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

Figures & data

Figure 1 Example DCE scenario.

Table 1 Attributes and Levels Presented in the DCE

Attribute	Description	Injection		Oral (Current)
Frequency of administration	How often the treatment is taken or administered.	Taken every second month (fixed)		Daily
Location of administration	The place or setting where the treatment is administered.	Specialist clinic (The injection will be administered by a doctor or a trained nurse at a clinic specialized for providing HIV services)		Unrestricted location
		GP clinic (The injection will be administered by a doctor or a trained nurse at a GP clinic)
		Community based clinic (The injection will be administered by a trained nurse at a community health clinic near where you live)
		District nursing service (The injection will be administered by a trained nurse at your home)
How many pills/injections	This refers to the amount of HIV medication (pills or injections) taken at each time.	One injection		Current number of pills
		Two injections (received one after the other)
Short-term side effects (mild or moderate)	The likelihood of having undesirable symptoms caused by taking HIV medication. Side effects can either not interfere with daily activities at all or may interfere with daily activities to a moderate extent (clinically referred to as Grade 1 or Grade 2 side effects). Common side effects include fatigue, headache and nausea. These side effects may require additional treatment, although in mild circumstances this will not be required. Short term side effects are usually experienced for a short period of time upon starting on a new treatment.	Low risk (15%)		Side effects currently experienced
		Medium risk (20%)
		High risk (25%)
Adherence to medication dosing regimen	The extent of adherence that is recommended to ensure virological suppression is sustained, decreasing the risk of transmission or resistance.	1 week of allowance after a missed dose		Ongoing adherence required
		Ongoing adherence required
Long term health problems	Long-term health problems associated with treatments such as risk of coronary heart disease (eg CHD or stroke), bone fracture and chronic kidney disease (CKD) (eg impaired kidney function).	Low risk (fixed)		Low risk
Injection site reactions	An adverse reaction, such as rash or redness, at the site of an injection. [Mild: tenderness with or without associated symptoms (eg, warmth, redness, itching) Moderate: pain, lipodystrophy (lose or gain fat in certain body areas), swelling, phlebitis (inflammation of a vein)]	Mild		Nil
		Moderate
Patient support program	Additional support service available to patients when commencing a treatment, with no out-of-pocket costs.	No support service (No patient support program will be available)		Current patient support availability
		Nurse support phone line at no additional cost (This will involve a nurse that can be contacted with relation to any questions regarding treatment and a reminder of the next appointment for administration of the injectable)
Out-of-pocket costs for 2 months	The cost of treatment to you associated with taking HIV treatments over a period of 2 months. It includes medication cost (eg pills, injections) and doctor’s fees (eg GP/specialist fees).	General	Concession	Current cost
		$0	$0
		$15	$8
		$30	$16
		$45	$24
		$60	$32
		$75	$40
		$90	$48
		$105	$56

Abbreviations: GP, general practitioner; HIV, human immunodeficiency virus; CKD, chronic kidney disease; CHD, coronary heart disease.

