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Person-Centered Care
The Most Important Questions for Person-Centered Care in HIV

Released: May 22, 2024

Expiration: May 21, 2025

Marc Thompson
Marc Thompson,
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Key Takeaways
  • Patient-identified challenges with ART include mental health and quality-of-life concerns, but HCPs are not initiating these conversations during patient visits.

In my advocacy work, in speaking to other people living with HIV, I have found that HIV treatment is so tolerable that, today, concerns are less about antiretroviral therapy (ART)–related adverse effects. Rather, there are other issues in HIV care that have been identified by the community—issues about quality of life or mental health.

But some healthcare professionals (HCPs) who treat people living with HIV tend to focus on HIV and the specific medications that patients are receiving for HIV, which can make patients feel less inclined to raise concerns about other health conditions. Patients may feel the HCP visit is not the right place to do so because of the limited appointment time.

Compounding this, HIV-specialized HCPs rarely ask patients about the things that may be affecting their quality of life, such as emotional well-being, community and social connections, relationships, or work and purpose. These concerns are important, as they help those of us living with HIV engage in and maintain good overall health.

Furthermore, for patients who are virologically suppressed on ART, HCPs are not asking if their treatment is still the right regimen to continue with in their care. In my experience, and from what I have heard from others, HIV-specialized HCPs simply ask questions about adherence, for example, “Have you missed any doses? Are you taking your medication on time?” Conversations about whether the patient is satisfied with the regimen are not happening regularly, unless prompted by patients.

How Can HCPs Make a Difference?
The key action that all HCPs—and particularly those working with people living with HIV—can take is to look at patients holistically, so they are not just treating a single condition or virus. The questions that HCPs need to ask themselves include: Who is this person in front of me? What are their social circumstances? What does their identity tell me? What are the intersections of their lives?

I think these are crucial, yet simple, questions that can be answered within a few minutes of being with patients. Sometimes it requires one to be brave and step out of one’s comfort zone. Some HCPs need to approach patients with more humanity to recognize that they have a whole human in front of them.

I also think HCPs should be asking themselves about quality-of-life issues. What are the factors that can affect the quality of life of the people in their care? And how might these affect a person’s ability to engage with their care and self-manage their treatment?

Here are some questions to ask patients during their visit:

  • Are you okay with the treatment that you are currently taking? Does it fit in with your lifestyle?
  • Has anything in your life changed significantly since I saw you last?
  • Are you still seeing the same person/with the same partner as you mentioned in your last visit?
  • Are you still enjoying work?
  • Is your home life still safe, comfortable, and warm?
  • Are you able to access food and water?
  • Does your treatment still work for you?
  • Are you able to take your treatment when you are ready to?

Furthermore, HCPs should recognize that quality-of-life issues and solutions vary among people living with HIV. For some people, that may mean engaging with peer support or signposting to services and resources outside the clinic. In addition, the solution includes understanding individuals’ relationships with their community.

Making Space, Making Time
If you are an HCP reading this, you might well wonder how there can be time to bring up these questions with your patients. After all, given the success of HIV treatment and the fact that most of us with HIV are living well and living longer, we are seeing our HIV-specialized HCPs much less. And since many consultations and engagements with patients are now moving to the digital space (eg, telehealth), we may only see an HCP face to face twice per year. But HCPs can get lots of information sent to them digitally; therefore, in face-to-face consultations, time needs to be dedicated to drill down to the more complex issues to meet patients’ needs.

If this time is not available during a specific appointment, HCPs should use tools outside of these visits where someone can engage with a different kind of HCP in the clinic to get education and answers to questions.

I am a big champion for peer support and peer providers. Maybe there is an opportunity for HIV-specialized HCPs to engage more strongly with peer supporters who can provide wraparound care and support to patients outside of their clinic visit.

New Options
Finally, HCPs need to stay up to date with all of the changes occurring in HIV treatment, whether that be new options or new modalities like injectables and long-acting ART. This may sound like a really simple ask, but HCPs are incredibly busy. Yet they need to be updated because the game is changing so quickly.

What is important for HCPs to know is that patients may be unaware of newly available options that may be more accessible and acceptable to them. HCPs should be initiating these conversations. They may not need to change their ART regimen, but patients should be educated on any updates in HIV treatment and allowed to determine if they would like to change their regimen to an option that works better for them. This is really empowering for people who are living with HIV, and it enables them to feel in control of their care as well.

Your Thoughts?
Do you discuss patients’ ART options as treatment options and modalities evolve? You can get involved by posting a comment below.