The effect of partner HIV status on motivation to take antiretroviral and isoniazid preventive therapies: a conjoint analysis

Abstract

Antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) are important to reduce morbidity and mortality among people newly diagnosed of HIV. The successful uptake of ART and IPT requires a comprehensive understanding of patients’ motivation to take such therapies. Partners also play an important role in the decision to be initiated and retained in care. We quantified patients’ motivation to take preventive therapies (ART and IPT) and compared by partner HIV status among people newly diagnosed of HIV. We enrolled and surveyed adults (≥18 years) with a recent HIV diagnosis (<6 months) from 14 public primary care clinics in Matlosana, South Africa. Participants received eight forced-choice tasks comparing two mutually exclusive sub-sets of seven possible benefits related to preventive therapies. A linear probability model was fitted to estimate the probability of prioritizing each benefit. Tests of concordance were conducted across partner HIV status (no partner, HIV− or unknown, or HIV+). A total of 424 people completed surveys. At the time of interview, 272 (64%) were on ART and 334 (79%) had a partner or spouse. Keeping themselves healthy for their family was the most important motivator to take preventive therapies (p < 0.001). Preventing HIV transmission to partners was also highly prioritized among participants with current partners independent of partner’s HIV status (p < 0.001), but it was least prioritized among those without current partners (p = 0.72). Keeping themselves healthy was less prioritized. We demonstrate that social responsibility such as supporting family and preventing HIV transmission to partners may pose greater motivation for ART and IPT initiation and adherence compared to individual health benefits. These messages should be emphasized to provide effective patient-centered care and counseling.

Persons living with HIV in sero-discordant partnerships experience improved HIV care engagement compared with persons living with HIV in sero-concordant partnerships: a cross-sectional analysis of four African countries

“…The results of a qualitative study conducted in Kenya showed that the majority of PLWH in sero-discordant dyads reported their primary motivation for ART uptake was the prevention of transmission [ 6 ]. Another study in South Africa, reported similar motivations and that prevention of transmission may serve as an even greater motivation than individual health benefits [ 23 ]. These motivations are often cited in stable sero-discordant dyads, which makes up nearly all sero-discordant dyads in this analysis (97% reported being married).…”

Factors associated with knowledge about ‘Undetectable HIV viral load is Untransmittable’ among Zambian adults on antiretroviral therapy: a mixed method approach

“…According to Schaefer et al (13), knowledge is one of the factors required to decide which HIV prevention measure one practises and that is dependent on the motivation and benefits. In a recent literature review, findings on TasP in advanced countries by Hollingdrake et al (15) and by Kim et al (23) indicated that some people were motivated to opt for TasP to prevent their partners from acquiring HIV infections. It is obvious that the choice to use TasP as an HIV prevention measure was based on an informed decision, although the studies did not assess the knowledge of U=U.…”

“…A study across 25 countries showed 66.5% PLHIV reported ever discussing U=U with their healthcare providers (22). A study conducted in South Africa, however, found that sexual partners (23%) in discordant or HIV unknown status relationships were motivated to take ART to protect their partners from HIV infections (23). A recent study in Eswatini found that asymptomatic PLHIV felt motivated to adhere to ART when their VL declined (3).…”