Preferences of people living with HIV for differentiated care models in Kenya: A discrete choice experiment.

<h4>Introduction</h4>To improve retention on HIV treatment in Africa, public health programs are promoting a family of innovations to service delivery-referred to as "differentiated service delivery" (DSD) models-which seek to better meet the needs of both systems and patients...

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Autores principales:	Sagar Dommaraju, Jill Hagey, Thomas A Odeny, Sharon Okaka, Julie Kadima, Elizabeth A Bukusi, Craig R Cohen, Zachary Kwena, Ingrid Eshun-Wilson, Elvin Geng
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/9e6dbd09a2c14f5581a87c4ff3a4a75e
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spelling	oai:doaj.org-article:9e6dbd09a2c14f5581a87c4ff3a4a75e2021-12-02T20:14:55ZPreferences of people living with HIV for differentiated care models in Kenya: A discrete choice experiment.1932-620310.1371/journal.pone.0255650https://doaj.org/article/9e6dbd09a2c14f5581a87c4ff3a4a75e2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0255650https://doaj.org/toc/1932-6203<h4>Introduction</h4>To improve retention on HIV treatment in Africa, public health programs are promoting a family of innovations to service delivery-referred to as "differentiated service delivery" (DSD) models-which seek to better meet the needs of both systems and patients by reducing unnecessary encounters, expanding access, and incorporating peers and patients in patient care. Data on the relative desirability of different models to target populations, which is currently sparse, can help guide prioritization of specific models during scale-up.<h4>Methods</h4>We conducted a discrete choice experiment to assess patient preferences for various characteristics of treatment services. Clinically stable people living with HIV were recruited from an HIV clinic in Kisumu, Kenya. We selected seven attributes of DSD models drawn from literature review and previous qualitative work. We created a balanced and orthogonal design to identify main term effects. A total of ten choice tasks were solicited per respondent. We calculated relative utility (RU) for each attribute level, a numerical representation of the strength of patient preference. Data were analyzed using a Hierarchical Bayesian model via Sawtooth Software.<h4>Results</h4>One hundred and four respondents (37.5% men, 41.1 years mean age) preferred receiving care at a health facility, compared with home-delivery or a community meeting point (RU = 69.3, -16.2, and -53.1, respectively; p << 0.05); receiving those services from clinicians and pharmacists-as opposed to lay health workers or peers (RU = 21.5, 5.9, -24.5; p < 0.05); and preferred an individual support system over a group support system (RU = 15.0 and 4.2; p < 0.05). Likewise, patients strongly preferred longer intervals between both clinical reviews (RU = 40.1 and -50.7 for 6- and 1-month spacing, respectively; p < 0.05) and between ART collections (RU = 33.6 and -49.5 for 6- and1-month spacing, respectively; p < 0.05).<h4>Conclusion</h4>Although health systems find community- and peer-based DSD models attractive, clinically stable patients expressed a preference for facility-based care as long as clinical visits were extended to biannual. These data suggest that multi-month scripting and fast-track models best align with patient preferences, an insight which can help prioritize use of different DSD models in the region.Sagar DommarajuJill HageyThomas A OdenySharon OkakaJulie KadimaElizabeth A BukusiCraig R CohenZachary KwenaIngrid Eshun-WilsonElvin GengPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 8, p e0255650 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Sagar Dommaraju Jill Hagey Thomas A Odeny Sharon Okaka Julie Kadima Elizabeth A Bukusi Craig R Cohen Zachary Kwena Ingrid Eshun-Wilson Elvin Geng Preferences of people living with HIV for differentiated care models in Kenya: A discrete choice experiment.
description	<h4>Introduction</h4>To improve retention on HIV treatment in Africa, public health programs are promoting a family of innovations to service delivery-referred to as "differentiated service delivery" (DSD) models-which seek to better meet the needs of both systems and patients by reducing unnecessary encounters, expanding access, and incorporating peers and patients in patient care. Data on the relative desirability of different models to target populations, which is currently sparse, can help guide prioritization of specific models during scale-up.<h4>Methods</h4>We conducted a discrete choice experiment to assess patient preferences for various characteristics of treatment services. Clinically stable people living with HIV were recruited from an HIV clinic in Kisumu, Kenya. We selected seven attributes of DSD models drawn from literature review and previous qualitative work. We created a balanced and orthogonal design to identify main term effects. A total of ten choice tasks were solicited per respondent. We calculated relative utility (RU) for each attribute level, a numerical representation of the strength of patient preference. Data were analyzed using a Hierarchical Bayesian model via Sawtooth Software.<h4>Results</h4>One hundred and four respondents (37.5% men, 41.1 years mean age) preferred receiving care at a health facility, compared with home-delivery or a community meeting point (RU = 69.3, -16.2, and -53.1, respectively; p << 0.05); receiving those services from clinicians and pharmacists-as opposed to lay health workers or peers (RU = 21.5, 5.9, -24.5; p < 0.05); and preferred an individual support system over a group support system (RU = 15.0 and 4.2; p < 0.05). Likewise, patients strongly preferred longer intervals between both clinical reviews (RU = 40.1 and -50.7 for 6- and 1-month spacing, respectively; p < 0.05) and between ART collections (RU = 33.6 and -49.5 for 6- and1-month spacing, respectively; p < 0.05).<h4>Conclusion</h4>Although health systems find community- and peer-based DSD models attractive, clinically stable patients expressed a preference for facility-based care as long as clinical visits were extended to biannual. These data suggest that multi-month scripting and fast-track models best align with patient preferences, an insight which can help prioritize use of different DSD models in the region.
format	article
author	Sagar Dommaraju Jill Hagey Thomas A Odeny Sharon Okaka Julie Kadima Elizabeth A Bukusi Craig R Cohen Zachary Kwena Ingrid Eshun-Wilson Elvin Geng
author_facet	Sagar Dommaraju Jill Hagey Thomas A Odeny Sharon Okaka Julie Kadima Elizabeth A Bukusi Craig R Cohen Zachary Kwena Ingrid Eshun-Wilson Elvin Geng
author_sort	Sagar Dommaraju
title	Preferences of people living with HIV for differentiated care models in Kenya: A discrete choice experiment.
title_short	Preferences of people living with HIV for differentiated care models in Kenya: A discrete choice experiment.
title_full	Preferences of people living with HIV for differentiated care models in Kenya: A discrete choice experiment.
title_fullStr	Preferences of people living with HIV for differentiated care models in Kenya: A discrete choice experiment.
title_full_unstemmed	Preferences of people living with HIV for differentiated care models in Kenya: A discrete choice experiment.
title_sort	preferences of people living with hiv for differentiated care models in kenya: a discrete choice experiment.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/9e6dbd09a2c14f5581a87c4ff3a4a75e
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Preferences of people living with HIV for differentiated care models in Kenya: A discrete choice experiment.

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