Differentiated care preferences of stable patients on ART in Zambia: a discrete choice experiment

Eshun-Wilson, Ingrid, Mukumbwa-Mwenechana, Mpande, Kim, Hae-Young, Zannolini, Arianna, Mwamba, Chanda P., Dowdy, David, Kalunkumya, Estella, Lumpa, Mwansa, Beres, Laura K., Roy, Monica, Sharma, Anjali, Topp, Steph M., Glidden, Dave V., Padian, Nancy, Ehrenkranz, Peter, Sikazwe, Izukanji, Holmes, Charles, Bolton-Moore, Carolyn, and Geng, Elvin H. (2019) Differentiated care preferences of stable patients on ART in Zambia: a discrete choice experiment. Journal of Acquired Immune Deficiency Syndrome, 81 (5). pp. 540-546.

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Background: Although differentiated service delivery (DSD) models for stable patients on antiretroviral therapy (ART) offer a range of health systems innovations, their comparative desirability to patients remains unknown. We conducted a discrete choice experiment to quantify service attributes most desired by patients to inform model prioritization

Methods: Between July and December 2016 a sample of HIV-positive adults on ART at 12 clinics in Zambia were asked to choose between two hypothetical facilities which differed across six DSD attributes. We used mixed logit models to explore preferences, heterogeneity and trade-offs

Results: Of 486 respondents, 59% were female and 85% resided in urban locations. Patients strongly preferred infrequent clinic visits (3 vs. 1-month visits: β (i.e. relative utility) =2.84; p <0.001). Milder preferences were observed for: waiting time for ART pick-up (1 vs. 6 hrs.; β=-0.67; p<0.001) or provider (1 vs. 3 hrs.; β=-0.41; p=0.002); ‘buddy’ ART collection (β=0.84; p <0.001); and ART pick-up location (clinic vs. community: β=0.35; p=0.028). Urban patients demonstrated a preference for collecting ART at a clinic (β=1.32, p<0.001), and although the majority of rural patients preferred community ART pick-up (β=-0.74, p=0.049), 40% of rural patients still preferred facility ART collection.

Conclusions: Stable patients on ART primarily want to attend clinic infrequently, supporting a focus in Zambia on optimizing multi-month prescribing over other DSD features - particularly in urban areas. Substantial preference heterogeneity highlights the need for DSD models to be flexible, and accommodate both setting features and patient choice in their design.

Item ID: 58298
Item Type: Article (Research - C1)
ISSN: 1944-7884
Copyright Information: Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Funders: Bill and Melinda Gates Foundation (BMGF), National Institute of Allergy and Infectious Diseases (NIH)
Projects and Grants: BMGF OPP 1115306, NIH P30 AI027763, NIH K24 AI134413
Date Deposited: 07 Jul 2019 22:27
FoR Codes: 42 HEALTH SCIENCES > 4204 Midwifery > 420402 Models of care and place of birth @ 40%
42 HEALTH SCIENCES > 4203 Health services and systems > 420311 Health systems @ 50%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320211 Infectious diseases @ 10%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920401 Behaviour and Health @ 50%
92 HEALTH > 9202 Health and Support Services > 920299 Health and Support Services not elsewhere classified @ 50%
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