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. 2023 Dec 15;94(5):429-436.
doi: 10.1097/QAI.0000000000003303. Epub 2023 Nov 10.

Preferences of Pregnant and Postpartum Women for Differentiated Service Delivery in Kenya

John Humphrey  1 , Esther Wanjama  2 , James G Carlucci  3 , Violet Naanyu  4   5 , Edwin Were  6 , Lindah Muli  5 , Marsha Alera  5 , Alan McGuire  7   8 , Winstone Nyandiko  9 , Julia Songok  5   9 , Kara Wools-Kaloustian  1 , Gregory Zimet  3
Affiliations

Preferences of Pregnant and Postpartum Women for Differentiated Service Delivery in Kenya

John Humphrey et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Differentiated service delivery models are implemented by HIV care programs globally, but models for pregnant and postpartum women living with HIV (PPWH) are lacking. We conducted a discrete choice experiment to determine women's preferences for differentiated service delivery.

Setting: Five public health facilities in western Kenya.

Methods: PPWH were enrolled from April to December 2022 and asked to choose between pairs of hypothetical clinics that differed across 5 attributes: clinic visit frequency during pregnancy (monthly vs. every 2 months), postpartum visit frequency (monthly vs. only with routine infant immunizations), seeing a mentor mother (each visit vs. as needed), seeing a clinician (each visit vs. as needed), and basic consultation cost (0, 50, or 100 Kenya Shillings [KSh]). We used multinomial logit modeling to determine the relative effects (β) of each attribute on clinic choice.

Results: Among 250 PPWH (median age 31 years, 42% pregnant, 58% postpartum, 20% with a gap in care), preferences were for pregnancy visits every 2 months (β = 0.15), postpartum visits with infant immunizations (β = 0.36), seeing a mentor mother and clinician each visit (β = 0.05 and 0.08, respectively), and 0 KSh cost (β = 0.39). Preferences were similar when stratified by age, pregnancy, and retention status. At the same cost, predicted market choice for a clinic model with fewer pregnant/postpartum visits was 75% versus 25% for the standard of care (ie, monthly visits during pregnancy/postpartum).

Conclusion: PPWH prefer fewer clinic visits than currently provided within the standard of care in Kenya, supporting the need for implementation of differentiated service delivery for this population.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Attributes and levels for the DCE.
FIGURE 2.
FIGURE 2.
Results of multinomial logit regression models for preferences.
FIGURE 3.
FIGURE 3.
Preference shares among participants overall and by participant characteristics.
See this image and copyright information in PMC

References

    1. World Health Organization. Key Considerations for Differentiated Antiretroviral Therapy Delivery for Specific Populations: Children, Adolescents, Pregnant and Breastfeeding Women and Key Populations. Geneva: World Health Organization; 2017. Available at: https://apps.who.int/iris/handle/10665/258506. Accessed August 15, 2023.
    1. International AIDS Society. Differentiated Care for HIV: A Decision Framework for Antiretroviral Therapy Delivery. Geneva: IAS; 2017. Available at: https://differentiatedservicedelivery.org/wp-content/uploads/decision-fr.... Accessed August 31, 2023.
    1. Hagey JM, Li X, Barr-Walker J, et al. . Differentiated HIV care in sub-Saharan Africa: a scoping review to inform antiretroviral therapy provision for stable HIV-infected individuals in Kenya. AIDS Care. 2018;30:1477–1487. - PubMed
    1. International AIDS Society. Differentiated Service Delivery. 2023. Available at: http://www.differentiatedservicedelivery.org. Accessed June 3, 2023.
    1. Chimukuche RS, Wringe A, Songo J, et al. . Investigating the implementation of differentiated HIV services and implications for pregnant and postpartum women: a mixed methods multi-country study. Glob Public Health. 2021;16:274–287. - PMC - PubMed

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