Motivators and Barriers To Use Of Combination Therapies In Patients With HIV Disease

The successful two-drug combination therapy in 1994 and protease inhibitors in 1995 set the stage for a new era in treatment of HIV disease, creating a burst of optimism over the prospect that HIV might be a controllable disease. Initial studies of protease containing triple-drug regimens suggested that these combinations could, in some cases, slow clinical progression of the disease and prolong the lives of patients. In anecdotal reports, physicians and patients described a kind of "Lazarus" effect in which previously disabled individuals found themselves regaining lost functions, returning to work and planning their futures, instead of preparing for death. There are still many unknowns about these multi-drug regimens, including their durability of effect and how many individuals for whom they will be effective. Nonetheless, the drugs have proven quite effective in clinical trials and are helping many people stay alive longer and experience better quality of life while they are alive. We thought it important to understand better why people do and do not take advantage of these therapeutic advances. Developing the medications may be only half of the battle; the other half involves making sure that HIV infected individuals have access to the drugs and that they make thoughtful decisions about whether or not to take them. If some of the barriers to taking the drugs can be addressed, they should. We conducted in-depth qualitative interviews with 114 individuals in the HIV community--75 HIV infected men and women, 18 hotline operators and supervisors, 11 case managers, and 10 physicians and nurse practitioners.