Background: 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 the selection and prioritization of different types of DSD models.

Methods: We used a discrete choice experiment (DCE) to elicit patient preferences for HIV treatment services and how they differ across DSD models. We surveyed adults aged >18 years, enrolled in HIV care for >6 months between February and March 2019 at four facilities in Kisumu County, Kenya.  DCE offered patients a series of comparisons between three treatment models, each of which varied in seven attributes: ART refill location, the quantity of ART dispensed at each refill, medication pick-up hours, type of adherence support, clinical visit frequency, staff attitude, and professional cadre of the person providing ART refills.  We used a hierarchical Bayesian model to estimate attribute importance and the relative desirability of care characteristics, latent class analysis (LCA) for groups of preferences, and mixed logit model for willingness to trade analysis.

Results: Of 242 patients, 128 (53.8%) were females and 150 (62.8%) lived in rural areas.  Patients placed the greatest importance on ART refill location [19.5% (95%CI 18.4, 20.6)] and adherence support [19.5% (95%CI 18.7, 20.3)], followed by staff attitude [16.1% (95%CI 15.1, 17.2)]. In the mixed logit, patients preferred the nice attitude of the 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 & 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%).

Conclusions: Participants preferred 3 to 6-month refill intervals or clinic visit spacing, which DSD provides for stable patients. While DSD has also encouraged community ART group options, our results suggest strong patient preferences for ART refills from health centers or by pharmacists over lay caregivers or community members. These preferences held across gender and urban/rural subpopulations. 

Pre-randomized options for the choice tasks were generated from the Lighthouse Studio software using a Balanced Overlap technique, and the questionnaires were administered to participants using Android tablets in their preferred language (English, Kiswahili, or Luo). Data were managed in Sawtooth Software and extracted for analysis in STATA.

STATA, R.