Research into attitudes towards starting treatment early

The H-TEAM’s research aimed to gain insight into the perceptions of, as well as the motivating and demotivating factors for, starting treatment early (in case of a CD4 count of over 500) among people living with HIV and HIV practitioners.
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What research methods were used?

The research comprised interviews with thirteen HIV-positive patients – who had a CD4 count over 500 cells/m3 at the moment of diagnosis – and sixteen HIV practitioners, among whom nine internist-infectious diseases specialists and seven HIV counsellors. The intention was to investigate a group of participants which was as diverse as possible (in terms of gender, age, ethnicity and attitude towards early starting) to give a broad overview of the factors that play a role in the decision-making process of starting treatment early or not.

Aim of the research

The H-TEAM’s research aimed to gain insight into the perceptions of, as well as the motivating and demotivating factors for, starting treatment early (in case of a CD4 count of over 500) among people living with HIV and HIV practitioners.

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Why this investigation?

The potential advantages of starting antiretroviral therapy (ART) early – such as the prevention of health loss and virus transmissions – are largely determined by the willingness of HIV patients and HIV practitioners (to advise) to start treatment in case of a high CD4 count

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Their perceptions of the (potential) positive and negative effects of early treatment greatly influence this. It is important for the H-TEAM to gain insight into the motivating and demotivating factors in order to develop strategies that will enable people living with HIV to make a fast and successful start to their treatment.

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What research methods were used?

The research comprised interviews with thirteen HIV-positive patients – who had a CD4 count over 500 cells/m3 at the moment of diagnosis – and sixteen HIV practitioners, among whom nine internist-infectious diseases specialists and seven HIV counsellors.

Read more

The intention was to investigate a group of participants which was as diverse as possible (in terms of gender, age, ethnicity and attitude towards early starting) to give a broad overview of the factors that play a role in the decision-making process of starting treatment early or not.

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Research results:

The majority of practitioners and patients appeared to feel positive about early treatment, and they quickly started treatment (or advised their patients to do so). The ideas and decision-making processes related to early treatment were influenced by treatment-related factors and patient-related factors.

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Ideas about early treatment that played a prominent role were mainly connected to the possible positive and negative effects on the physical and mental health of patients. In this context, the chances of experiencing side-effects in the short and long run play a role. Also, the impact of treatment on the patients’ sense of control appears to be an important reason to either start treatment immediately or not. The positive effect of treatment on the further spread of the virus in the Netherlands was seen as an additional advantage.

Both patients and practitioners underlined the importance of having a number of patient-related conditions in place for early treatment. Patients’ willingness and likelihood of adhering to medication over a long period of time was considered an essential condition for being allowed to start treatment (quickly). In this context, patients’ (emotional) stability in particular plays a crucial role. That is, both the overall mental condition of patients and the degree to which they are still emotional about the diagnosis. Finally, decision-making about early treatment was largely determined by the degree to which the treatment matched the patients’ identity (such as their personality and cultural background).

During the interviews, the practitioners frequently stated that the major challenge comes from a small group of patients who postpone starting treatment for a very long time. That is why we wanted to investigate the characteristics of this group and their reasons for not wanting to start treatment. During the research, the group of patients who were being seen by healthcare workers but did not want to start treatment, appeared to be very small, and they could not be reached or did not want to be interviewed about their reasons for postponing treatment. In addition, we couldn’t discover a clear patient profile (in terms of background and disease characteristics) for this group. Nearly all patients who had stopped visiting healthcare services for their HIV-infection, and were therefore unlikely to be receiving any form of treatment, appeared to be men, and the majority of them had an African background.

Work package participants

Prof. Dr Suzanne (S.E.) Geerlings, Internal Medicine, Academic Medical Center, Amsterdam (AMC)

Prof. Dr Jan (J.M.) Prins, Internal Medicine, Academic Medical Center, Amsterdam (AMC)

Anne (A.) van Puffelen, Amsterdam Institute for Global Health and Development (AIGHD)

Team

  • Anne van Puffelen
    Anne van Puffelen

    Member
    AIGHD

  • Marijn de Bruin
    Marijn de Bruin

    Member
    UvA

  • Suzanne Geerlings
    Suzanne Geerlings

    Project Leader
    AMC

  • Jan Prins
    Jan Prins

    Project Leader
    AMC