Optimizing Differentiated HIV Treatment Models in Urban Zimbabwe: Assessing Patient Preferences Using a Discrete Choice
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ORIGINAL PAPER
Optimizing Differentiated HIV Treatment Models in Urban Zimbabwe: Assessing Patient Preferences Using a Discrete Choice Experiment Michael Strauss1 · Gavin George1 · Joanne E. Mantell2 · Munyaradzi Mapingure3 · Tsitsi B. Masvawure4 · Matthew R. Lamb5,6 · Jennifer M. Zech5 · Godfrey Musuka3 · Innocent Chingombe3 · Martin Msukwa7 · Rodrigo Boccanera8 · Clorata Gwanzura9 · Tsitsi Apollo9 · Miriam Rabkin5,6
© The Author(s) 2020
Abstract Differentiated service delivery holds great promise for streamlining the delivery of health services for HIV. This study used a discrete choice experiment to assess preferences for differentiated HIV treatment delivery model characteristics among 500 virally suppressed adults on antiretroviral therapy in Harare, Zimbabwe. Treatment model characteristics included location, consultation type, healthcare worker cadre, operation times, visit frequency and duration, and cost. A mixed effects logit model was used for parameter estimates to identify potential preference heterogeneity among participants, and interaction effects were estimated for sex and age as potential sources of divergence in preferences. Results indicated that participants preferred health facility-based services, less frequent visits, individual consultations, shorter waiting times, lower cost and, delivered by respectful and understanding healthcare workers. Some preference heterogeneity was found, particularly for location of service delivery and group vs. individual models; however, this was not fully explained by sex and age characteristics of participants. In urban areas, facility-based models, such as the Fast Track model requiring less frequent clinic visits, are likely to better align with patient preferences than some of the other community-based or group models that have been implemented. As Zimbabwe scales up differentiated treatment models for stable patients, a clear understanding of patient preferences can help in designing services that will ensure optimal utilization and improve the efficiency of service delivery. Keywords HIV treatment · Discrete choice experiment · Differentiated service delivery · Zimbabwe · Urban Resumen La entrega de servicios diferenciados representa una gran promesa para optimizar la prestación de servicios sanitarios para el VIH. Este estudio utilizó un experimento de elecciones discretas para evaluar las preferencias en cuanto a las características de los modelos diferenciados de prestación de tratamiento para el VIH entre 500 adultos con supresión viral bajo tratamiento Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10461-020-02994-z) contains supplementary material, which is available to authorized users. 5
ICAP at Columbia University, New York, NY, USA
6
Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
7
ICAP at Columbia University, Pre
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