title: Prescribing and using self-injectable antiretrovirals: how concordant are physician and patient perspectives?
abstract: BACKGROUND
  The selection of agents for any treatment regimen is in part influenced by physician and patient attitudes. This study investigated attitudinal motivators and barriers to the use of self-injectable antiretroviral agents among physicians and patients and measured the degree of concordance between physician and patient perspectives.
  
  
  METHODS
  Attitudes toward prescribing and usage of self-injectable antiretroviral therapy (SIAT) were assessed by structured interview in 2 cohorts sampled from the European Union and the USA: 499 HIV-treating physicians and 603 treatment-experienced HIV-infected patients. Motivators and barriers to prescribing SIAT were identified from statistical analysis of the associations between physicians' ratings of enfuvirtide-based therapy compared to standard oral-based therapy and 2 indicators of enfuvirtide prescribing behavior. Patients' attitudes were assessed by their responses to a written profile of enfuvirtide and their ratings of the likelihood of accepting a treatment offer.
  
  
  RESULTS
  Both indicators of SIAT prescribing behavior were predicted by the same pattern of physician beliefs. Nonprescribing was associated with: (1) the belief that offering enfuvirtide would be perceived negatively by patients, leading to treatment refusal and nonadherence; (2) the belief that prescribing enfuvirtide is harder to justify in terms of time/resources; and (3) a lack of confidence in the efficacy and use of enfuvirtide in practice (all p < 0.05). However, physicians' beliefs were not in concordance with patients' views. After reading a profile of enfuvirtide, 76% patients said that they would be moderately or highly likely to accept a treatment offer, although most (72%) had not discussed enfuvirtide with their doctor. Patients' beliefs predicted the likelihood of accepting enfuvirtide.
  
  
  CONCLUSIONS
  Physician and patient beliefs about SIAT influence prescribing behavior and compliance yet may not be concordant, with patients having more positive attitudes towards SIAT than anticipated by physicians.
authors.affiliation: Centre for Behavioural Medicine, Department of Policy & Practice, School of Pharmacy, University of London, London, UK. rob.horne@pharmacy.ac.uk
authors.forename: Robert
authors.initials: R
authors.lastname: Horne
authors.forename: Colin
authors.initials: C
authors.lastname: Kovacs
authors.forename: Christine
authors.initials: C
authors.lastname: Katlama
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Clotet
authors.forename: Carmina R
authors.initials: CR
authors.lastname: Fumaz
authors.forename: Michael
authors.initials: M
authors.lastname: Youle
authors.forename: Ranjababu
authors.initials: R
authors.lastname: Kulasegaram
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
authors.forename: Calvin
authors.initials: C
authors.lastname: Cohen
authors.forename: Jihad
authors.initials: J
authors.lastname: Slim
authors.forename: Peter
authors.initials: P
authors.lastname: Shalit
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cooper
authors.forename: Christos
authors.initials: C
authors.lastname: Tsoukas