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“Cure” Versus “Clinical Remission”: The Impact of a Medication Description on the Willingness of People Living with HIV to Take a Medication

AIDS and Behavior volume 24, pages 2054–2061 (2020)Cite this article

Abstract

Many people living with HIV (PLWHIV) state that they would be willing to take significant risks to be “cured” of the virus. However, how they interpret the word “cure” in this context is not clear. We used a randomized survey to examine whether PLWHIV had a different willingness to take a hypothetical HIV medication if it causes flu-like symptoms, but provides: (a) cure, (b) remission that was labeled “cure”, or (c) remission. PLWHIV (n = 454) were more willing to take a medication that provided a “cure” versus a “remission” if the side effects lasted less than 1 year. PLWHIV were more willing to take a medication that provided a remission that was labeled “cure” versus a “remission” (p = 0.01) if the side effects lasted 2 weeks. Clinicians and researchers should be aware of the impact of the word “cure” and ensure that PLWHIV fully understand the possible outcomes of their treatment options.

Abstracta

Mucha gente que vive con el VIH dice que estaría dispuesta a tomar riesgos significativos para ser “curado(a)s” del virus. Sin embargo, no es claro cómo se interpreta la palabra “cura” en este contexto. Nosotros usamos una encuesta aleatoria para examinar que tanto la gente que vive con el VIH está dispuesta a tomar un medicamento hipotético para el VIH si causa síntomas como de la gripe, pero provee: a) cura, b) remisión que es etiquetada como “cura”, o c) remisión. Las personas que vive con el VIH (n = 454) estaban más dispuestas a tomar un medicamento que provee una “cura” en vez de una “remisión” si los efectos secundarios duraban menos que un año. Las personas que viven con el VIH estaban más dispuestas a tomar un medicamento que proveía una remisión que estaba etiquetada como “cura” envés de “remisión” (p = 0.01) si los efectos secundarios duraban dos semanas. Los clínicos(a)s e investigadores deben tener en cuenta el impacto de la palabra “cura” y asegurarse que la gente que vive con el VIH entienda completamente los posibles resultados de sus opciones para tratamiento.

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Acknowledgments

This research is supported by NIH Grant R56AI114617, Principal Investigator: Nir Eyal. 08/01/2014- 07/31/2019. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funding source had NO involvement in: study design, the data collection, analysis, and interpretation of data, the writing of the report or the decision to submit the paper for publication. We are grateful to the Emory Center for AIDS Research and UCLA Medical Center for the assistance in conducting the experiment.

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Authors and Affiliations

  1. Duke University, 100 Fuqua Drive, Durham, NC, 27708, USA

    Ilona Fridman

  2. Marketing Department, Fuqua School of Business, Duke University, 100 Fuqua Drive, Durham, NC, 27708, USA

    Peter A. Ubel

  3. School of Medicine, Duke University, 2301 Erwin Rd, Durham, North Carolina, 27710, USA

    Peter A. Ubel & Karen A. Scherr

  4. Sanford School of Public Policy, Duke University, 201 Science Dr., Durham, NC, 27708, USA

    Peter A. Ubel

  5. Center for Medical Ethics and Health Policy, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA

    Jennifer Blumenthal-Barby

  6. Emory University School of Medicine and Grady Memorial Hospital, 201 Dowman Drive, Atlanta, GA, 30322, USA

    Cameron V. England & Jeffrey L. Lennox

  7. Ronald Reagan UCLA Medical Center UCLA Medical Center, 1919 Santa Monica Blvd, Santa Monica, CA, 90404, USA

    Judith S. Currier & Catherine N. Le

  8. Division of Medical Ethics, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

    Nir Eyal

  9. Division of Infectious Diseases, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Nir Eyal & Daniel R. Kuritzkes

  10. Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA

    Kenneth A. Freedberg

  11. Divisions of General Internal Medicine and Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA

    Kenneth A. Freedberg

  12. Harvard University Center for AIDS Research, Harvard University, Boston, MA, USA

    Kenneth A. Freedberg

  13. Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Kenneth A. Freedberg

  14. Departments of Medicine, Medical Ethics and Health Policy, and Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Perelman School of Medicine, the Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of Health Economics, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Scott D. Halpern

  15. Division of Infectious Disease, Department of Medicine, Emory University, The Hope Clinic, 500 Irvin Ct Suite 200, Decatur, GA, USA

    Colleen F. Kelley

  16. Cancer Control and Population Sciences, Duke Cancer Institute, Durham, USA

    Kathryn I. Pollak

  17. Department of Population Health Sciences, Duke School of Medicine, 2424 Erwin Rd, Durham, NC, 27705, USA

    Kathryn I. Pollak

  18. Department of Health Behavior and Health Education, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA

    Brian J. Zikmund-Fisher

  19. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA

    Brian J. Zikmund-Fisher

Authors
  1. Ilona Fridman
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  2. Peter A. Ubel
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  3. Jennifer Blumenthal-Barby
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  4. Cameron V. England
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  5. Judith S. Currier
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  6. Nir Eyal
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  9. Colleen F. Kelley
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  11. Catherine N. Le
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  14. Brian J. Zikmund-Fisher
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  15. Karen A. Scherr
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Correspondence to Ilona Fridman.

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Appendix

Appendix

Intention to Take Medication

Due to skewness in the data, we also ran a non-parametric test, which indicated similar results (Kruskal–Wallis Test, χ2 = 13.60, p = 0.001); Cure group vs. Remission group (Mann–Whitney U = 9,182.00, p < .001); Cure group vs Remission labeled “Cure” group (Mann–Whitney U = 10,169.00, p = 0.10); Remission labeled “Cure” group vs. Remission group (Mann–Whitney U = 9535.50, p = 0.04).

Attitude Toward Medication

We ran a non-parametric test, that indicated similar results: Cure group provided the highest rating, Remission group provided the lowest rating, and Remission labeled “Cure” group was in between of them (Kruskal–Wallis Test, χ2 = 16.99, p = 0.00). Cure group vs. Remission group (Mann–Whitney U = 8785.50, p = 0.00). Cure group vs Remission labeled “Cure” group (Mann–Whitney U = 9579.50, p = 0.02); Remission labeled “Cure” group vs. Remission group (Mann–Whitney U = 9730.50, p = 0.08).

Intention to Take Medication by the Duration of Side Effects

In this part, we repeated analysis for the intention to take the medication with the full sample (n = 454). We evaluated the participants’ willingness to tolerate side effects for each item using a MANOVA procedure with Bonferroni adjustment to account for multiple comparisons. The MANOVA test indicated a significant difference overall, MANOVA results, F(449, 3) = 4.23, p = .00, η2 = .03. Mean differences and statistics for each item is reported in Table 4. The columns illustrate the mean difference in participants’ willingness to take the medication between each pair of groups. In all cases, the mean of the second group listed was subtracted from the mean of the first group listed. Higher numbers indicated a stronger intend to take the medication.

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Fridman, I., Ubel, P.A., Blumenthal-Barby, J. et al. “Cure” Versus “Clinical Remission”: The Impact of a Medication Description on the Willingness of People Living with HIV to Take a Medication. AIDS Behav 24, 2054–2061 (2020). https://doi.org/10.1007/s10461-019-02769-1

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Keywords

  • Cure
  • Decision-making
  • Behavior
  • Remission
  • HIV
  • PLWHIV