Recorded presentation

Mary K. Irvine, MPH, Nancy L VanDevanter, DrPH, Danielle Greene, MPH, Saba A Jearld, MPH, Renee Cohall, ACSW, and Mary Arnold, NP. Center for Applied Public Health, Mailman School of Public Health, Columbia University, 722 W. 168th St., 12th Floor, New York, NY 10032, (212) 342-0152, mki5@columbia.edu

Background: Research on physician-patient interactions has been valuable in explaining factors for patient satisfaction, service utilization, and health outcomes. Less is known about the relationships between providers and their patients’ family caregivers, particularly in the context of pediatric HIV treatment. Research in this area can further family-centered program development, by elucidating how styles of client-provider communication may impact families’ ability to adhere to antiretroviral regimens. Methods: Qualitative interviews were conducted with a purposive sample of 30 caregivers recruited from Ryan White CARE Act Title IV clinics. Respondents included biological, kinship and non-kinship-adoptive caregivers between the ages of 29 and 73; 90% were female, 60% African-American, and 40% Latino. Interviews explored coordinative, informational, environmental, and interpersonal aspects of care. All sessions were audio-taped, transcribed, coded independently by two researchers, and analyzed in ATLAS.ti. Results: Respondents illustrated ways in which open client-provider communication facilitated adherence, e.g., through regimen adjustments based on feedback about taste, comfort, or convenience. They indicated that “kid-friendliness” was critical for making twice-daily medication administration and frequent clinic appointments bearable. Their descriptions of clinic interactions conveyed the everyday workings of a partnership for care, as reflected in the exchange of treatment ideas, the negotiation of changes to family routines, and the sharing of decisions and commitments. Conclusions: Not only the array of services offered, but also the interpersonal dynamics of client-provider encounters, can support the treatment of children with HIV. Caregivers’ accounts illuminate which elements of care make a substantial difference to the lived experience of pediatric antiretroviral adherence.

Learning Objectives: At the conclusion of this session, the participant will be able to

• Articulate three characteristics of client-centered care, as highlighted by respondents in this study.
• Describe aspects of the provider-client relationship that can impact adherence, in a pediatric HIV care setting.

Keywords: Adherence, Children and Adolescents

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation