乌干达艾滋病毒感染者对结核病预防性治疗方案特征的偏好：一项离散选择实验

Preferences of people living with HIV for features of tuberculosis preventive treatment regimens in Uganda: a discrete choice experiment.

作者信息

Aschmann Hélène E, Musinguzi Allan, Kadota Jillian L, Namale Catherine, Kakeeto Juliet, Nakimuli Jane, Akello Lydia, Welishe Fred, Nakitende Anne, Berger Christopher, Dowdy David W, Cattamanchi Adithya, Semitala Fred C, Kerkhoff Andrew D

机构信息

Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, California, USA.

Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.

出版信息

J Int AIDS Soc. 2024 Dec;27(12):e26390. doi: 10.1002/jia2.26390.

DOI:10.1002/jia2.26390

PMID:39587885

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11589386/

Abstract

INTRODUCTION

Tuberculosis (TB) preventive treatment (TPT) is recommended for people living with HIV (PLHIV) in high TB burden settings. While 6 months of daily isoniazid remains widely used, shorter regimens are now available. However, little is known about preferences of PLHIV for key features of TPT regimens.

METHODS

From July to November 2022, we conducted a discrete choice experiment among adult PLHIV engaged in care at an urban HIV clinic in Kampala, Uganda. Participants chose between two hypothetical TPT regimens with five different features (pills per dose, frequency, duration, need for adjusted antiretroviral therapy [ART] dosage and side effects), organized across nine random choice tasks. We analysed preferences using hierarchical Bayesian estimation, latent class analysis and willingness-to-trade simulations.

RESULTS

Of 400 PLHIV, 392 (median age 44, 72% female, 91% TPT-experienced) had high-quality choice task responses. Pills per dose was the most important attribute (relative importance 32.4%, 95% confidence interval [CI] 31.6-33.2), followed by frequency (20.5% [95% CI 19.7-21.3]), duration (19.5% [95% CI 18.6-20.5]) and need for ART dosage adjustment (18.2% [95% CI 17.2-19.2]). Latent class analysis identified three preference groups: one prioritized less frequent, weekly dosing (N = 222; 57%); another was averse to ART dosage adjustment (N = 107; 27%); and the last prioritized short regimens with fewer side effects (N = 63; 16%). All groups highly valued fewer pills per dose. Overall, participants were willing to accept a regimen of 2.8 months' additional duration [95% CI: 2.4-3.2] to reduce pills per dose from five to one, 3.6 [95% CI 2.4-4.8] months for weekly rather than daily dosing and 2.2 [95% CI 1.3-3.0] months to avoid ART dosage adjustment.

CONCLUSIONS

To align with preferences of PLHIV in Uganda, decision-makers should prioritize the development and implementation of TPT regimens with fewer pills, less frequent dosing and no need for ART dosage adjustment, rather than focus primarily on duration of treatment.

摘要

引言

在结核病高负担地区，建议对艾滋病毒感染者（PLHIV）进行结核病预防性治疗（TPT）。虽然每日服用异烟肼6个月的方案仍被广泛使用，但现在有了更短的治疗方案。然而，对于艾滋病毒感染者对TPT方案关键特征的偏好了解甚少。

方法

2022年7月至11月，我们在乌干达坎帕拉一家城市艾滋病毒诊所接受治疗的成年艾滋病毒感染者中进行了一项离散选择实验。参与者在两种假设的TPT方案之间进行选择，这两种方案具有五个不同特征（每剂药丸数量、服药频率、疗程、是否需要调整抗逆转录病毒疗法[ART]剂量以及副作用），通过九个随机选择任务进行安排。我们使用分层贝叶斯估计、潜在类别分析和意愿交易模拟来分析偏好。

结果

在400名艾滋病毒感染者中，392人（中位年龄44岁，72%为女性，91%有TPT经验）有高质量的选择任务回答。每剂药丸数量是最重要的属性（相对重要性32.4%，95%置信区间[CI]31.6 - 33.2），其次是服药频率（20.5%[95%CI 19.7 - 21.3]）、疗程（19.5%[95%CI 18.6 - 20.5]）和是否需要调整ART剂量（18.2%[95%CI 17.2 - 19.2]）。潜在类别分析确定了三个偏好组：一组优先选择服药频率较低的每周给药方案（N = 222；57%）；另一组厌恶调整ART剂量（N = 107；27%）；最后一组优先选择副作用较少的短疗程方案（N = 63；16%）。所有组都非常重视每剂药丸数量较少。总体而言，参与者愿意接受额外2.8个月的疗程[95%CI：2.4 - 3.2]，以使每剂药丸数量从五颗减少到一颗；愿意接受额外3.6[95%CI 2.4 - 4.8]个月的疗程，以从每日给药改为每周给药；愿意接受额外2.2[95%CI 1.3 - 3.0]个月的疗程，以避免调整ART剂量。