Strauss Michael, George Gavin, Mantell Joanne E, Mapingure Munyaradzi, Masvawure Tsitsi B, Lamb Matthew R, Zech Jennifer M, Musuka Godfrey, Chingombe Innocent, Msukwa Martin, Boccanera Rodrigo, Gwanzura Clorata, Apollo Tsitsi, Rabkin Miriam
Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa.
Department of Psychiatry, Division of Gender, Sexuality and Health, The New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA.
AIDS Behav. 2021 Feb;25(2):397-413. doi: 10.1007/s10461-020-02994-z.
Differentiated service delivery holds great promise for streamlining the delivery of health services for HIV. This study used a discrete choice experiment to assess preferences for differentiated HIV treatment delivery model characteristics among 500 virally suppressed adults on antiretroviral therapy in Harare, Zimbabwe. Treatment model characteristics included location, consultation type, healthcare worker cadre, operation times, visit frequency and duration, and cost. A mixed effects logit model was used for parameter estimates to identify potential preference heterogeneity among participants, and interaction effects were estimated for sex and age as potential sources of divergence in preferences. Results indicated that participants preferred health facility-based services, less frequent visits, individual consultations, shorter waiting times, lower cost and, delivered by respectful and understanding healthcare workers. Some preference heterogeneity was found, particularly for location of service delivery and group vs. individual models; however, this was not fully explained by sex and age characteristics of participants. In urban areas, facility-based models, such as the Fast Track model requiring less frequent clinic visits, are likely to better align with patient preferences than some of the other community-based or group models that have been implemented. As Zimbabwe scales up differentiated treatment models for stable patients, a clear understanding of patient preferences can help in designing services that will ensure optimal utilization and improve the efficiency of service delivery.
差异化服务提供对于简化艾滋病毒健康服务的提供具有巨大潜力。本研究采用离散选择实验，评估了津巴布韦哈拉雷500名接受抗逆转录病毒治疗且病毒得到抑制的成年人对差异化艾滋病毒治疗提供模式特征的偏好。治疗模式特征包括地点、咨询类型、医护人员类别、运营时间、就诊频率和时长以及费用。使用混合效应逻辑模型进行参数估计，以确定参与者之间潜在的偏好异质性，并估计性别和年龄作为偏好差异潜在来源的交互效应。结果表明，参与者更喜欢基于医疗机构的服务、就诊频率较低、个人咨询、等待时间较短、成本较低，以及由尊重患者且善解人意的医护人员提供服务。发现了一些偏好异质性，特别是在服务提供地点以及团体与个人模式方面；然而，参与者的性别和年龄特征并未完全解释这一点。在城市地区，基于医疗机构的模式，如需要就诊频率较低的快速通道模式，可能比已实施的一些其他基于社区或团体的模式更符合患者偏好。随着津巴布韦扩大针对稳定患者的差异化治疗模式，清楚了解患者偏好有助于设计能确保最佳利用并提高服务提供效率的服务。
