HIV doctors underestimate patients’ willingness to use injectables

Patients who could benefit from injectable therapies are a lot less needle-phobic than doctors assume, according to research conducted by pharmacist and behavioural scientist Professor Robert Horne.  The “Open Mind” study presented at the 10th European AIDS Conference/EACS in Dublin showed over three quarters of patients would be willing to accept self-administered subcutaneous  injectable therapy if offered. 

Professor Horne of Brighton University carried out the study to investigate why only 10 per cent of patients eligible for the injectable antiretroviral (ARV) therapy enfuvirtide (Fuzeon, T-20), actually receive it.   The drug is indicated for treatment-experienced patients with HIV in combination with other ARV drugs.  It is intended as a further option when resistance to standard oral drugs develops.  Clinical trials show it can double patients’ chances of achieving undetectable viraemia and that it generally improves health-related quality of life.

However, Prof Horne says his findings have wider relevance to other injectable therapies for serious medical conditions such as diabetes, multiple sclerosis and hepatitis C, where clinical outcomes could potentially be seriously compromised by choosing non-injectable treatment options.

The study included 603 treatment-experienced HIV patients and 499 physicians with three years’ or more HIV experience who had at least 15 per cent of patients with exposure to eight or more ARVs.  It looked at practicalities as well as perceptions that are barriers or motivators to delivery of optimal treatment.

Results showed 76 per cent of doctors agreed injectable therapy offers  superior clinical outcomes but almost half believed it would increase non-adherence and treatment refusal while 40 per cent thought patients would feel drawbacks outweighed benefits.  Of patients however, 72 per cent said they had never been given opportunities to discuss injectable therapy as a treatment option.  Over three quarters said they would be likely to accept injectable therapy if offered while 60 per cent felt confident about self-injecting and were motivated to accept treatment as directed.

“This does not call for doctor-bashing,” said Prof Horne.  “Doctors have good intentions in limiting patient access to injectable treatments but they may be depriving the patients most likely to benefit,” he commented.  “Misplaced beliefs may influence prescribing more than published guidelines. The study will help in designing intelligent, streetwise interventions to address the problem.”  One of these may be to give pharmacists a greater role in educating patients on treatment options, he added. (end)

To see more features by Olwen Glynn Owen follow this link to his first feature article and scroll to the end for a list:
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