Exploring Relative Preferences for HIV Service Features Using Discrete Choice Experiments: a Synthetic Review

I. Eshun-Wilson, H. Y. Kim, S. Schwartz, M. Conte, D. V. Glidden, E. H. Geng

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose of Review: Aligning HIV treatment services with patient preferences can promote long-term engagement. A rising number of studies solicit such preferences using discrete choice experiments, but have not been systematically reviewed to seek generalizable insights. Using a systematic search, we identified eleven choice experiments evaluating preferences for HIV treatment services published between 2004 and 2020. Recent Findings: Across settings, the strongest preference was for nice, patient-centered providers, for which participants were willing to trade considerable amounts of time, money, and travel distance. In low- and middle-income countries, participants also preferred collecting antiretroviral therapy (ART) less frequently than 1 monthly, but showed no strong preference for 3-compared with 6-month refill frequency. Facility waiting times and travel distances were also important but were frequently outranked by stronger preferences. Health facility–based services were preferred to community- or home-based services, but this preference varied by setting. In high-income countries, the availability of unscheduled appointments was highly valued. Stigma was rarely explored and costs were a ubiquitous driver of preferences. Summary: While present improvement efforts have focused on designs to enhance access (reduced waiting time, travel distance, and ART refill frequency), few initiatives focus on the patient-provider interaction, which represents a promising critical area for inquiry and investment. If HIV programs hope to truly deliver patient-centered care, they will need to incorporate patient preferences into service delivery strategies. Discrete choice experiments can not only inform such strategies but also contribute to prioritization efforts for policy-making decisions.

Original languageEnglish (US)
Pages (from-to)467-477
Number of pages11
JournalCurrent HIV/AIDS reports
Volume17
Issue number5
DOIs
StatePublished - Oct 1 2020

Keywords

  • Differentiated care
  • Discrete choice experiment
  • HIV
  • Preference
  • Review
  • Service delivery

ASJC Scopus subject areas

  • Virology
  • Infectious Diseases

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