title: Becoming a "treatment success": what helps and what hinders patients from achieving and sustaining undetectable viral loads.
abstract: Highly active antiretroviral therapy (HAART) adherence research has focused predominantly on individuals with less than optimal clinical outcomes; therefore, little is known about the experiences of individuals who sustain undetectable viral loads. The present study used a qualitative method to explore how individuals who have sustained undetectable viral loads account for their success, and to identify challenges, as well as possible needs, for continued success. Participants were 20 patients at an outpatient infectious disease clinic in an urban center. Participants completed two 60-minute interviews. The Critical Incident Technique was used to identify and classify critical incidents linked with sustaining treatment success. Of the 438 critical incidents collected, 316 were identified as helpful and 122 were identified as unhelpful. Helpful categories included resolving ambivalence, using personal strengths, and fostering helpful relationships. Unhelpful categories were mood, lack of social support, financial difficulties, and medication factors. Doing well on antiretroviral therapy is a dynamic process that requires ongoing attention from both the patient and care provider. The results of this study highlight the efforts of patients to maintain their health and remind care providers not to assume that patients are not facing continuous challenges. Findings from the present study suggest that psychosocial factors do contribute to improved clinical outcomes in patients taking HAART.
authors.affiliation: Canadian HIV Clinical Trials Network, St. Paul's Hospital/BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada. valfonso@cfenet.ubc.ca
authors.forename: Victoria
authors.initials: V
authors.lastname: Alfonso
authors.forename: Josie
authors.initials: J
authors.lastname: Geller
authors.forename: Nicole
authors.initials: N
authors.lastname: Bermbach
authors.forename: Anne
authors.initials: A
authors.lastname: Drummond
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D001955:British Columbia / Q000453:epidemiology; D017281:Cost of Illness; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D013647:Task Performance and Analysis; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D019037:Urban Health Services / Q000706:statistics & numerical data*; D019562:Viral Load