乌干达艾滋病毒感染者中结核病预防性治疗方案的预测选择与可接受性——一项离散选择实验

Predicted choice and acceptability of regimens for tuberculosis preventive treatment among people living with HIV 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, CA USA.

Center for Tuberculosis, University of California San Francisco, San Francisco, CA USA.

出版信息

medRxiv. 2025 Mar 13:2025.03.12.25323350. doi: 10.1101/2025.03.12.25323350.

DOI:10.1101/2025.03.12.25323350

PMID:40162275

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11952610/

Abstract

INTRODUCTION

Little is known about how people living with HIV would choose if offered different tuberculosis preventive treatment (TPT) regimens, and under which conditions they would accept treatment. Actionable evidence regarding preference for TPT is needed to inform policy and the development of novel TPT regimens.

METHODS

Adults engaged in care at an HIV clinic in Kampala, Uganda, completed a discrete choice experiment survey with nine random choice tasks. In each task, participants first chose between two hypothetical TPT regimens with differing treatment features (number of pills, frequency, duration, adjusted antiretroviral dosage, and side effects). Second, they answered if they would accept the selected treatment, versus taking no treatment. We simulated predicted TPT regimen choice based on hierarchical Bayesian estimation of individual preference weights.

RESULTS

Among 400 participants, 394 gave high-quality answers and were included (median age 44, 71.8% female, 91.4% previously received TPT). Across nine tasks, 60.2% (237/394) accepted all selected TPT regimens, 39.3% (155/394) accepted some regimens, and 0.5% (2/394) accepted none. Regimens requiring antiretroviral dosage adjustment were more likely to be unacceptable (adjusted odds ratio, aOR 27.4, 95% confidence interval [CI] 18.5 - 40.7), as were regimens requiring more pills per dose (aOR 24.5 [95% CI 16.6 - 36.3] for 10 pills compared to 1 or 5 pills per dose). Choice simulations showed that if only 6 months of daily isoniazid (6H) was available, 11.9% would prefer no TPT. However, offering a 4-pill, fixed-dose combination 3HP regimen in addition to 6H increased the acceptability from 88.1% to 98.8% (predicted choice of 3HP 94.5%, 6H 4.4%, no TPT 1.2%).

CONCLUSIONS

While adults living with HIV in Uganda demonstrate a high willingness to accept different TPT regimens, offering regimens with preferred features, such as 3HP as a fixed-dose combination, could drive TPT acceptance and uptake from high to nearly universal.

摘要

引言

对于感染艾滋病毒的人在面对不同的结核病预防性治疗（TPT）方案时会如何选择，以及在何种情况下他们会接受治疗，目前了解甚少。需要有关TPT偏好的可操作证据，以为政策制定和新型TPT方案的开发提供参考。

方法

乌干达坎帕拉一家艾滋病毒诊所的成年患者完成了一项包含九个随机选择任务的离散选择实验调查。在每个任务中，参与者首先在两种具有不同治疗特征（药丸数量、服药频率、疗程、抗逆转录病毒药物剂量调整和副作用）的假设TPT方案之间进行选择。其次，他们回答是否会接受所选治疗，还是不接受治疗。我们基于个体偏好权重的分层贝叶斯估计模拟了预测的TPT方案选择。

结果

在400名参与者中，394人给出了高质量答案并被纳入分析（中位年龄44岁，女性占71.8%，91.4%曾接受过TPT）。在九个任务中，60.2%（237/394）接受了所有选定的TPT方案，39.3%（155/394）接受了部分方案，0.5%（2/394）未接受任何方案。需要调整抗逆转录病毒药物剂量的方案更有可能不被接受（调整后的优势比，aOR 27.4，95%置信区间[CI] 18.5 - 40.7），每剂需要更多药丸的方案也是如此（与每剂1或5颗药丸相比，10颗药丸的aOR为24.5 [95% CI 16.6 - 36.3]）。选择模拟显示，如果仅提供6个月的每日异烟肼（6H），11.9%的人会选择不进行TPT。然而，除了6H之外还提供一种4颗药丸的固定剂量组合3HP方案，可使接受率从88.1%提高到98.8%（预测选择3HP的比例为94.5%，6H为4.4%，不进行TPT为1.2%）。