regimen to patients needs and lifestyle. Anticipation of side effects, providing better info for may lead to better adherence. Authors claim that we can assume that presence of tangible and emotional support increases adherence. Tailoring regimen to pt needs points to importance of communication & exploring other adherence barriers. Different perceptions of reasons for non-adherence between pt- providers points to flaws in and importance of communication.
Multi and univariate analysis dependent variable, report on correlates or predictors of adherence. Inconsistently associated: age, race, drug use, alcohol, depression, knowledge and beliefs about treatment, patient satisfaction with health care/patient/provider relationship though data are limited. (See p124 for list of factors not generally associated eg gender, educational attainment). Telephone survey (Gallant 1998) found that physicians and patients have different perceptions of reasons for non-adherence. Discussion: Flaws in literature make it difficult to synthesise; no gold standard for measuring adherence, (how, what and when); sample sizes small, often convenience, no control group. Clinicians need to be careful not to stereotype patients based on sociodemographic features; appear largely unrelated. Authors draw attention to risk of stereotyping and discrimination, and the importance and challenges of communication and relationship between providers- minority clients. Atkinson et al. (2008) To expand on the work by Harzke et al. (2004), who examined the relationships, within a sample of crack cocaine between adherence and psychosocial and other measures suggested by the Transactional USA, Quantitative Standardized questionnaires: Elicitation of Compliance and Adherence Behaviors Questionnaire TCU Self-Rating Form (SRF): measures psychological functioning crack cocaine users on highly active antiretroviral therapy (ART). (N=130). Adherence was positively associated with ART optimism and adherence self-efficacy. ART optimism was positively associated with relationship, inversely associated with HIV-related stress symptoms. Adherence self-efficacy was positively associated with presence of social support. Patient-doctor relationship was inversely associated with anxiety/depressive symptoms. Discussion: Increasing optimism and self-efficacy may foster adherence. This a good patient-doctor relationship and a satisfying social network. Proposed connection between identified correlates/mechanism: doctor Findings point to importance of d-p relationship for adherence, due to link with ART optimism, self-efficacy Authors suggest that important aspects of the relationship are pt cenrtedness and as mediating factors (leading to optimism etc) Importance of making pt feel as person underscores importance of communication. Authors call for improving providers’ capacity to make pt feel as a person.
categorise (and sub-categorise) question types; quant analysis of frequency of Q-type and rates of disclosures following Q type, and regression to predict disclosure. three days would you say that you missed any of the dosages of your medicines?’; general time frame (‘Now, have you missed any?’); leading (‘So you haven’t missed any HIV meds at all?’, or confronting with evidence. They examined sequential order of asking question-type, and which/when were most likely to elicit disclosure. Question order and disclosure was non-significant. Main finding: non-adh disclosure was 3.64 higher for negatively-frame questions compared with other Q types. So, substantial minority of providers did not ask or elicit disclosure. Negatively framed questions are most effective. The authors discuss various explanations (e.g. they are direct, ‘missed’ normalizes non-adh). Other questions can be interpreted in other ways (e.g. as about medication not adh, or simply invite minimal ‘fine’ answers) Graham et al. (2015) To determine if trust in physicians and healthcare system predicted subsequent linkage, retention and adherence amongst patients newly diagnosed with HIV US (Houston, Texas) Quantitative Questionnaires. Administered every 3 months, Measurements: Self-reported ART use Clinic attendance (through medical record review). Trust in physicians in general Trust in healthcare system Alcohol use Newly diagnosed patients (N=178) Of 178, 139 were linked within 90 days, 93 retained at 12 months; 91/113 with low CD4 count initiated ART. Of these, 51 reported ≥95%, and only 41 achieved undetectable viral load by 1 year. Univariate regression showed trust in physician (in general) was associated with retention in care. Trust in healthcare system did not predict any outcome variables. Multivariate analysis (adjusting for gender, race/ethnicity and education) confirmed this significant association. Discussion Higher trust in physicians predicts more successful retention in HIV care. Unusual in being a prospective study. Problem with measuring in physicians in general rather than in a specific physician (due to testing before patient had one) Qual research to see understanding of trust would be helpful Suggests trust is multidimensional – supports call for further research into this variable.