Holistic care, behavior contracts improve HIV patient outcomes

Managing patients with HIV isn’t as simple as treating the disease. These patients have complex psychosocial and physical health histories, but supportive care and commitment contracts can lead to improved outcomes, according to new research.

A report published in AIDS and Behavior found that older individuals with HIV are living with complex physical and psychosocial problems that negatively affect their overall quality of life. The study focused on patients with HIV aged 50 and older and found that substance abuse, mental health issues, demographic challenges a

nd comorbid physical conditions lead to a reduced quality of life. Clinical and supportive care were identified as key to managing this range of issues, as they could complicate the success of the HIV therapeutic regimen, according to the report.

“A chronic condition like HIV should not be addressed in a silo or without taking into consideration other co-occurring conditions, especially when we’re working with older people living with HIV,” said Jeffrey T. Parsons, PhD, co-author of the report told Medical Economics. “We found that many participants in our study

were dealing with a range of other conditions and, as such, issues relating to HIV management and care should be seen as operating in the context of, or alongside, other medical and physical issues arising from these co-morbidities.”

HIV management and care efforts should strive to consider co-occurring conditions. Efforts to address issues such as substance use behavior and mental health would benefit from a more holistic approach that considers the range of chronic conditions that people are dealing with at once, he said.

“Our study also showed that the more comorbid conditions an older adult living with HIV has, the lower their overall quality of life-and that’s over and above the impact of depression and substance use on quality of life,” Parsons, professor and director of the Hunter College Center for HIV/AIDS Educational Studies and Training (CHEST) at Hunter College in New York City, said.

Next: Addressing the whole patient

Addressing the whole patient

The hope is that the report will lead to increased awareness among caregivers to address the whole patient and the struggles they face alongside HIV infection.

“Other related health behaviors and outcomes may often need to be addressed in the context of more than solely HIV,” Parsons said. “Conversely, for the older person living with HIV, issues around HIV management operate within a wider context of comorbidities and behaviors.”

One way to address comorbidities driven by behavior is with a commitment contract, according to a report published in AIDS. The study investigated whether behavior contracts that incentivized compliance with recommended care plans improved health outcomes. The research team found that patients in the incentivized group had improved anti-retroviral therapy adherence and viral suppression at the conclusion of the study.

Marcella Alsan, MD, MPH, PhD

Marcella Alsan, MD, MPH, PhD, lead author of the report and assistant professor at the Stanford School of Medicine in California, , said the contracts were effective in improving adherence to HIV regimens because it gave patients more control over their healthcare.

“My hope is that physicians and medical providers recognize the role that modifying the choice architecture can play in improving health outcomes,” Alsan, core faculty at the Center for Health Policy/Primary Care Outcomes Research at Stanford, said. “Our research on commitment contracts for HIV treatment adds to a growing body of evidence-including obesity and smoking-on how behavioral economics can be leveraged to improve health.”