Communication prior to antiretroviral initiation

Thoughtful, high-quality clinician–patient communication about starting antiretroviral therapy (ART) is a cornerstone of HIV care, and specific guidelines regarding exactly what ought to be discussed with patients considering ART have been in place since 2006. The extent to which the recommended topics are discussed and how these topics are addressed in observed dialogue in HIV care has not been studied. We conducted a content analysis to describe how these dialogues occur and, secondarily, assessed the frequency with which the recommended topics are discussed. Our study analyzed patient–clinician dialogue regarding ART initiation, comparing the content of 24 audio-recorded dialogues with the recommended guidelines, and describing how communication about the recommended topics takes place. While patient readiness to initiate therapy was discussed in the majority of visits (n = 18), the remaining topics (e.g. patient understanding of HIV and its treatment, motivation to adhere, barriers to and facilitators of adherence, social support, daily schedules, tolerance of pills) were discussed less often. Based on the findings, we suggest that systems be put in place (e.g. checklists) to guide providers in these discussions, and that providers utilize the teach-back method to ensure patient understanding.