title: Initiation of therapy with a subcutaneously administered antiretroviral in treatment-experienced HIV-infected patients: understanding physician and patient perspectives.
abstract: Enfuvirtide (Fuzeon) is the first self-injectable antiretroviral (ARV) therapy approved for the treatment of HIV. This study was undertaken to explore the perceptions of injectable ARVs among physicians and treatment-experienced HIV-infected patients and identify potential motivators or barriers to the initiation of injectable ARV therapies. This empirical study was conducted based on qualitative field research conducted in multiple centres in five European countries and the US. A purposive sampling strategy was employed and structured interviews carried out with physicians and patients. Discussion guides for these interviews focused on attitudinal responses to a range of key areas. For physicians, these areas included HIV treatment, treatment-experienced patients and their relationships with them and injectable therapy usage, while for patients - some of whom were receiving enfuvirtide therapy - the focus included relationships with their physicians and attitudes towards injectable ARV therapy. Sixty-eight physicians and 43 patients were interviewed. Qualitative analysis of the interview responses revealed a number of recurring themes among physician and patient perceptions of HIV and its treatment. Physicians tended to view injectable ARVs as a last resort, with only limited suitability among treatment-experienced patients and a low level of patient acceptability. In contrast, patients generally perceived the potential value of effective injectable ARV therapy, if recommended to them by their physicians, indicating that its benefits could outweigh the drawbacks associated with its administration. This study identified some potential disconnects between physician and patient perceptions of injectable therapy. Our findings emphasize the need for patients to discuss their treatment goals with their physicians so that they can work together to find the regimen that is most likely to achieve these goals.
authors.affiliation: Department of Practice and Policy, Centre for Behavioural Medicine, School of Pharmacy, University of London, UK. rob.horne@pharmacy.ac.uk
authors.forename: Rob
authors.initials: R
authors.lastname: Horne
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cooper
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D018450:Disease Progression; D004334:Drug Administration Schedule; D000077560:Enfuvirtide; D005260:Female; D015700:HIV Envelope Protein gp41 / Q000008:administration & dosage* / Q000009:adverse effects; D023581:HIV Fusion Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D015497:HIV-1; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007279:Injections, Subcutaneous / Q000009:adverse effects / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D010446:Peptide Fragments / Q000008:administration & dosage* / Q000009:adverse effects; D010817:Physician-Patient Relations; D010820:Physicians; D012646:Self Administration / Q000009:adverse effects / Q000523:psychology
chemical_list: D015700:HIV Envelope Protein gp41; D023581:HIV Fusion Inhibitors; D010446:Peptide Fragments; D000077560:Enfuvirtide