Combination antiretroviral therapy

Health care providers confront emerging dilemmas

Barbara Gerbert, A. Bronstone, K. Clanon, P. Abercrombie, David Bangsberg

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)409-421
Number of pages13
JournalAIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
Volume12
Issue number4
StatePublished - 2000
Externally publishedYes

Fingerprint

Health Personnel
health care
HIV
physician
uncertainty
Uncertainty
Hope
Therapeutics
optimism
assistant
health status
Physician Assistants
medication
Aptitude
Nurse Practitioners
nurse
San Francisco
Medication Adherence
Group
Focus Groups

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Social Sciences (miscellaneous)
  • Health(social science)
  • Health Professions(all)

Cite this

Combination antiretroviral therapy : Health care providers confront emerging dilemmas. / Gerbert, Barbara; Bronstone, A.; Clanon, K.; Abercrombie, P.; Bangsberg, David.

In: AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, Vol. 12, No. 4, 2000, p. 409-421.

Research output: Contribution to journalArticle

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