Exploring Relative Preferences for HIV Service Features Using Discrete Choice Experiments: a Synthetic Review

Abstract

Purpose of Review Aligning HIV treatment services with patient preferences can promote long-term engagement. A rising number of studies solicit such preferences using discrete choice experiments, but have not been systematically reviewed to seek generalizable insights. Using a systematic search, we identified eleven choice experiments evaluating preferences for HIV treatment services published between 2004 and 2020. Recent Findings Across settings, the strongest preference was for nice, patient-centered providers, for which participants were willing to trade considerable amounts of time, money, and travel distance. In low- and middle-income countries, participants also preferred collecting antiretroviral therapy (ART) less frequently than 1 monthly, but showed no strong preference for 3-compared with 6-month refill frequency. Facility waiting times and travel distances were also important but were frequently outranked by stronger preferences. Health facility–based services were preferred to community- or home-based services, but this preference varied by setting. In high-income countries, the availability of unscheduled appointments was highly valued. Stigma was rarely explored and costs were a ubiquitous driver of preferences. Summary While present improvement efforts have focused on designs to enhance access (reduced waiting time, travel distance, and ART refill frequency), few initiatives focus on the patient-provider interaction, which represents a promising critical area for inquiry and investment. If HIV programs hope to truly deliver patient-centered care, they will need to incorporate patient preferences into service delivery strategies. Discrete choice experiments can not only inform such strategies but also contribute to prioritization efforts for policy-making decisions.

Patients’ preferences for antiretroviral therapy service provision: a systematic review

“…In this review, health facility-based models of ART were highly valued than community-based models. It is consistent with previous evidence [ 16 , 56 ]. This type of valuation could continue overstretching the existing health system and might create a barrier in scaling up ART to where PLHIV live and work hence deter achievement of 95-95-95 targets by 2030.…”

“…Therefore, 34 articles were assessed for eligibility. From these, 11 articles were excluded: three were abstracts without full text [ 26 – 28 ], three were review articles focusing on general HIV services [ 14 – 16 ], one study assessed HIV infected pregnant women [ 29 ], one study was repeated publication [ 30 ], one primary study focused on general HIV service [ 31 ], one study assessed General practitioner or HIV clinic appointment [ 32 ], and one study assessed medical and psychosocial support [ 33 ]. Finally, 23 studies were included in the review.…”

“…If a study reported the utility coefficients in a continuous scale of measurement, then the coefficients for discrete levels of each attribute were calculated in reference to a baseline category with the lowest utility value in the same attribute. In the case of the odds ratio reported in a study, the relative impact of each attribute was computed by dividing the highest odds ratio value by the lowest odds ratio value [ 16 ]. However, for studies other than discrete choice experiments (rating, ranking, or best–worst scaling studies) included in this review, the reported rankings in the form of mean, relative importance score, or graphical presentation were directly taken.…”

“…Previous reviews lacked particular focus and in-depth investigation of ART service provision. Most of the systematic reviews were conducted on the general HIV care aspects (prevention, counseling and testing, service delivery, and ART) [ 14 , 15 ], included only discrete choice experiment-based studies on HIV treatment service ignoring other designs [ 16 ], and focused on HIV care in high-income countries which are not highly affected by the HIV pandemic [ 14 ].…”

Effects of community-based antiretroviral therapy initiation models on HIV treatment outcomes: A systematic review and meta-analysis

“…Few studies included in this review assessed implementation outcomes beyond cost. Additional study findings regarding fidelity to intervention protocols, challenges and required adaptations, explorations of variability in PLWH and provider preferences and acceptability, provider and health system adoption, and sustainability could aid future implementation and should be incorporated into future study design and reporting [47][48][49][50].…”