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P17.16 Personal decisions around anti-retroviral therapies (art): findings from the literature and from a qualitative longitudinal study with people living with hiv (plhiv) in regional queensland, australia
  1. K Bolsewicz1,
  2. L Fitzgerald1,
  3. J Debattista2,
  4. B Gardiner1,
  5. A Whittaker3
  1. 1School of Population Health, University of Queensland
  2. 2Metro North Public Health Unit, Metro North Hospital & Health Service
  3. 3Monash University

Abstract

Introduction Patient-centred care is cornerstone of effective management of complex illnesses, yet little is known about personal decision processes around ART, especially among PLHIV living in remote areas. This paper examines how PLHIV living in regional Queensland make treatment decisions, and compares it with findings from the literature.

Methods The narratives around ART were elicited as part of a three year qualitative longitudinal study with 69 PLHIV over 35 from regional Queensland, recruited by key HIV organisations. Thematic analysis will continue at each and across time points. A comprehensive literature review (2003–13) on factors impacting people’s decisions around ART in Australia, Canada and the UK is under review [AC-2015–03–0185].

Results Decisions around treatment depended upon a range of psychosocial and structural factors. Some PLHIV discontinued ART and engaged in ‘cleansing’ of the body using natural therapies. ART was also experienced symbolically, as a reminder of one’s HIV status, but also as a means to a full life. The active coping style and treatment adherence of the peer models were seen as expressions of not succumbing to fear and stigma. The constructive and destructive influences of significant others on one’s continuum of care were highlighted. Non-medical advice was often sought when the health system was felt lacking.

Conclusion PLHIV in regional Queensland engage in nuanced analysis of various costs and benefits of ART uptake, in which biomedical concerns play an important yet often minor role. These findings are congruent with the literature: people’s abilities and motivations around ART are influenced by a host of interconnected, broader social factors. Findings have implications for the management of HIV and other complex diseases in that patient-centred care needs to move beyond purely biomedical considerations. This presentation will outline psychosocial factors providers can focus on to effectively address patient’s underlying concerns and support their choices around treatment.

Disclosure of interest statement The Living Positive in Queensland Study is funded by the Australia Research Council as a Linkage Project Grant [LP110200318]. Queensland Positive People, Queensland AIDS Council, and Positive Directions - Anglicare (now closed) were the original partner organisations of the study.

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