Comparison of perceived versus actual care complexity in HIV-positive patients receiving antiretroviral treatment: The STRATPATIENT study.

Abstract

Introduction: HIV is now considered a chronic disease due to advances in antiretroviral therapy (ART), which have improved survival but have also increased both comorbidities and polypharmacy. This underscores the need for personalized care strategies such as the Capacity-Motivation-Opportunity (CMO) model and patient stratification tools. This study aimed to identify the discrepancy between patient-perceived and actual care complexity in HIV-positive patients on ART, as assessed by a stratification tool.

Methods: A retrospective, observational study at Valme Hospital (April-June 2024) included HIV-positive patients aged over 18 years on stable ART, excluding clinical trial participants. Data collected included age, sex, route of HIV acquisition, viral load, CD4 count, AIDS stage, comorbidities, polypharmacy and the Medication Regimen Complexity Index (MRCI). Perceived complexity was assessed using a visual analogue scale, whereas complexity according to the stratification tool was calculated with the variables of the CMO model.

Results: A total of 411 participants with a median age of 55 years were included, of whom 72.5 % had comorbidities, primarily cardiovascular. The median MRCI score was 8, with 85.4 % of patients were classified at stratification level 3, while 74.9 % reported low perceived healthcare complexity. Concordance between stratification and perceived complexity was weak. Significant associations were observed between perceived complexity and AIDS stage, extensive polypharmacy, and stratification levels.

Conclusion: This study emphasises integrating objective assessments and patient perspectives to improve healthcare evaluation and patient-centered care.