Trainings to increase confidence and comfort
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By and large, trainings were considered valuable to increase providers’ confidence to interpret DRM testing results and improve providers’ ability to teach others to interpret DRM testing results. One provider underscored that the absence of any type of DRM testing training at their clinic was the reason for their co-workers’ inability to interpret DRM testing results independently. At the same time, one policymaker noted that regardless of training reception, providers were still “shy,” lacking the confidence to correctly interpret results and make subsequent clinical decisions. Notably, despite not having undergone formal training to interpret testing results, several providers commented on how clearly laid out words such as “resistance” and “non-susceptible”, i.e., phenotypic interpretation using the Stanford HIV Drug Resistance Database, printed on DRM testing results documents by the resulting lab made DRM testing results interpretation easier. In addition to ordering and interpreting DRM testing results, providers also reported a lack of formal training on how to counsel patients after receiving and processing the DRM testing results themselves. One policymaker further highlighted that counseling patients can be difficult due to the challenge of making technical language around DRM testing more accessible for patients. On the other hand, when asked about the meaning of their DRM testing results, patients used non-technical and digestible language, such as “not working well” or “not effective,” to explain their results. Overall, most patients seemed to be satisfied by the language used by their providers to counsel on their results, expressing gratitude towards their provider’s kindness, guidance, and efforts to motivate them and alleviate their fears during these sessions, while desiring to know why they may have to change their drug regimens. Notably, patients trusted providers and study staff in their knowledge of HIV treatment, with two patients reporting that they wanted doctors and the study staff to educate and counsel them on their results.