Attitude Is Key Part of Treatment Adherence: Study Suggests Which Attitudes to Watch

A small Chicago study suggests that attitudes about HIV/AIDS among HIV-infected people can be broken down into types that are predictive of how well the patients will adhere to their medication regimes. "The people who do well over the long haul are different from those who don't do well, principally on the basis of being able to take their medications," said Dr. John Flaherty, associate professor of medicine at Northwestern University. "I think we spend most of our time in the clinic on that issue with patients."

Seventy-two HIV patients were given 34 statements to rank according to how much they agreed or disagreed with them. The first part of the questionnaire dealt with demographics, the patient's drugs, and illnesses. The second part involved ranking various attitude statements. HAART adherence was determined by a self-report questionnaire, plus results from viral load and genotypic assay.

Analysis revealed the following five different patient attitudes:

• Empowered: Patients who clearly knew about HIV/AIDS and why it is important to take antiretroviral medication. The patients who fit into this group had the greatest amount of adherence, said Farheen Ali, MD, study coauthor and fellow of infectious disease at the University of Chicago.
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• Dependent: Patients who could be described as depressed. They identified with statements that showed they were very dependent on physicians and family support, Ali said. "They didn't understand why they were supposed to take medications, but they did so because they were told to do so."

• Ashamed: "This group predominantly expressed feelings of shame and guilt about the disease," Ali said. "They felt they were responsible for contracting HIV in the first place." This group tended to be more adherent than not adherent.

• Optimistic: HIV patients who could be described as blind optimists, who believed they were OK and who planned to continue taking their medications, Ali said. While they tended not to know or understand much about their disease, they did appear to be adherent, he said.

• Denial: HIV patients who predominantly said they strongly agreed that they would live their natural life spans, Ali noted. These patients require a lot of work because of their unrealistic expectations and beliefs, he said. The patients "all had excuses for missing their medication doses, such as they fell asleep or [were] out of the house. So it seemed they felt they'd be OK, but didn't want to deal with the medication." The denial group also reported that they had not received all the information they needed from their physicians, and they appeared to have some distrust of the medical community, he added.

Because of the small cohort, the differences were not statistically significant, and further studies will need to be conducted to confirm the findings, said Flaherty. It is crucial that clinicians are able to refer patients to social workers, psychiatrists, advanced practice nurses, and others who may help them with their psychological issues that impact adherence, Flaherty said. The study, "Subjective Attitudes and Adherence to HAART in HIV-Infected Adults," was presented in October at the 40th Annual Meeting of the Infectious Diseases Society of America in Chicago.

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