|Reasons for Not Starting Antiretroviral
Therapy: A Multinational Survey among Patients and their Physicians|| |
|J. Fehr1, D. Nicca2, J.-C. Goffard3, D.H.-U. Haerry4, R. Diazaraque5, B. Ledergerber1|
|1University Hospital Zurich, University of Zurich, Infectious Diseases and Hospital Epidemiology, Zurich, Switzerland, 2Cantonal Hospital St. Gallen, Division of Infectious Diseases and Hospital Hygiene, St. Gallen, Switzerland, 3University Hospital Erasme, AIDS Reference Centre, Bruxelles, Belgium, 4Positive Council, Zurich, Switzerland, 5Gilead Sciences Ltd, Medical Affairs, Uxbridge, United Kingdom|
|Objectives: To better understand why chronically HIV-infected patients at different CD4 cell-levels (group A: < 350/µl; B: 349-500/µl; C: >500/µl) were not on ART. |
Methods: Paired treatment naive patients and their physicians independently completed a 90-item-questionnaire about barriers and the readiness to start/defer ART before the consultation. The study was carried out at 34 sites in 9 countries in Europe and Australia.
Results: Between 12/2011 and 10/2012 508 pairs of patients- and physicians-questionnaires were completed. 426(84%) patients were male; median age 37 years (IQR:30-45). There were 39(8%), 138(27%) and 330(65%) participants in groups A-C. Physicians were very experienced as 90% cared for >50 patients and 80% had >5 years of experience. Most important reasons for patients not to start ART were the statement 'I rely on my body to tell me when to start' and 'lack of symptoms' in the domain 'Body and symptoms' (figure). This was especially true for patients with CD4< 350/µl. Irrespective of CD4, 47% of patients 'didn't want to think about HIV'. Asked about readiness, 50% each in groups A/B were 'not ready to start' and 32%/33% were 'ambivalent'. Physicians thought that for 28 (6%) patients, guidelines were not suitable and for group A/B, physicians answered in 92 cases (18%) that ART was not indicated. Main reasons for physicians not to start treatment for group A/B were their perception that patients were 'too depressed' (13%) or that they hadn't know them long enough (13%).
Conclusion: Body awareness and lack of symptoms are the most common barriers for patients to start ART. This pattern is different compared to the past when ART toxicity and a high pill burden were the main barriers. With changing guidelines, a higher percentage of asymptomatic patients will be approached for a treatment. These new barrier patterns have to be considered.
MD Jan Fehr , University Hospital Zurich, University of Zurich , Zurich , Switzerland
Assigned in sessions:
18.10.2013, 14:00-16:00, Parallel Session, PS11, Sex, Drugs and Stigma, Copper Hall