Preferences for Hypertension Care in Malawi: A Discrete Choice Experiment Among People Living with Hypertension, With and Without HIV.

Autor: Hoffman R; David Geffen School of Medicine, Department of Medicine, Division of Infectious Diseases, University of California, Risa Hoffman, 911 Broxton Avenue Suite 301D, Los Angeles, CA, 90024, USA. Rhoffman@mednet.ucla.edu., Phiri K; Partners in Hope Medical Center, Lilongwe, Malawi., Kalande P; Partners in Hope Medical Center, Lilongwe, Malawi., Whitehead H; David Geffen School of Medicine, Department of Medicine, Division of Infectious Diseases, University of California, Risa Hoffman, 911 Broxton Avenue Suite 301D, Los Angeles, CA, 90024, USA., Moses A; Partners in Hope Medical Center, Lilongwe, Malawi., Rockers PC; Department of Global Health, Boston University School of Public Health, Boston, MA, USA., Tseng CH; David Geffen School of Medicine, Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA., Talama G; Partners in Hope Medical Center, Lilongwe, Malawi., Banda JC; Non-Communicable Disease and Mental Health Division, Ministry of Health, Lilongwe, Malawi., van Oosterhout JJ; David Geffen School of Medicine, Department of Medicine, Division of Infectious Diseases, University of California, Risa Hoffman, 911 Broxton Avenue Suite 301D, Los Angeles, CA, 90024, USA.; Partners in Hope Medical Center, Lilongwe, Malawi., Phiri S; Partners in Hope Medical Center, Lilongwe, Malawi.; School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi., Moucheraud C; Department of Public Health Policy and Management, New York University Global School of Public Health, New York, NY, USA.
Jazyk: angličtina
Zdroj: AIDS and behavior [AIDS Behav] 2024 Sep 13. Date of Electronic Publication: 2024 Sep 13.
DOI: 10.1007/s10461-024-04492-y
Abstrakt: Hypertension is the most common non-communicable disease diagnosed among people in sub-Saharan Africa. However, little is known about client preferences for hypertension care. We performed a discrete choice experiment in Malawi among people with hypertension, with and without HIV. Participants were asked to select between two care scenarios, each with six attributes: distance, waiting time, provider friendliness, individual or group care, antihypertensive medication supply, and antihypertensive medication dispensing frequency (three versus one month). Eight choice sets (each with two scenarios) were presented to each individual. Mixed effects logit models quantified preferences for each attribute. Estimated model coefficients were used to predict uptake of hypothetical models of care. Between July 2021 and April 2022 we enrolled 1003 adults from 14 facilities in Malawi; half were living with HIV and on ART for a median of 11 years. Median age of respondents was 57 years (IQR 49-63), 58.2% were female, and median duration on antihypertensive medications was 4 years (IQR 2-7). Participants strongly preferred seeing a provider alone versus in a group (OR 11.3, 95% CI 10.4-12.3), with stronger preference for individual care among those with HIV (OR 15.4 versus 8.6, p < 0.001). Three-month versus monthly dispensing was also strongly preferred (OR 4.2; 95% CI 3.9-4.5). 72% of respondents would choose group care if all other facility attributes were favorable, although PLHIV were less likely to make this trade-off (66% versus 77%). These findings have implications for the scale-up of hypertension care in Malawi and similar settings.
(© 2024. The Author(s).)
Databáze: MEDLINE
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