Exploring Relative Preferences for HIV Service Features Using Discrete Choice Experiments: a Synthetic Review
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IMPLEMENTATION SCIENCE (E GENG, SECTION EDITOR)
Exploring Relative Preferences for HIV Service Features Using Discrete Choice Experiments: a Synthetic Review I Eshun-Wilson 1 & H-Y Kim 2 & S Schwartz 3 & M Conte 4 & D V Glidden 5 & E H Geng 1
# The Author(s) 2020
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. Keywords Preference . Discrete choice experiment . Review . HIV . Service delivery . Differentiated care
Introduction
This article is part of the Topical Collection on Implementation Science * I Eshun-Wilson [email protected] 1
Division of Infectious Disease, School of Medicine, Washington University in St. Louis, Childrens Pl, St. Louis, MO 63110, USA
2
Department of Population Health, New York University School of Medicine, New York, USA
3
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
4
Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York, USA
5
Department of Epidemiology, University of California, San Francisco, USA
Improving engagement in HIV care will require an understanding of patient experiences and patient-centered approaches for service delivery [1–3]. Over the last two decades, a robust HIV response has had a substantial impact on increasing the number of people living
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