Combination antiretroviral therapy: Health care providers confront emerging dilemmas

• Published in: AIDS care Vol. 12; no. 4; pp. 409 - 421
• Main Authors: Gerbert, B., Bronstone, A., Clanon, K., Abercrombie, P., Bangsberg, D.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis Group 01.08.2000; Taylor & Francis Ltd
• Subjects: Acquired Immunodeficiency Syndrome - drug therapy; Adult; AIDS/HIV; Antiretroviral therapy; Antiviral Agents - therapeutic use; Attitude of Health Personnel; Dilemmas; Drug therapy; Drug Therapy, Combination; Epidemics; Female; Focus Groups; Health Personnel; Health professionals; HIV; HIV Infections - drug therapy; HIV Seropositivity - drug therapy; Human immunodeficiency virus; Humans; Male; Middle Aged; Patients; USA; USA, California, San Francisco
• ISSN: 0954-0121; 1360-0451
• DOI: 10.1080/09540120050123819

Recent editorials, conferences and clinical practice articles have discussed providers' concerns and practices regarding prescribing antiretroviral combination therapy for HIV. We aimed to deepen our understanding of these largely anecdotal reports and of the challenges facing experienced HIV clinicians today using qualitative methodology. Eight focus groups using a structured discussion guide were conducted. Data were analyzed by constant comparative analysis and open codes. Participants were a diverse group of 23 physicians, eight nurse practitioners and four physician assistants with significant experience providing care to HIV-seropositive patients in various San Francisco Bay Area health care settings. The following major themes emerged from the data: (1) providers expressed new optimism about helping HIV-seropositive patients live; (2) the main factors affecting providers' decisions about when to start combination therapy were the risks versus benefits of delaying therapy, and patients' health status, readiness to adhere and treatment preferences; (3) providers lacked resources to prepare patients to begin therapy and enhance adherence; (4) providers varied regarding assessment of adherence; and (5) providers were anxious about making decisions under conditions of uncertainty and were concerned about patient health outcomes. We concluded that experienced HIV clinicians were hopeful and excited about their increasing ability to help patients. This hope, however, was tempered by scepticism about the future and by their daily struggles to make treatment decisions under conditions of great uncertainty. Without access to adjunct supports or a multidisciplinary team, providers may not be able to optimally assess and enhance antiretroviral medication adherence.