Understanding Treatment Preferences Among People Living with HIV in Australia: A Discrete Choice Experiment

Simon Fifer,1 Thames Kularatne,1 Marcus Tan,2 Fraser Drummond,3 John Rule4,5 1Community and Patient Preference Research Pty Ltd, Sydney, NSW, Australia; 2Reimbursement & Market Access, GlaxoSmithKline Australia Pty Ltd, Melbourne, VIC, Australia; 3Medical Dept, ViiV Healthcare Australia, Melbourne, VIC, Australia; 4National Association of People with HIV Australia, Newtown, NSW, Australia; 5School of Population Health, University of New South Wales, Sydney, AustraliaCorrespondence: Simon Fifer, Level 20, 25 Bligh St, Sydney, 2000, Australia, Tel +61 403 862 091, Email simon.fifer@cappre.com.auPurpose: To better understand what is most important to people living with human immunodeficiency virus (PLWH) when choosing their treatment. We assessed how PLWH trade off the potential risks and benefits of oral and long acting injectable (LAI) treatments.Participants and Methods: Firstly, in-depth interviews were conducted with 11 PLWH to develop a holistic understanding of experiences and determine attributes that contribute to treatment decision-making. Secondly, a discrete choice experiment (DCE) was used to understand the treatment preferences for PLWH with n = 99 PLWH aged 18 years or over with a diagnosis of human immunodeficiency virus (HIV) and who were currently using anti-retroviral therapy (ART). Study participants were presented with 12 scenarios and asked to select their preferred treatment among two hypothetical injectable treatment alternatives, “injection 1” and “injection 2” and their current oral ART treatment. The DCE data were modelled using a latent class model (LCM).Results: The model revealed significant heterogeneity in preferences for treatment attributes among study participants. Two segments/classes of PLWH were identified. The first segment expressed a strong preference for their current oral treatment; the second segment showed strong preference for the injection treatment and for it to be administered in a GP clinic. Overall, out-of-pocket cost was the most important attribute for participants. One-third of PLWH were willing to switch to an LAI.Conclusion: Not all PLWH valued the same treatment attributes equally. Overall, out-of-pocket costs for treatments were considered by respondents as the most determining factor in making treatment choices. Results have important implications for healthcare policy and will serve to better inform patients and stakeholders involved in the treatment decision-making process about the treatment preferences of PLWH. Clinicians are encouraged to consider shared decision-making to establish the treatment course that best aligns with PLWH’s treatment goals.Keywords: patient preferences, discrete choice experiment, conjoint analysis, HIV, treatment goals, shared decision-making