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Patient preferences for HIV service delivery models; a Discrete Choice Experiment in Kisumu, Kenya

Novel “differentiated service delivery” models for HIV treatment that reduce clinic visit frequency, minimize waiting time, and deliver treatment in the community promise retention improvement for HIV treatment in Sub-Saharan Africa. Quantitative assessments of differentiated service delivery (DSD)...

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Autores principales: Mando, Raphael Onyango, Moghadassi, Michelle, Juma, Eric, Ogollah, Cirilus, Packel, Laura, Kulzer, Jayne Lewis, Kadima, Julie, Odhiambo, Francesca, Eshun-Wilson, Ingrid, Kim, Hae-Young, Cohen, Craig R., Bukusi, Elizabeth A., Geng, Elvin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021384/
https://www.ncbi.nlm.nih.gov/pubmed/36962597
http://dx.doi.org/10.1371/journal.pgph.0000614
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author Mando, Raphael Onyango
Moghadassi, Michelle
Juma, Eric
Ogollah, Cirilus
Packel, Laura
Kulzer, Jayne Lewis
Kadima, Julie
Odhiambo, Francesca
Eshun-Wilson, Ingrid
Kim, Hae-Young
Cohen, Craig R.
Bukusi, Elizabeth A.
Geng, Elvin
author_facet Mando, Raphael Onyango
Moghadassi, Michelle
Juma, Eric
Ogollah, Cirilus
Packel, Laura
Kulzer, Jayne Lewis
Kadima, Julie
Odhiambo, Francesca
Eshun-Wilson, Ingrid
Kim, Hae-Young
Cohen, Craig R.
Bukusi, Elizabeth A.
Geng, Elvin
author_sort Mando, Raphael Onyango
collection PubMed
description Novel “differentiated service delivery” models for HIV treatment that reduce clinic visit frequency, minimize waiting time, and deliver treatment in the community promise retention improvement for HIV treatment in Sub-Saharan Africa. Quantitative assessments of differentiated service delivery (DSD) feature most preferred by patient populations do not widely exist but could inform selection and prioritization of different DSD models. We used a discrete choice experiment (DCE) to elicit patient preferences of HIV treatment services and how they differ across DSD models. We surveyed 18+year-olds, enrolled in HIV care for ≥6 months between February-March, 2019 at four facilities in Kisumu County, Kenya. DCE offered patients a series of comparisons between three treatment models, each varying across seven attributes: ART refill location, quantity of dispensed ART at each refill, medication pick-up hours, type of adherence support, clinical visit frequency, staff attitude, and professional cadre of person providing ART refills. We used hierarchical Bayesian model to estimate attribute importance and relative desirability of care characteristics, latent class analysis (LCA) for groups of preferences and mixed logit model for willingness to trade analysis. Of 242 patients, 128 (53.8%) were females and 150 (62.8%) lived in rural areas. Patients placed greatest importance on ART refill location [19.5% (95% CI 18.4, 10.6) and adherence support [19.5% (95% CI 18.17, 20.3)], followed by staff attitude [16.1% (95% CI 15.1, 17.2)]. In the mixed logit, patients preferred nice attitude of staff (coefficient = 1.60), refill ART health center (Coeff = 1.58) and individual adherence support (Coeff = 1.54), 3 or 6 months for ART refill (Coeff = 0.95 and 0.80, respectively) and pharmacists (instead of lay health workers) providing ART refill (Coeff = 0.64). No differences were observed by gender or urbanicity. LCA revealed two distinct groups (59.5% vs. 40.5%). Participants preferred 3 to 6-month refill interval or clinic visit spacing, which DSD offers stable patients. While DSD has encouraged community ART group options, our results suggest strong preferences for ART refills from health-centers or pharmacists over lay-caregivers or community members. These preferences held across gender&urban/rural subpopulations.
