Safer sex decision-making among men with haemophilia and HIV and their female partners

An exploratory qualitative study of adult heterosexual men with haemophilia and HIV and women who were their sexual partners was conducted as formative research to better understand cognitive factors involved in behavioural intentions and practices which comprise HIV risk-reduction for sexual transmission. The study sought to generate hypotheses, uncover themes, and develop a broad perspective on possible determinants of behaviours related to HIV transmission risk reduction. Qualitative analysis of these data served as a basis for developing a subsequent quantitative, hypothesis-testing survey and an intervention. Face-to-face interviews were conducted with 23 single men and 28 married men with haemophilia and HIV infection, and 28 married women partners selected through stratified, purposeful sampling. The interviews identified beliefs, attitudes, and values underlying decisions regarding target behaviours related to preventing sexual transmission of HIV, including (1) using condoms consistently during vaginal intercourse and (2) talking to partners about risk reduction. The interviews elicited information about perceived advantages and disadvantages of performing each of the targeted behaviours, and factors that facilitate or prevent performing them. Qualitative analysis of coded responses yielded important themes regarding how choices are made about sexual activity and safer sex. Most notably, communication between partners (1) plays a direct, key role in facilitating condom use and (2) forms the basis for maintaining emotional intimacy in these relationships. The link between condom use and communicating about safer sex was viewed as pivotal in achieving HIV prevention for individuals in serodiscordant couples. Recommendations for risk reduction intervention development are discussed.     

A multicentre, randomized trial on the benefit/risk profile of amiodarone, flecainide and propafenone in patients with cardiac disease and complex ventricular arrhythmias

The long-term benefit/risk profiles of amiodarone, flecainideand propafenone were compared in 141 patients with complex ventriculararrhythmias and cardiac disease, in a trial designed to mimicthe clinical decision-making process. The patients were randomizedto various sequences of the three drugs, at two dose levelsandfollowedfor 2 years. Drug or doses were changed to deal withinsufficient reduction of arrhythmias at 24 h ECG or severeadverse drug reaction (ADR). At 2 years 18 patients haddied(9/18 suddenly), 19 had withdrawn because of major clinicalevents or severe ADR, 13 had dropped out, seven hadbeen non-respondersthroughout the entire sequence of drugs, whereas eight werenon-responders only at the last visit. Thus, 76 patients (54%)were responders after 2 years. Of these, 57 were respondersfor 2 years with thefirst drug. Median exposure time to amiodarone,518 days . patienr', was higher than for flecainide and propafenone,218 and 178, respectively, indicating better overall responseto amiodarone (P<001). A total of50 ADRs led to drug with-drawal,with cardiovascular ADR being less frequent (P<003) for amiodarone(2/11) than for flecainide (13/16) and propafenone (16/23).In conclusion, with sequences of amiodarone, flecainide andpropafenone, an overall response rate of 79% couldbe obtainedintheshort-term (7–28 days) and54% at 2years. Amiodaronehas a morefavourable therapeutic profile than flecainide andpropafenone in these patients, having less tendency to worsenheartfailure.     

The cost of HIV medication adherence support interventions: results of a cross-site evaluation

The objective of this study was to determine the direct cost of HIV adherence support programmes participating in a cross-site evaluation in the US. Data on the frequency, type, and setting of adherence encounters; providers' professions; and adherence tools provided were collected for 1,122 patients enrolled in 13 interventions at 9 sites. The site staff estimated the average duration of each type of encounter and national wage rates were used for labour costs. The median (range) adherence encounters/year among interventions was 16.5 (4.3-104.6) per patient; encounters lasted 24.6 (8.9-40.9) minutes. Intervention direct cost was correlated with the average frequency of encounters (r = 0.57), but not with encounter duration or providers' professions. The median direct cost/month was 35 dollars(5 dollars-58 dollars) per patient, and included direct provider costs (66%); incentives (17%); reminders and other tools (8%); and direct administrative time, provider transportation, training, and home delivery (9%). The median direct cost/month from a societal perspective, which includes patient time and travel costs, was 47 dollars(24 dollars-114 dollars) per patient. Adherence interventions with moderate efficacy costing < or =100 dollars/month have been estimated to meet a cost-effectiveness threshold that is generally accepted in the US. Payers should consider enhanced reimbursement for adherence support services.