Treatment Challenges, Priorities, and Relationship with Healthcare Providers in HIV Care: A Cross-Sectional Survey of Portuguese Adults Living with HIV

Abstract

BACKGROUND: The World Health Organization’s definition of health focuses on health-related quality of life in all domains, not just the “absence of disease or infirmity”. We investigated various treatment challenges among People living with HIV (PLHIV) in Portugal. METHODS: We analyzed data for n=60 adult PLHIV with a confirmed diagnosis and on anti-retroviral therapy (ART) who participated in the 2019 Positive Perspectives Survey. Descriptive analyses were performed using R Version 3.6.1. RESULTS: Most participants were virally suppressed (97%), male (67%); <50 years (51%); and had ≥1 non-HIV comorbidity (70%). Overall, 15% reported trouble swallowing pills, 35% experienced ART side effects, 22% felt daily oral ART limited their life, 25% were stressed by their dosing schedule, 33% said daily oral dosing cued bad memories, while 63% said daily dosing reminded them of their HIV. These challenges were associated with treatment-avoidance behaviors; PLHIV reported missing ≥1 ART dose within the past month because of food requirements 27%, side effects 12%, concerns about long-term ART impacts 10%, and problems swallowing 5%. Overall, 73% were open to taking long-acting, nondaily ART if they remained virologically controlled. Only 35% overall perceived no communication barriers with their HCPs; these individuals had higher prevalence of optimal physical (86% vs. 49%, p=0.011) and mental health (86% vs. 36%, p<0.001) than those with a perceived barrier. CONCLUSION: For some PLHIV, taking pills daily was linked with diverse emotional challenges, including pill fatigue and anxiety. Clinicians should consider patient preferences when prescribing ART and engage PLHIV in treatment decisions.