Involvement, Perception, and Understanding as Determinants for Patient-Physician Relationship and Their Association with Adherence: A Questionnaire Survey among People Living with HIV and Antiretroviral Therapy in Austria.

BACKGROUND: The relationship between patients and healthcare professionals (physicians) is the cornerstone of successful long-term antiretroviral therapy for people living with human immunodeficiency virus (HIV). PURPOSE: This study aimed to investigate the connection between involvement, perception, and understanding as the basis for the patient-physician relationship and drug adherence, measured as the probability of non-adherence. METHODS: In an online survey, people with HIV were asked about their relationship with their physicians and the extent to which they felt involved in treatment-related decisions. A statistical analysis was conducted to determine whether a better patient-physician relationship was associated with higher adherence to therapy. This was performed by univariate group comparison (Mann-Whitney-U, Fishers Exact Test) and logistic regression. RESULTS: A total of 303 persons living with HIV participated in the survey, and 257 patients were included in the analysis. Overall, 27.6% were classified as non-adherent and self-reporting based on whether an antiretroviral therapy (ART) was taken in the past or how often the ART was interrupted. This proportion was significantly higher among patients aged 50-74 years (39.7%) and those with a longer therapy duration (9-15 years: 46.6%; from 15 years on: 55.8%). Therapy-non-adherent patients showed significantly lower scores in the relationship aspects understanding (2.68 vs. 3.03), participation (2.63 vs. 3.07), and perception (3.00 vs. 3.24) compared to adherent patients. Logistic regression analysis confirms that higher scores for understanding, involvement, and perception are strongly associated with a reduction in the risk of becoming non-adherent. This was true for all examined regression models, regardless of whether they were adjusted for the length of therapy and socio-demographic characteristics. CONCLUSION: The results reinforce the need for awareness among health care professionals (HCP) regarding understanding, involvement, and perception as important aspects to improve the quality of the patient-physician relationship for high adherence levels with maximized non-adherence in ART management by PLWH.

Prevalence and Associations of Illicit Drug and Polydrug Use in People Living with HIV in Vienna.

We aimed to determine the prevalence of drug and polydrug use in people living with HIV in Austria for the first time for which a two center cross-sectional study was performed. Participants were recruited from consecutive patients during their regularly scheduled visits. In total 438 participants were included in the analysis. For this study we used paper-pencil and online-based questionnaires. The prevalence of illicit drug use was 60.5%; with cannabis use at 31.5%, nitrates at 31.5%, sildenafil/tadalafil at 24% and cocaine at 14%, being the most used substances. Use of more than one substance (polydrug) in drug users was 69.4% or 42.0% in the total study population. Younger age, male gender, and living in an urban area were associated with drug use. Moreover, drug use during clubbing and sex, HIV therapy non-adherence and younger age were associated with polydrug use. Drug users reported condomless sex in 42.4% and performing sexual acts they would not do sober in 44.1%. Results indicate a high prevalence of illicit drug use in PLWHIV in Austria. New research focusing on illicit drug use in PLWHIV should focus on the use of substances during sex and surrounding practices.

Health literacy, source of information and impact on adherence to therapy in people living with HIV.

INTRODUCTION: Adequate information and health literacy (HL) has a high impact on patients understanding on the causes and consequences of many chronic diseases, including HIV, and is a crucial prerequisite to ensure adherence to therapy regimens. Several Austrian patient organizations developed an online survey together with MSD (the so-called "PAB-test") aimed to evaluate how people living with HIV perceive the level of care in Austria. MATERIALS AND METHODS: An online survey has been developed to assess HL in people living with HIV and to evaluate the impact of HL on therapy adherence. HL was assessed with seven items regarding the self-rated comprehension of HIV related information, which showed a high reliability (Cronbach's alpha=0.876). A low health literacy was defined by reaching a score below the median of 20 points in the related indicator. RESULTS: A total of 303 subjects completed the questionnaire. Women slightly had more often a low HL than men (57.1% vs 44.7%, p=0.335). Heterosexual subjects had more often a low HL compared to homosexual ones (58.3% vs 38.1%, p=0.007). Health literacy slightly increased with age (not significant). An increasing education level correlated with higher HL, (66.7%, 46.2%, and 38.9% of persons showed low HL with primary, secondary and tertiary education, respectively, p=0.037). The number of missed appointments with the HIV physician was significantly higher in the low HL population (30.0% vs 14.4%, p=0.002), which also showed to be more prone to interrupt the therapy without consulting a physician (22.4% vs 9.8%, p=0.006). The low HL population, however, did not report of having forgotten the medication intake more often than the one with high HL (33.1% vs 39.1%, p=0.305). The most important source of information is the treating physician, followed by NGOs/patient organizations and the internet (Figure 1). CONCLUSIONS: There are significant differences in HL between different sub-groups in the HIV community. Low HL is significantly associated with a higher frequency of missed doctor appointments and interruptions of treatment, but does not impact adherence to therapy (self-reported). The identified information providers (medical doctors, NGOs/patient organizations) should be encouraged to contribute towards increased HL in HIV patients.

Involvement of HIV patients in treatment-related decisions.

INTRODUCTION: The improvement of antiretroviral therapy in the past decades has had a major impact on life expectancy and quality of life of people living with HIV, and also on the relationship between patients and their physicians. What used to be an acute treatment for life threatening complications, and an end-of-life therapy in the beginning of the epidemic, turned over the time into a lifelong care. The good relationship between patients and physicians represents the cornerstone of an optimal long-term therapy. Shared decision making between patients and physicians is a crucial prerequisite for the success of this approach. Several Austrian patient organizations developed an online survey together with MSD (the so-called "PAB-test") aimed to evaluate how people living with HIV perceive the level of care in Austria. MATERIALS AND METHODS: An online survey has been developed to evaluate how people living with HIV feel about the relationship with their physicians and to what extent they feel involved in treatment related decisions. RESULTS: A total of 303 subjects completed the questionnaire. 44% felt "totally" involved in their therapy, 40% "strongly involved", 12% "fairly involved", 3% "poorly involved" and 1% "not at all involved" in their therapy. The proportion of subjects who felt totally involved in the therapy was equally distributed between sex, sexual orientation, age groups, groups of various education level, and between patients treated predominantly in intramural or extramural medical care. The most important factor for people living with HIV to feel involved in their therapy is a low amount of long-term ART-related side-effects (Figure 1). CONCLUSIONS: The results show that the majority of people living with HIV in Austria feel involved in therapy related decisions. This proportion is equally distributed in patients with different socio-demographic or socio-economic characteristics or level of medical care delivery. According to the survey, the most important reason for people living with HIV to be involved in their therapy is to avoid long-term side effects.