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spelling pubmed-100213842023-03-17 Patient preferences for HIV service delivery models; a Discrete Choice Experiment in Kisumu, Kenya Mando, Raphael Onyango Moghadassi, Michelle Juma, Eric Ogollah, Cirilus Packel, Laura Kulzer, Jayne Lewis Kadima, Julie Odhiambo, Francesca Eshun-Wilson, Ingrid Kim, Hae-Young Cohen, Craig R. Bukusi, Elizabeth A. Geng, Elvin PLOS Glob Public Health Research Article Novel “differentiated service delivery” models for HIV treatment that reduce clinic visit frequency, minimize waiting time, and deliver treatment in the community promise retention improvement for HIV treatment in Sub-Saharan Africa. Quantitative assessments of differentiated service delivery (DSD) feature most preferred by patient populations do not widely exist but could inform selection and prioritization of different DSD models. We used a discrete choice experiment (DCE) to elicit patient preferences of HIV treatment services and how they differ across DSD models. We surveyed 18+year-olds, enrolled in HIV care for ≥6 months between February-March, 2019 at four facilities in Kisumu County, Kenya. DCE offered patients a series of comparisons between three treatment models, each varying across seven attributes: ART refill location, quantity of dispensed ART at each refill, medication pick-up hours, type of adherence support, clinical visit frequency, staff attitude, and professional cadre of person providing ART refills. We used hierarchical Bayesian model to estimate attribute importance and relative desirability of care characteristics, latent class analysis (LCA) for groups of preferences and mixed logit model for willingness to trade analysis. Of 242 patients, 128 (53.8%) were females and 150 (62.8%) lived in rural areas. Patients placed greatest importance on ART refill location [19.5% (95% CI 18.4, 10.6) and adherence support [19.5% (95% CI 18.17, 20.3)], followed by staff attitude [16.1% (95% CI 15.1, 17.2)]. In the mixed logit, patients preferred nice attitude of staff (coefficient = 1.60), refill ART health center (Coeff = 1.58) and individual adherence support (Coeff = 1.54), 3 or 6 months for ART refill (Coeff = 0.95 and 0.80, respectively) and pharmacists (instead of lay health workers) providing ART refill (Coeff = 0.64). No differences were observed by gender or urbanicity. LCA revealed two distinct groups (59.5% vs. 40.5%). Participants preferred 3 to 6-month refill interval or clinic visit spacing, which DSD offers stable patients. While DSD has encouraged community ART group options, our results suggest strong preferences for ART refills from health-centers or pharmacists over lay-caregivers or community members. These preferences held across gender&urban/rural subpopulations. Public Library of Science 2022-10-27 /pmc/articles/PMC10021384/ /pubmed/36962597 http://dx.doi.org/10.1371/journal.pgph.0000614 Text en © 2022 Mando et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Mando, Raphael Onyango
Moghadassi, Michelle
Juma, Eric
Ogollah, Cirilus
Packel, Laura
Kulzer, Jayne Lewis
Kadima, Julie
Odhiambo, Francesca
Eshun-Wilson, Ingrid
Kim, Hae-Young
Cohen, Craig R.
Bukusi, Elizabeth A.
Geng, Elvin
Patient preferences for HIV service delivery models; a Discrete Choice Experiment in Kisumu, Kenya
title Patient preferences for HIV service delivery models; a Discrete Choice Experiment in Kisumu, Kenya
title_full Patient preferences for HIV service delivery models; a Discrete Choice Experiment in Kisumu, Kenya
title_fullStr Patient preferences for HIV service delivery models; a Discrete Choice Experiment in Kisumu, Kenya
title_full_unstemmed Patient preferences for HIV service delivery models; a Discrete Choice Experiment in Kisumu, Kenya
title_short Patient preferences for HIV service delivery models; a Discrete Choice Experiment in Kisumu, Kenya
title_sort patient preferences for hiv service delivery models; a discrete choice experiment in kisumu, kenya
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021384/
https://www.ncbi.nlm.nih.gov/pubmed/36962597
http://dx.doi.org/10.1371/journal.pgph.0000614
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