Patient preferences for long-acting HIV treatment: a preference heterogeneity assessment

Abstract

Background: Long-acting antiretroviral therapy (LA-ART) is an emerging alternative to daily oral ART pills that may improve HIV treatment adherence. We studied preference heterogeneity for LA-ART among people with HIV (PWH) in western Washington State and Atlanta, Georgia to determine how preference heterogeneity was related to individual characteristics.

Methods: We recruited 699 PWH to complete a survey including 17 choice-tasks, each of which included two hypothetical LA-ART alternatives and current daily oral therapy. Each hypothetical alternative was defined by mode (long-acting [LA] oral pills, subcutaneous injections, intramuscular injections, and implants), frequency, treatment location (home, clinic, or pharmacy), injection pain, pre-treatment time undetectable, pre-treatment reaction testing, and late-dose leeway. We fitted a latent class model to the data and investigated associations between class membership and individual characteristics.

Results: Our sample had three classes which were defined by their treatment preferences. Two classes preferred LA-ART over current treatment: the LA-Implant class (29%) and the LA-Oral-or-Injection class (35%). In contrast, the Daily-or-LA-Oral class (36%) preferred current treatment or LA oral pills taken at home. Compared to the third class, participants from the other two were younger, more educated, less adherent to current ART, and less averse to injections. Further, LA-Implant participants were less likely to be virally suppressed and had easier clinic access. LA-Oral-or-Injection participants had a higher prevalence of psychotic disorders.

Conclusion: These results provide a deeper understanding of the preference landscape for LA-ART and can aid in the development of interventions better aligned with individual preferences.

Keywords: Discrete choice experiment; Long-acting ART; Preference heterogeneity; Preferences elicitation.

Fig. 1

Preferences for long-acting antiretroviral therapy across classes. The number in parenthesis after each class label denotes the share of the overall sample in each class (i.e., preference group). Colored bars represent point-estimates for each attribute level and black bars represent 95% confidence intervals. Positive values indicate higher relative preference, while negative values indicate lower relative preference. LA: long-acting

Fig. 2

Relative importance of attributes across classes. The relative importance of each attribute (i.e., mode of administration interacted with pain, location, frequency, time undetectable, negative reaction testing, late dose leeway) was quantified as the absolute difference between the most and least-preferred attribute-levels’ coefficients to obtain the attribute’s range of influence, and then divided by the sum of all other attributes ranges. This metric reflects the level of influence of each attribute in the participants’ decision-making process to choose between LA-ART options. LA: long-acting