Affect Antiretroviral Therapy Adherence Research Articles

A binational comparison of HIV provider attitudes towards the use of complementary and alternative medicine among HIV-positive Latino patients receiving care in the US–Mexico border region

Use of complementary and alternative medicine (CAM) is common among Latinos living with HIV in the United States (US)–Mexico border region. Health providers may vary in their approach to communicating acceptance or non acceptance of CAM use, which can undermine patient confidence in disclosing CAM use. Patient–provider communication about CAM is important because certain types of CAM can affect antiretroviral therapy (ART) adherence. We undertook the present binational study to understand US and Mexican provider beliefs, and perceptions surrounding CAM use among Latino patients, and to learn if and how CAM communication occurs. Between July and December 2010, we conducted in-depth, qualitative interviews in Tijuana and San Diego. Analysis procedures drew upon principles of Grounded Theory. The sample was comprised of 19 HIV-health care providers, including 7 women and 12 men. Emerging CAM-related themes were: Provider's perceptions, attitudes and knowledge about CAM; CAM types and modalities; and patient–provider CAM communication. Many clinicians were uncomfortable supporting CAM use with their patients. San Diego providers reported more frequent instances of CAM use among Latino patients than Tijuana providers. Providers from both cities reported that patients infrequently disclose CAM use and almost half do not routinely ask patients about CAM practices. Most of the providers acknowledged that they lack information about CAM, and are concerned about the drug interaction as well as the effects of CAM on adherence. Our findings have important implications for understanding provider communication surrounding CAM use in a highly transnational population and context. Because CAM use may undermine ART adherence and is highly prevalent among Latinos, provider communication about CAM is critical to improved health outcomes among HIV-positive Latinos. Considering the significant growth of US Latinos, especially in the US–Mexico border region, assessment of Mexican and US provider training and communication needs surrounding Latino patient CAM use is warranted.

Case study: Accessible primary health care—A foundation to improve health outcomes for people who inject drugs

Issue Injecting drug users (IDUs) represent a large part of the population with HIV globally, however, IDUs continue to have less access to HIV treatment than non-IDUs. While IDUs with HIV potentially fare as well on anti-retroviral therapy (ART) as non-IDUs in terms of HIV disease progression, ART adherence is critical. Opioid dependent IDUs may experience lifestyle instability affecting ART adherence. IDUs often have a range of complex health and social welfare needs beyond HIV. The approach Opioid agonist pharmacotherapies such as methadone maintenance treatment, improve overall health and psychosocial stability among opioid-dependent IDUs. The integration of pharmacotherapies into primary health care settings also allows the direct observation of the concomitant administration of HIV treatments. This dual treatment approach maximises HIV treatment adherence and enables the timely management of other clinical issues. Where relevant, sexual and reproductive, infant and maternal health services should also be incorporated alongside HIV and hepatitis B and C prevention services. Services should be anonymous and confidential, and be provided by a multidisciplinary team in a non-judgemental way. Involvement of IDUs in service planning should also be promoted to ensure the acceptability of the model to the target population. A case study The Kirketon Road Centre (KRC) in Kings Cross, Australia, is an example of a community-based primary health care service delivery model that comprehensively addresses a range of complex health and social welfare needs IDUs may have. Established in 1987 to prevent HIV/AIDS and other transmissible infections among “at risk” young people, IDUs and commercial sex workers, the KRC model has also proven versatile in upscaling to meet hepatitis C and other emerging health needs of IDUs in a timely way. Conclusion Integrated primary health care models should be promoted more widely as a foundation to improve the health outcomes of IDUs.