Differentiated Care Preferences of Stable Patients on Antiretroviral Therapy in Zambia: A Discrete Choice Experiment
| Autor: | Eshun-Wilson, Ingrid, Mukumbwa-Mwenechanya, Mpande, Kim, Hae-Young, Zannolini, Arianna, Mwamba, Chanda P, Dowdy, David, Kalunkumya, Estella, Lumpa, Mwansa, Beres, Laura K, Roy, Monika, Sharma, Anjali, Topp, Steph M, Glidden, Dave V, Padian, Nancy, Ehrenkranz, Peter, Sikazwe, Izukanji, Holmes, Charles B, Bolton-Moore, Carolyn, Geng, Elvin H |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Rural Population Male Attitude of Health Personnel discrete choice antiretroviral therapy Clinical Sciences Zambia differentiated care HIV HIV Infections Patient Preference Health Services Good Health and Well Being Clinical Research Antirheumatic Agents Virology Ambulatory Care Public Health and Health Services Humans Female preference Delivery of Health Care |
| Zdroj: | Journal of acquired immune deficiency syndromes (1999), vol 81, iss 5 |
| Popis: | BackgroundAlthough 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.MethodsBetween July and December 2016, a sample of HIV-positive adults on ART at 12 clinics in Zambia were asked to choose between 2 hypothetical facilities that differed across 6 DSD attributes. We used mixed logit models to explore preferences, heterogeneity, and trade-offs.ResultsOf 486 respondents, 59% were female and 85% resided in urban locations. Patients strongly preferred infrequent clinic visits [3- vs. 1-month visits: β (ie, relative utility) = 2.84; P < 0.001]. Milder preferences were observed for waiting time for ART pick-up (1 vs. 6 hours.; β = -0.67; P < 0.001) or provider (1 vs. 3 hours.; 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 most rural patients preferred community ART pick-up (β = -0.74, P = 0.049), 40% of rural patients still preferred facility ART collection.ConclusionsStable patients on ART primarily want to attend clinic infrequently, supporting a focus in Zambia on optimizing multimonth 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. |
| Databáze: | OpenAIRE |
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