Clinical reasons for starting MDRT not enough. not enough is done in terms of facilitating readiness and commitment to treatment. Important to allow enough time to prepare for treatment Altice et Report on US: Four Quantitative HIV+ Generally, high level of trust in current physician. Findings point to importance al., (2001) prisoners correlates of prison clinics and fragility of trust. Authors (N=205), ART acceptance Cross-sectional Approximately 1/3 had negative experience with health acknowledge this but do not most IUDs, and adherence survey (in English care provider in past. indicate how providers may 52% male, & Spanish) practically foster trust. 48% female. Women more trust in DR: 82% of women said they trusted Validated, Dr a lot or completely; significantly lower (65% ) amongst Relationship between standardized men. and communication, and measures between trust and ART assessing Those with less trust in Dr reported less discussion of acceptance and adherence. depression, locus emotional issues. of control, trust in Difference between trust in physician, medical ART acceptance strongly associated with trust in physician medication and provider. institutions, and medication; trust in medication also associated with society ART adherence. Certain groups (men, minorities) less trust in Men and non-whites less trust in medical institutions. medical institutions Majority feels is a cure for AIDS but government is ‘there keeping it from me’. Significant minority (31% ) felt that had been experimented on in public hospitals ‘they without being told’. Discussion in physician and medicine, and therapeutic relationship central in ART initiation process. Interventions should target health care delivery system and both patient and physician. Ammassari Studies Examine studies High income Quantitative Found to be consistently associated: Tailoring regimen to pt needs et al. published of barriers to settings Symptoms, side effects, negative life events, stress, points to importance of (2002). between optimal HAART Systematic review family/social support, regimen complexity, communication & exploring 1998-2002. adherence and of studies treatment to need to tailor other adherence barriers. –points Reporting summarize reporting regimen to patients needs and lifestyle. on adult results correlates of Different perceptions of human adherence Anticipation of side effects, providing better info for reasons for non-adherence subjects may lead to better adherence. Authors claim between pt- providers points Used that we can assume that presence of tangible and to flaws in and importance of adherence emotional support increases adherence. communication. as
Clinical reasons for starting MDRT not enough. not enough is done in terms of facilitating readiness and commitment to treatment. Important to allow enough time to prepare for treatment Altice et al., (2001) Report on correlates of ART acceptance and adherence US: Four prison clinics Quantitative Cross-sectional survey (in English & Spanish) Validated, standardized measures assessing depression, locus of control, trust in physician, medical institutions, society HIV+ prisoners (N=205), most IUDs, 52% male, 48% female. Generally, high level of trust in current physician. Approximately 1/3 had negative experience with health care provider in past. Women more trust in DR: 82% of women said they trusted Dr a lot or completely; significantly lower (65% ) amongst men. Those with less trust in Dr reported less discussion of emotional issues. ART acceptance strongly associated with trust in physician and medication; trust in medication also associated with ART adherence. Men and non-whites less trust in medical institutions. Majority feels ‘there is a cure for AIDS but government is keeping it from me’. Significant minority (31% ) felt that ‘they had been experimented on in public hospitals without being told’. Discussion in physician and medicine, and therapeutic relationship central in ART initiation process. Interventions should target health care delivery system and both patient and physician. Findings point to importance and fragility of trust. Authors acknowledge this but do not indicate how providers may practically foster trust. Relationship between and communication, and between trust and ART acceptance and adherence. Difference between trust in medication and provider. Certain groups (men, minorities) less trust in medical institutions Ammassari et al. (2002). Examine studies of barriers to optimal HAART adherence and summarize results High income settings Quantitative Systematic review of studies reporting correlates of adherence Studies published between 1998-2002. Reporting on adult human subjects Used adherence as Found to be consistently associated: Symptoms, side effects, negative life events, stress, family/social support, regimen complexity, treatment –points to need to tailor regimen to patients needs and lifestyle. Anticipation of side effects, providing better info for may lead to better adherence. Authors claim that we can assume that presence of tangible and emotional support increases adherence. Tailoring regimen to pt needs points to importance of communication & exploring other adherence barriers. Different perceptions of reasons for non-adherence between pt- providers points to flaws in and importance of communication.
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