The ANRS-Ipergay trial, an opportunity to use qualitative research to understand the perception of the “participant”-physician relationship

ABSTRACT

The ANRS-IPERGAY trial consisted in providing sexual activity-based antiretroviral prophylaxis for HIV prevention (PrEP) with a package of prevention tools (counselling, condoms, HIV and sexually transmitted infections’ screening) to highly exposed HIV-negative men who have sex with men (MSM). Few data exist concerning the patient-physician relationship in the particular context of PrEP, where physicians discuss sexual behaviours with MSM who are not classic patients, in that consultation is for prevention purposes, not for illness. This study took place during the open-label extension of ANRS-IPERGAY trial when all participants received PrEP. In this qualitative study, we examined how physicians perceived their relationship with participants in the ANRS-IPERGAY trial. Of all 30 physicians involved in the trial who were contacted by email to participate in an interview about their opinions and perceptions of ANRS-IPERGAY 18 volunteered to participate in the current sub-study. We performed a vertical analysis for each interview to identify the extract in each physician’s discourse concerning their relationship with MSM participants, and conducted a horizontal analysis to construct the thematic tree and subsequently investigate differences and similitudes between themes. An analysis of all physicians’ discourses showed that the participant-physician relationship during the trial could be described through 4 themes: (i) personal experience of the relationship, (ii) trust and non-judgement, (iii) positive relational climate and (iv) influence of physician’s characteristics (age, gender, etc.) on relationship.

We found that the particular context of PrEP led some physicians to adopt a patient-as-partner approach during consultations rather than a paternalist or hierarchical approach. Indeed, the close follow-up provided by the trial and the active role of patients in their own prevention care trajectory, are more compatible with the patient-as-partner approach. The prescription of PrEP may lead to an evolution in patient-physician relationships and may even modify the professional identity of physicians.

KEYWORDS:

• Patient-physician relationship
• PrEP
• ANRS-IPERGAY trial
• patient-as-partner

Acknowledgements

We would like to thank the study’s participants for their time and their dedication to this research, for the benefit of their community. We also thank the AIDES community advocacy group and their community peer counsellors who made this study possible, through their availability and continuous interaction with the participants and study staff at study sites and, most importantly, between scheduled visits. This work was sponsored by the ANRS (France Recherche Nord & Sud Sida-HIV Hépatites) and funded by ANRS, the Canadian HIV Trials Network, the Fonds de dotation Pierre Bergé pour la Prévention – SIDACTION, and the Bill and Melinda Gates Foundation. MDC was the recipient of a doctoral fellowship from ANRS. Our thanks also to Jude Sweeney for the English revision.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by Agence Nationale de Recherches sur le Sida et les Hépatites Virales; Bill and Melinda Gates Foundation; the Canadian HIV Trials Network; the Fonds de dotation Pierre Bergé pour la Prévention; Sidaction.