Though the vast majority of people living with HIV surveyed in France had a high degree of trust in their HIV doctor, a small percentage began to lose trust over time, say the authors of a new study published in the April 1 issue of the Journal of Acquired Immune Deficiency Syndromes.
Though a number of studies in HIV have focused on the relationship between the patient and the provider, few have specifically examined factors associated with a loss of trust during ongoing care.
Marie Préau, PhD, from Nantes University in Nantes, France, and her colleagues from the Agence Nationale sur le Sida (ANRS) conducted regular surveys of 1,026 HIV-positive patients enrolled in the APROCO cohort study. While the primary goal of the study was to evaluate the safety and efficacy of various protease inhibitor regimens, it also asked participants to complete surveys on a regular basis regarding trust issues with their health care providers.
On a scale of 0 to 4, participants were asked to rate their level of trust in their treatment providers. A rating of 0 reflected "no confidence whatsoever," whereas a rating of 4 reflected "total confidence."
The vast majority, 96.4 percent, of those surveyed indicated that they had relatively strong level of trust in their provider, either a score of 3 or 4. Over the next 60 months 7 percent reported a loss of trust in their provider. Roughly half of these individuals ultimately regained trust in their provider.
The two factors most strongly associated with a loss of trust were having cumulated severe HIV or treatment-related problems, and having providers who were minimally responsive to patient concerns.
People who lost trust in their providers were more likely to be younger, have lower CD4 counts, be smokers, perceive antiretrovirals as not being effective, and be dissatisfied with explanations given by medical staff. The authors hypothesize that smoking itself did not necessarily predispose a person to a loss of trust as much as that providers may have treated smokers in a manner that caused them to feel less satisfied with their care.
While Préau's team stresses that the degree of trust in providers was high in nearly all those they surveyed, they also point out that for providers to maintain that trust, they must be careful not to minimize patient concerns and to be responsive to side effects and other health concerns.
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