纽约市艾滋病毒护理协调计划特征的患者偏好：离散选择实验的潜在类别分析。
Client preferences for HIV Care Coordination Program features in New York City: latent class analysis of a discrete choice experiment.
机构信息
Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, New York, USA.
Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.
出版信息
J Int AIDS Soc. 2023 Aug;26(8):e26162. doi: 10.1002/jia2.26162.
INTRODUCTION
The PROMISE study, launched in 2018, evaluates the implementation of revisions to the HIV Care Coordination Program (CCP) designed to minimize persistent disparities in HIV outcomes among high-need persons living with HIV in New York City. We conducted a discrete choice experiment (DCE) assessing the preferences of CCP clients to inform improvements to the program's design.
METHODS
Clients chose between two hypothetical CCP options that varied across four program attributes: help with antiretroviral therapy (ART) adherence (directly observed therapy [DOT] vs. remind via phone/text vs. adherence assessment), help with primary care appointments (remind and accompany vs. remind and transport vs. remind only), help with issues other than primary care (coverage and benefits vs. housing and food vs. mental health vs. specialty medical care) and visit location (meet at home vs. via phone/video vs. program visit 30 or 60 minutes away). The latent class analysis identified different preference patterns. A choice simulation was performed to model client preferences for hypothetical CCPs as a whole.
RESULTS
One hundred and eighty-one CCP clients from six sites implementing the revised CCP completed the DCE January 2020-March 2021. Most clients had stable housing (68.5%), reported no problem substance use in the last 3 months (72.4%) and achieved viral suppression (78.5) with only 26.5% receiving DOT within a CCP. 77.3% of responses were obtained before the COVID-19 pandemic. Preferences clustered into three groups. Visit location and ART adherence support were the most important attributes. Group 1 (40%) endorsed telehealth for visit location; telehealth for ART adherence support; and help with securing housing/food; Group 2 (37%) endorsed telehealth for visit location; telehealth for ART adherence support; and staff reminding/arranging appointment transportation; Group 3 (23%) endorsed staff meeting clients at program location and staff working with clients for medication adherence. In the choice simulation, Basic and Medium hypothetical CCPs were endorsed more than Intensive CCPs.
CONCLUSIONS
This DCE revealed a strong preference for telehealth and a relatively low preference for intensive services, such as DOT and home visits; preferences were heterogeneous. The findings support differentiated care and remote service delivery options in the NYC CCP, and can inform improvements to CCP design.
简介
PROMISE 研究于 2018 年启动，评估了对 HIV 护理协调计划（CCP）的修订的实施情况，旨在最大限度地减少纽约市 HIV 高需求人群中 HIV 结局持续存在的差异。我们进行了离散选择实验（DCE），评估了 CCP 客户对该计划设计的改进的偏好。
方法
客户在两个假设的 CCP 选项之间进行选择，这两个选项在四个计划属性上有所不同：抗逆转录病毒治疗（ART）依从性的帮助（直接观察治疗 [DOT] 与通过电话/短信提醒 vs. 依从性评估），初级保健预约的帮助（提醒和陪同 vs. 提醒和运输 vs. 仅提醒），初级保健以外问题的帮助（覆盖范围和福利 vs. 住房和食品 vs. 心理健康 vs. 专科医疗护理）和就诊地点（在家见面 vs. 通过电话/视频 vs. 30 或 60 分钟外的项目访问）。潜在类别分析确定了不同的偏好模式。进行了选择模拟，以模拟客户对整个假设的 CCP 的偏好。
结果
2020 年 1 月至 2021 年 3 月，来自六个实施修订后的 CCP 的 181 名 CCP 客户完成了 DCE。大多数客户有稳定的住房（68.5%），报告过去 3 个月内没有药物滥用问题（72.4%），并实现了病毒抑制（78.5%），只有 26.5%的患者在 CCP 中接受 DOT。77.3%的回复是在 COVID-19 大流行之前获得的。偏好分为三组。就诊地点和 ART 依从性支持是最重要的属性。第 1 组（40%）赞成远程医疗就诊地点；ART 依从性支持的远程医疗；并帮助获得住房/食物；第 2 组（37%）赞成远程医疗就诊地点；ART 依从性支持的远程医疗；并由工作人员提醒/安排预约交通；第 3 组（23%）赞成工作人员在项目地点与客户会面，并与客户合作进行药物治疗。在选择模拟中，基本和中等假设的 CCP 比强化 CCP 更受欢迎。
结论
这项 DCE 显示出对远程医疗的强烈偏好，以及对密集服务（如 DOT 和家访）的相对较低的偏好；偏好是异质的。研究结果支持在纽约市 CCP 中进行差异化护理和远程服务提供选择，并可为 CCP 设计的改进提供信息。
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