Patient profiles as organizing HIV clinicians’ ART adherence management: a qualitative analysis

ABSTRACT

The effectiveness of antiretroviral therapy (ART) depends on optimal clinical management and patient adherence. Little is known about patient characteristics that clinicians consider in the management of ART adherence. Exploring this issue, five focus groups were conducted with 31 HIV-clinicians from across France. A qualitative typological analysis suggests that clinician management of patient adherence is based on characteristics that coalesce into seven patient profiles. For the “passive” patient, described as taking ART exactly as prescribed without questioning their doctor’s expertise, a directive and simple management style was preferred. The “misleading” patient is characterized as concerned with social desirability and as reporting no adherence difficulties for fear of displeasing their doctor. If clinical outcomes are suboptimal, the clinicians’ strategy is to remind them of the importance of open patient-clinician communication. The “stoic” patient is described as requesting and adequately taking the most potent ART available. Here, clinicians emphasize assessment of side effects, which the patient may minimize. The “hedonistic” patient’s festive lifestyle and sexual risk-taking are seen as compromising adherence; with them, clinicians stress the patient’s responsibility for their own health and that of their sexual partners. The “obsessive” patient is portrayed as having an irrational fear of ART failure and an inability to distinguish illusory from genuine adherence barriers. With this patient, clinicians seek to identify the latter. The “overburdened” patient is recognized as coping with life priorities that interfere with adherence and, with them, a forgiving ART is favored. The “underprivileged” patient is presented as having limited education, income and housing. In this case, clinicians seek to improve the patient’s living conditions and access to care. These results shed light on HIV clinicians’ ART adherence management. The value of these profiles for HIV care and patients should be investigated.

KEYWORDS:

• Antiretroviral therapy
• ART adherence management
• HIV clinicians
• HIV patient profiles
• qualitative analysis

Acknowledgment

We thank the participants of this study and the anonymous reviewer for their valuable input. We also thank Chantal Burelle for her administrative assistance.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

David Lessard http://orcid.org/0000-0002-1151-3763

Additional information

Funding

BL is supported by a Research Scholar award of the FRQS (Quebec Health Research Funds) and holds a Strategy for Patient-Oriented Research (SPOR) Mentorship Chair in Innovative Clinical Trials awarded by the Canadian Institutes of Health Research (CIHR: #383427). This study was conducted as a part of a larger study (The I-Score Study) which is supported in part by both the Canadian HIV Trials Network, Canadian Institutes of Health Research (CTN 283) and by a research grant from the Merck Canada Inc. Investigator Initiated Studies Program (IISP-53538). The opinions expressed in this manuscript are those of the authors and do not necessarily represent those of Merck Canada Inc. or its affiliates or related companies.