October 2001

From Yale University

HIV patients more likely to accept a drug regimen if they trust in the physician, Yale researchers find

A study of HIV-infected prisoners shows that they are more likely to accept antiretroviral therapy (ART) if they have trust in the treatment, their physicians and in medical institutions, highlighting the important role that trust plays in HIV therapy, Yale researchers report.

The researchers also found that lack of social support, complexity of medication regimen and adverse side effects all reduce adherence to ART. The study, led by Frederick L. Altice, M.D., associate professor of medicine (AIDS Program) at Yale School of Medicine, is published in the September issue of Journal of Acquired Immune Deficiency Syndromes.

"This is the first study to demonstrate the role of trust in the therapeutic process," said Altice. "These results underscore the idea that caregivers need to have the patient buy into the treatment process if marginalized members of the HIV population are going to reap the benefits of the latest treatment options for AIDS."

While ART has been successful in treating AIDS patients in the general population and has resulted in reduced AIDS infection and mortality, Altice said ART has not been as successful in marginalized HIV-infected populations because there is a lack of acceptance and adherence to the treatment regimens. "There is a lot of mistrust in these treatments, such as concern that the drugs may be poisons designed to harm them, rather than heal their symptoms," said Altice.

Altice and his team surveyed 205 HIV-infected prisoners in four ambulatory prison HIV clinics. Sixty-four percent of the study participants had only been offered ART within a prison setting and only three percent had prescriptions for ART at the time of incarceration. The team found that a remarkable 80 percent of study participants were adherent to their HIV therapy. They also found that participants who had trust in their medical institutions were about 20 percent more likely to adhere to ART than their more mistrustful counterparts.

Lack of trust in peers and in physicians also played a large role in acceptance of HIV medications. Participants who felt mistreated by their physicians were 47 percent less likely to take ART, and those who were socially isolated and mistrusted peers were 89 percent less likely to take ART.

"This study shows that by building trust and promoting acceptance, we can successfully demystify ART for members of marginalized populations, in this case prisoners who were injection drug users," Altice said. "We must also develop better systems of social support to assist patients if we expect them to optimally adhere to treatment."

Other researchers on the study include Farzad Mostashari, M.D., who is now at the New York City Department of Health, and Gerald Friedland, M.D., professor of medicine and in the Department of Epidemiology and Public Health, and director of the AIDS Program at Yale.











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