U.S. patient preferences for long-acting HIV treatment: a discrete choice experiment

Abstract

Introduction: Recent advances in long-acting antiretroviral therapy (LA-ART) could provide new options for HIV treatment and reduce adherence barriers, if regimens are acceptable to patients. We elicited preferences for key attributes of potential LA-ART regimens among people with HIV (PWH) in the United States, focusing on four treatment modes (oral tablets, subcutaneous injections, intramuscular injections, and implants), product characteristics and location of administration.

Methods: A discrete choice experiment was conducted among PWH aged ≥18 years recruited from HIV clinics in Washington State and Atlanta, Georgia from March 2021 to June 2022. Participants responded to 17 choice scenarios, each with three options: two systematically generated hypothetical LA-ART regimens and a constant opt-out (their current daily oral treatment). LA-ART regimen descriptions included treatment mode, pain, dosing frequency, location, pre-treatment time with undetectable viral load, pre-treatment negative reaction testing and "late-dose leeway" (i.e. flexibility or forgiveness in timing the next dose). We used conditional logistic regression, with an interaction between treatment mode and pain, to estimate preference weights for all attribute levels.

Results: Seven hundred participants (350 at each site) enrolled, with median age 51 years (range 18-73); 70% identified as cisgender male, 24% as cisgender female and 6% as non-binary or transgender. LA oral tablets were the only mode preferred over current daily oral treatment, with annual implants and injections the next most preferred LA-ART option. Longer time between doses was preferred, and administration at home was preferred to clinics, which were preferred to pharmacies. Attributes with less impact on preferences included oral lead-in treatment to achieve viral suppression or test for negative reactions and late-dose leeway around the prescribed dosing interval. Participants in Atlanta were more likely to prefer their current daily oral ART than participants from Seattle.

Conclusions: PWH in the United States may soon have several options for LA-ART. Our results suggest that LA oral tablets will be preferred by many patients over their current daily oral treatment, while implants and injections with longer duration may be acceptable to some. Future research should investigate sources of preference heterogeneity and actual uptake of and adherence to LA-ART products, when available.

Keywords: HIV; antiretroviral agents; antiretroviral therapy; choice behaviour; delayed-action preparations; patient preference.

Figure 1

Example choice set presenting two different long‐acting antiretroviral therapy (LA‐ART) regimens (Option A and Option B) and the constant Option C opt‐out (current daily oral regimen). For each LA‐ART option, attributes presented included treatment type, location, frequency, pain, pre‐treatment time undetectable, pre‐treatment negative reaction testing and late‐dose leeway. “Long” late‐dose leeway was defined as 100% of the dosing interval and “short” late‐dose leeway was defined as 50% of the dosing interval for that specific treatment option.

Figure 2

Long‐acting antiretroviral treatment (LA‐ART) preference weights from conditional logistic regression, entire study population. Mean preference‐weight estimates for each attribute relative to the mean attribute effect are presented, normalized around zero. Black lines with bars indicate 95% confidence intervals for preference weights. Positive weights indicate higher preference relative to the other levels evaluated. The overall relative importance of an attribute overall is the difference between the largest and the smallest preference weights of that attribute. “Long” late‐dose leeway was defined as 100% of the dosing interval and “short” late‐dose leeway was defined as 50% of the dosing interval for that specific treatment option.