Satisfaction with care in HIV-infected patients treated with long-term follow-up antiretroviral therapy: the role of social vulnerability

Abstract

The aim of this study was to determine factors associated with complete satisfaction with the care provided (satisfaction with physicians and satisfaction with services and organization) among HIV-infected patients followed up in the French ANRS CO8 APROCO-COPILOTE cohort. Analyses focused on cross-sectional data collected during the ninth year of cohort follow-up. Satisfaction with care, sociodemographic characteristics, and behavioral data were collected using self-administered questionnaires, while clinical data were derived from medical records. Complete satisfaction with care was defined as being 100% satisfied. Two logistic regression models were used to identify predictors of (1) complete satisfaction with physicians (n=404) and (2) complete satisfaction with services and organization (n=396). Sixteen percent of patients were completely satisfied with physicians, while 15.9% were completely satisfied with services and organization. Being older and reporting fewer discomforting antiretroviral therapy (ART) side effects were factors independently associated with complete satisfaction with both physicians and services and organization. Strong support from friends and absence of hepatitis C (HCV) co-infection were independently associated with complete satisfaction with physicians, while strong support from one's family and comfortable housing conditions were independently associated with complete satisfaction with services and organization. Even after nine years of follow-up, social vulnerabilities still strongly influence HIV-infected patients’ interactions with the health care system. Day-to-day experience with the disease, including perceived treatment side effects, appears to play a key role in the quality of these interactions. More attention should be given to patient satisfaction, especially for socially vulnerable patients, in order to avoid potentially detrimental consequences such as poor adherence to ART.

Keywords:

• satisfaction with care
• satisfaction with physician
• side effects
• quality of life
• social support

Acknowledgements

The ANRS CO8 APROCO-COPILOTE Study Group:

Scientific Committee:

Steering Committee: Principal investigators: C. Leport, F. Raffi

Methodology: G. Chêne, R. Salamon

Social sciences: J-P. Moatti, J. Pierret, B. Spire

Virology: F. Brun-Vézinet, H. Fleury, B. Masquelier

Pharmacology: G. Peytavin, R. Garraffo

Other members: D. Costagliola, P. Dellamonica, C. Katlama, L. Meyer, D. Salmon, A. Sobel.

Events Validation Committee: L. Cuzin, M. Dupon, X. Duval, V. Le Moing, B. Marchou, T. May, P. Morlat, C. Rabaud, A. Waldner-Combernoux

Project coordination: P. Reboud

Clinical Research Group: V. Le Moing, C. Lewden

Clinical Centres (investigators): Amiens (Pr JL. Schmit), Angers (Dr JM. Chennebault), Belfort (Dr JP. Faller), Besançon (Pr JL. Dupond, Dr JM. Estavoyer, Dr Drobachef), Bobigny (Pr O. Bouchaud), Bordeaux (Pr M. Dupon, Pr Longy-Boursier, Pr P. Morlat, Pr JM. Ragnaud), Bourg-en-Bresse (Dr P. Granier), Brest (Pr M. Garré), Caen (Pr R. Verdon), Compiègne (Dr D. Merrien), Corbeil Essonnes (Dr A. Devidas), Créteil (Pr A. Sobel), Dijon (Pr P. Chavanet), Garches (Pr C. Perronne), Lagny (Dr P. Lagarde), Libourne (Dr J. Ceccaldi), Lyon (Pr C. Chidiac), Meaux (Dr C. Allard), Montpellier (Pr J. Reynes), Nancy (Pr T. May), Nantes (Pr F. Raffi), Nice (Pr JG Fuzibet, Pr P. Dellamonica), Orléans (Dr P. Arsac), Paris (Pr E. Bouvet, Pr F. Bricaire, Pr P. Bergmann, Pr J. Cabane, Dr J. Monsonego, Pr P.M. Girard, Pr L. Guillevin, Pr S. Herson, Pr C. Leport, Pr MC. Meyohas, Pr J.M. Molina, Pr G. Pialoux, Pr D. Salmon), Poitiers (Pr F. Roblot), Reims (Pr C. Strady), Rennes (Pr C. Michelet), Saint-Etienne (Pr F. Lucht), Saint-Mandé (Pr T. Debord), Strasbourg (Pr D. Rey), Toulon (Dr JP. De Jaureguiberry), Toulouse (Pr B. Marchou), Tours (Pr P. Choutet).

Data monitoring and statistical analysis: J. Appy, S. Boucherit, V. Bouteloup, C. Brunet-François, V. Caron, M.P. Carrieri, F. Couturier, J.L. Ecobichon, L. Hardel, P. Kurkdji, S. Martiren, M. Onanga, E. Pereira, M. Préau, C. Protopopescu, A. Taieb.

Funding: Agence Nationale de Recherches sur le Sida et les hépatites virales (ANRS, Action Coordonnée n°7).

Other support: Collège des Universitaires de Maladies Infectieuses et Tropicales (CMIT ex APPIT), and the following associated pharmaceutical companies: Abbott, Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead, Glaxo- SmithKline, Pfizer, and Roche.