The systematic development of attributes and levels for a discrete choice experiment of HIV patient preferences for long-acting antiretroviral therapies in the United States

Aaron T Brah,Brett Hauber,Jane M Simoni,Douglas Barthold,Ann C Collier,Vincent C Marconi,Rodney J Y Ho,Susan M Graham

doi:10.1186/s12981-022-00435-6

Abstract

IntroductionPatient preferences for long-acting antiretroviral therapies (LA-ART) should inform development of regimens with optimal adherence and acceptability. We describe a systematic process used to identify attributes and levels for a discrete choice experiment (DCE) designed to elicit preferences for potential LA-ART options in the US.MethodsOur approach was conducted in four stages: data collection, data reduction, removing inappropriate attributes, and optimizing wording. We started with 8 attributes defining potential LA-ART products based on existing literature and knowledge of products in development. We conducted 12 key informant interviews with experts in HIV treatment. The list of attributes, the set of plausible levels for each attribute, and restrictions on combinations of attribute levels were updated iteratively.ResultsDespite uncertainty about which products will become available, key informant discussions converged on 4 delivery modes (infusions and patches were not considered immediately feasible) and 6 additional attributes. Treatment effectiveness and frequency of clinical monitoring were dropped. Oral lead-in therapy was split into two attributes: pre-treatment time undetectable and pre-treatment negative reaction testing. We omitted product-specific systemic and local side effects. In addition to mode, the final set of attributes included: frequency of dosing; location of treatment; pain; pre-treatment time undetectable; pre-treatment negative reaction testing; and late-dose leeway.ConclusionsA systematic process successfully captured elements that are both feasible and relevant to evaluating the acceptability of potential LA-ART alternatives to patients.

Highlights

Patient preferences for long-acting antiretroviral therapies (LA-ART) should inform development of regimens with optimal adherence and acceptability
The topic guide began with an introduction followed by four questions: (1) “Which LA-ART hypothetical products are most likely to come on the market in the 5–10 years?” (2) “Which type of hypothetical product is most exciting to you and why?” (3) “What do you think would be the main competitor for this product, and why?” and (4) “What challenges do you foresee with providing combination LA-ART regimens to patients in the United States?” Additional probes included: “How do the challenges of providing LA-ART for HIV treatment differ from those of providing LA-ART for HIV prevention?” and “Do you think that challenges or preferences might differ for patients who are ART-naïve compared to those who are ART-experienced?”
Themes from key informants (KI) interviews The major themes that emerged from KI interviews involved which products were most likely to be developed, should be removed from consideration or had significant barriers to development or roll-out, and which attributes were likely to be considered most desirable by patients

Summary

Introduction

Patient preferences for long-acting antiretroviral therapies (LA-ART) should inform development of regimens with optimal adherence and acceptability. Oral lead-in therapy was split into two attributes: pre-treatment time undetectable and pre-treatment negative reaction testing. The final set of attributes included: frequency of dosing; location of treatment; pain; pre-treatment time undetectable; pre-treatment negative reaction testing; and late-dose leeway. The development of long-acting antiretroviral therapy (LA-ART) is an important technological advance that could increase ART uptake and adherence by providing patients with new options to support viral suppression [1]. Regimens that required multiple pills taken one or more times each day have become less complicated, with a clear advantage for single-tablet daily oral regimens in terms of adherence and viral load suppression [2]. The advent of new LA-ART modalities will provide increased options for patients who face barriers to taking daily oral pills. An increasing body of evidence demonstrates patients are interested in and willing to try LA-ART [4,5,6,7]

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Discussion

Conclusion