Evaluating patient preference and satisfaction for human immunodeficiency virus therapy in France

Abstract

ObjectivesThe objectives were 1) to elicit relative preferences for attributes of antiretroviral therapies (ART) in people living with HIV (PLWH) and 2) to explore satisfaction and adherence with current ART.Patients and methodsWe conducted a multicenter cross-sectional study, consecutively enrolling PLWH receiving an ART. The quantitative part estimated the strength of preference for different attributes using an online discrete choice experiment (DCE). DCE data were analyzed using a mixed logit regression model. Qualitative data were collected through individual interviews. A preliminary coding framework was developed which was then further refined and applied during thematic analysis of factors influencing satisfaction and adherence.ResultsA total of 101 PLWH took part in the quantitative part and 31 in the qualitative part. Over 90% had an undetectable viral load. Quantitative data revealed a strong preference for a treatment with limited drug–drug interactions, diarrhea and long-term health problems (P<0.0001), and that did not need to be taken on an empty stomach (P<0.0001). Patients also preferred to avoid problems associated with treatment failure (P<0.0001) or one that left them with a higher viral load after the first weeks of treatment (P=0.044). Differences in CD4 cell count, and pills that must be taken with food were not significant drivers of treatment choice. The strength of these attributes was reflected in the qualitative data, highlighting the importance patients place on treatment efficacy, and also suggesting that some of these attributes may impact adherence. Many factors influencing adherence and satisfaction with treatment were identified, including pill size, worry about sexual transmission and impact on social life.ConclusionMost of the attributes included in this survey were important to participants when choosing an ART, in particular those related to quality of life, and these should be taken into account in order to optimize adherence and satisfaction.

A discrete choice experiment to assess patients’ preferences for HIV treatment in the rural population in Colombia

“…Our study, using a DCE, offers the advantage to assess the trade-offs between the most important attributes. Furthermore, previous DCEs have investigated patients' preferences in HIV treatment in Europe [16][17][18] . These studies also showed that efficacy and quality-of-life are important attributes for HIV patients.…”

“…First, a literature review in PubMed was conducted to examine which attributes were used in previous DCEs on patients' preferences in HIV treatment [16][17][18][19][20][21]30 . In addition, a previous best-worst scaling study of Hendriks et al 22 , which identified the most important treatment characteristics of HIV patients in Colombia, was used as the main basis for the attributes of the present study.…”

“…Stated preference studies are increasingly used to elicit patients' preferences in healthcare [13][14][15] . Over the last years, several preference studies on HIV treatment have been conducted in developed countries [16][17][18] , revealing the importance of efficacy of treatment and quality-of-life for HIV patients. Likewise some preference studies were conducted in developing countries, including Tanzania 19 , Thailand 20 , South Africa 21 , and Colombia 22 .…”

Differences in HIV cure clinical trial preferences of French people living with HIV and physicians in the ANRS‐APSEC study: a discrete choice experiment

“…The underlying assumptions in a DCE are that healthcare interventions can be described by their attributes (or characteristics) and that a respondent's valuation of an intervention depends on the level of each of these attributes . In DCE, respondents are presented with several pairs of hypothetical designs.…”

Using discrete choice experiments to design interventions for heterogeneous preferences: protocol for a pragmatic randomised controlled trial of a preference-informed, heterogeneity-focused, HIV testing offer for high-risk populations

“…27 DCEs are used increasingly to understand patient perspectives and to design patient-centred interventions. Although DCEs have been used in various contexts related to HIV, including testing, 20 28-32 prevention, [33][34][35][36] service delivery, [37][38][39] and treatment, [40][41][42][43][44] to our knowledge, DCEs have not yet been used to systematically design HCT interventions.…”