Mando Raphael Onyango, Moghadassi Michelle, Juma Eric, Ogollah Cirilus, Packel Laura, Kulzer Jayne Lewis, Kadima Julie, Odhiambo Francesca, Eshun-Wilson Ingrid, Kim Hae-Young, Cohen Craig R, Bukusi Elizabeth A, Geng Elvin
Research Care and Training Program, Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
Department of Gynecology, Obstetrics, and Reproductive Sciences, University of California San Francisco, California, United States of America.
PLOS Glob Public Health. 2022 Oct 27;2(10):e0000614. doi: 10.1371/journal.pgph.0000614. eCollection 2022.
Novel "differentiated service delivery" models for HIV treatment that reduce clinic visit frequency, minimize waiting time, and deliver treatment in the community promise retention improvement for HIV treatment in Sub-Saharan Africa. Quantitative assessments of differentiated service delivery (DSD) feature most preferred by patient populations do not widely exist but could inform selection and prioritization of different DSD models. We used a discrete choice experiment (DCE) to elicit patient preferences of HIV treatment services and how they differ across DSD models. We surveyed 18+year-olds, enrolled in HIV care for ≥6 months between February-March, 2019 at four facilities in Kisumu County, Kenya. DCE offered patients a series of comparisons between three treatment models, each varying across seven attributes: ART refill location, quantity of dispensed ART at each refill, medication pick-up hours, type of adherence support, clinical visit frequency, staff attitude, and professional cadre of person providing ART refills. We used hierarchical Bayesian model to estimate attribute importance and relative desirability of care characteristics, latent class analysis (LCA) for groups of preferences and mixed logit model for willingness to trade analysis. Of 242 patients, 128 (53.8%) were females and 150 (62.8%) lived in rural areas. Patients placed greatest importance on ART refill location [19.5% (95% CI 18.4, 10.6) and adherence support [19.5% (95% CI 18.17, 20.3)], followed by staff attitude [16.1% (95% CI 15.1, 17.2)]. In the mixed logit, patients preferred nice attitude of staff (coefficient = 1.60), refill ART health center (Coeff = 1.58) and individual adherence support (Coeff = 1.54), 3 or 6 months for ART refill (Coeff = 0.95 and 0.80, respectively) and pharmacists (instead of lay health workers) providing ART refill (Coeff = 0.64). No differences were observed by gender or urbanicity. LCA revealed two distinct groups (59.5% vs. 40.5%). Participants preferred 3 to 6-month refill interval or clinic visit spacing, which DSD offers stable patients. While DSD has encouraged community ART group options, our results suggest strong preferences for ART refills from health-centers or pharmacists over lay-caregivers or community members. These preferences held across gender&urban/rural subpopulations.
新型的艾滋病毒治疗“差异化服务提供”模式，可减少门诊就诊频率、将等待时间降至最低，并在社区提供治疗，有望改善撒哈拉以南非洲地区艾滋病毒治疗的留存率。目前，对于患者群体最喜欢的差异化服务提供（DSD）特征，尚未有广泛的定量评估，但这可为不同DSD模式的选择和优先级提供参考。我们采用离散选择实验（DCE）来了解患者对艾滋病毒治疗服务的偏好，以及这些偏好在不同DSD模式之间的差异。我们对2019年2月至3月期间在肯尼亚基苏木县四个医疗机构登记接受艾滋病毒护理≥6个月的18岁及以上人群进行了调查。DCE为患者提供了三种治疗模式之间的一系列比较，每种模式在七个属性上各不相同：抗逆转录病毒治疗（ART）补充地点、每次补充时发放的ART数量、取药时间、依从性支持类型、门诊就诊频率、工作人员态度以及提供ART补充的人员专业类别。我们使用分层贝叶斯模型来估计属性重要性和护理特征的相对可取性，使用潜在类别分析（LCA）来分析偏好组，并使用混合逻辑模型进行权衡意愿分析。在242名患者中，128名（53.8%）为女性，150名（62.8%）居住在农村地区。患者最为重视ART补充地点[19.5%（95%置信区间18.4，10.6）]和依从性支持[19.5%（95%置信区间18.17，20.3）]，其次是工作人员态度[16.1%（95%置信区间15.1，17.2）]。在混合逻辑模型中，患者更喜欢工作人员态度友好（系数 = 1.60）、在健康中心补充ART（系数 = 1.58）和个性化依从性支持（系数 = 1.54），每3或6个月补充一次ART（系数分别为0.95和0.80），以及由药剂师（而非非专业卫生工作者）提供ART补充（系数 = 0.64）。未观察到性别或城市/农村居住情况方面的差异。LCA揭示了两个不同的群体（59.5%对40.5%）。参与者更喜欢3至6个月的补充间隔或门诊就诊间隔，这是DSD为稳定患者提供的。虽然DSD鼓励了社区ART小组选项，但我们的结果表明，与非专业护理人员或社区成员相比，患者强烈倾向于在健康中心或由药剂师进行ART补充。这些偏好在不同性别和城市/农村亚群体中都存在。
