Preferences of people living with HIV for features of tuberculosis preventive treatment regimens - a discrete choice experiment.
Preferences of people living with HIV for features of tuberculosis preventive treatment regimens - a discrete choice experiment.
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艾滋病毒感染者对结核病预防治疗方案特征的偏好——一项离散选择实验。
DOI：
10.1101/2023.09.13.23295043
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Kerkhoff,AndrewD
中科院分区：
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作者：
Aschmann,HélèneE;Musinguzi,Allan;Kadota,JillianL;Namale,Catherine;Kakeeto,Juliet;Nakimuli,Jane;Akello,Lydia;Welishe,Fred;Nakitende,Anne;Berger,Christopher;Dowdy,DavidW;Cattamanchi,Adithya;Semitala,FredC;Kerkhoff,AndrewD
背景结核病（TB）预防性治疗（TPT）被推荐用于结核病高负担环境中的HIV感染者（PLHIV）。虽然每天服用6个月的异烟肼仍被广泛使用，但现在已有更短的治疗方案。然而，很少有人知道PLHIV的TPT方案的关键特征的偏好。方法我们在乌干达坎帕拉的一家城市艾滋病诊所从事护理工作的成年艾滋病病毒感染者中进行了一项离散选择实验。在九项随机选择任务中，参与者在两种具有不同特征（每剂药丸、频率、持续时间、调整抗逆转录病毒治疗[ART]剂量的需要和副作用）的假设TPT方案之间进行选择。我们使用分层贝叶斯估计，潜在类别分析和交易意愿模拟分析偏好。结果在400例艾滋病病毒感染者中，392例（中位年龄44岁，72%为女性，91%有TPT经验）有高质量的选择任务反应。每剂量的药丸是最重要的属性（相对重要性32.4%，95%置信区间[CI] 31.6 - 33.2），其次是频率（20.5% [95% CI 19.7 - 21.3]）、持续时间（19.5% [95% CI 18.6 - 20.5]）和需要ART剂量调整（18.2% [95% CI 17.2 - 19.2]）。潜在类别分析确定了三个偏好组：一个优先考虑频率较低的每周给药（N=222; 57%）;另一个反对ART剂量调整（N=107; 27%）;最后一个优先考虑短期和可耐受的方案（N=63; 16%）。所有组都高度重视每剂量的药丸数量。参与者愿意接受2.8个月的额外持续时间[95% CI：2.4 - 3.2]，以将每次剂量的药丸从5片减少到1片，每周而不是每天给药3.6个月[95% CI 2.4 - 4.8]，以及2.2个月[95% CI 1.3 - 3.0]，以避免ART剂量调整。结论：为了与艾滋病病毒感染者的偏好保持一致，决策者应该优先考虑开发和实施TPT方案，减少药丸，减少给药频率，不需要调整ART剂量，而不是主要关注治疗持续时间。
Background Tuberculosis (TB) preventive treatment (TPT) is recommended for people living with HIV (PLHIV) in high TB burden settings. While 6 months of daily isoniazid remains widely used, shorter regimens are now available. However, little is known about preferences of PLHIV for key features of TPT regimens. Methods We conducted a discrete choice experiment among adult PLHIV engaged in care at an urban HIV clinic in Kampala, Uganda. In nine random choice tasks, participants chose between two hypothetical TPT regimens with different features (pills per dose, frequency, duration, need for adjusted antiretroviral therapy [ART] dosage and side effects). We analyzed preferences using hierarchical Bayesian estimation, latent class analysis, and willingness-to-trade simulations. Results Of 400 PLHIV, 392 (median age 44, 72% female, 91% TPT-experienced) had high quality choice task responses. Pills per dose was the most important attribute (relative importance 32.4%, 95% confidence interval [CI] 31.6 – 33.2), followed by frequency (20.5% [95% CI 19.7 – 21.3]), duration (19.5% [95% CI 18.6 – 20.5]), and need for ART dosage adjustment (18.2% [95% CI 17.2 – 19.2]). Latent class analysis identified three preference groups: one prioritized less frequent, weekly dosing (N=222; 57%); another was averse to ART dosage adjustment (N=107; 27%); and the last prioritized short and tolerable regimens (N=63; 16%). All groups highly valued fewer pills per dose. Participants were willing to accept a regimen of 2.8 months’ additional duration [95% CI: 2.4 – 3.2] to reduce pills per dose from five to one, 3.6 [95% CI 2.4 – 4.8] months for weekly rather than daily dosing, and 2.2 [95% CI 1.3 – 3.0] months to avoid ART dosage adjustment. Conclusions To align with preferences of PLHIV, decision-makers should prioritize the development and implementation of TPT regimens with fewer pills, less frequent dosing, and no need for ART dosage adjustment, rather than focus primarily on duration of treatment.