Table 2 Participant Demographics and Clinical Characteristics

Demographic or Clinical Characteristic		Total (N=104) N (%)
Gender	Male	92 (88.46)
	Female	10 (9.62)
	Non-binary/gender fluid	1 (0.96)
	Prefer to self-describe	1 (0.96)
Age (years)	18–30	8 (7.69)
	31–40	21 (20.19)
	41–50	21 (20.19)
	51–60	38 (36.54)
	61–70	13 (12.5)
	71–80	3 (2.88)
Born with a variation of sex characteristics	Yes	1 (0.96)
	No	103 (99.04)
Occupational status	Working (full-time)	45 (43.27)
	Working (part-time)	13 (12.5)
	Working (casual)	6 (5.77)
	Not working	21 (20.19)
	Home duties and/or caring responsibilities	5 (4.81)
	Retired	12 (11.54)
	Student	1 (0.96)
	Prefer not to answer	1 (0.96)
Household composition	Couple with no children	28 (26.92)
	Couple family with children	5 (4.81)
	One parent family	2 (1.92)
	Single person household	40 (38.46)
	Group household (ie shared)	27 (25.96)
	Prefer not to answer	2 (1.92)
Sexual orientation	Straight or heterosexual	10 (9.62)
	Lesbian, gay or homosexual	81 (77.88)
	Bisexual	6 (5.77)
	Queer	4 (3.85)
	Other	2 (1.92)
	Prefer not to answer	1 (0.96)
State	Australian Capital Territory	7 (6.73)
	New South Wales	40 (38.46)
	Victoria	19 (18.27)
	Queensland	13 (12.5)
	South Australia	3 (2.88)
	Western Australia	16 (15.38)
	Tasmania	4 (3.85)
	Northern Territory	2 (1.92)
Area	Metro/city	80 (76.92)
	Regional	18 (17.31)
	Rural	6 (5.77)
Total annual household income (before Tax)	Up to $29,999	18 (17.31)
	$30,000 to $59,999	16 (15.38)
	$60,000 to $89,999	23 (22.12)
	$90,000 to $119,999	16 (15.38)
	$120,000 to $149,999	7 (6.73)
	$150,000 to $179,999	4 (3.85)
	$180,000 to $209,999	2 (1.92)
	$210,000 or more	10 (9.62)
	Prefer not to answer	8 (7.69)
Highest level of education attained	Year 11 or below	10 (9.62)
	Year 12	11 (10.58)
	Certificate III/IV	22 (21.15)
	Bachelor’s Degree	36 (34.62)
	Graduate Diploma or Graduate Certificate	8 (7.69)
	Postgraduate Level (Masters or Doctor of Philosophy)	17 (16.35)
Ethnicity	Australian	68 (65.38)
	Indigenous Australian or Torres Strait Islander	2 (1.92)
	New Zealander	7 (6.73)
	Asian	4 (3.85)
	Indian	2 (1.92)
	European	11 (10.58)
	South American	3 (2.88)
	African	1 (0.96)
	Other	6 (5.77)
Experienced side effects with current HIV treatment N (%)	Yes	32 (30.77)
	No	58 (55.77)
	Do not know/not sure	14 (13.46)
Side effects experienced N (%)*	Diarrhoea	5 (15.63)
	Appetite loss	3 (9.38)
	Lipodystrophy (lose or gain fat in certain body areas)	4 (12.5)
	Tiredness and fatigue	9 (28.13)
	Mood changes, depression, and anxiety	6 (18.75)
	Cholesterol elevation	6 (18.75)
	Nausea	2 (6.25)
	Weight gain	17 (53.13)
	Other	13 (40.63)
Dietary requirements associated with HIV medication N (%)	Yes	24 (23.08)
	No	79 (75.96)
	Do not know/not sure	1 (0.96)
Number of pills taken daily for HIV treatment mean (SD)		1.55 (1.36)
Perceived ability to swallow current tablet/capsule(s) for HIV N (%)	No difficulty with swallowing	91 (87.5)
	Very mild difficulty with swallowing	8 (7.69)
	Mild difficulty with swallowing	4 (3.85)
	Moderate difficulty with swallowing	1 (0.96)
	Severe difficulty with swallowing	0 (0)
Frequency of missed doses in the previous three months N (%)	Has not missed any doses in the previous three months	23 (22.12)
	Missed 1 to 6 doses in the previous three months	54 (51.92)
	Missed 7–12 doses in the previous three months	7 (6.73)
	Missed more than 12 doses in the previous three months	1 (0.96)
	Do not know/not sure	1 (0.96)
	Never missed taking HIV medication	18 (17.31)
Estimated cost for 2 months of HIV medication M (SD)		9.2 (19.08)
Estimated cost for 2 months of doctor’s fees for HIV M (SD)		21.72 (56.77)
Location of HIV medication collection N (%)	Pharmacy	54 (51.92)
	Hospital	34 (32.69)
	Health services	11 (10.58)
	Other	5 (4.81)
Patient category N (%)*	General	62 (59.62)
	Concession	14 (13.46)
	Pension	22 (21.15)
	Social security	1 (0.96)
	Other	2 (1.92)
	I do not know/not sure	3 (2.88)
Currently use HIV patient support phone lines N (%)	Yes	13 (12.5)
	No	91 (87.5)
Frequency of seeing healthcare team per year N (%)	Monthly	5 (4.81)
	Every second month	8 (7.69)
	Once every 3 months	22 (21.15)
	Once every 4 months	25 (24.04)
	Once every 5–6 months	37 (35.58)
	Once every 7–8 months	3 (2.88)
	Once a year	4 (3.85)
Convenience to travel to HIV doctor’s or nurse practitioner’s office N (%)	Very convenient	29 (27.88)
	Convenient	38 (36.54)
	Neither convenient nor inconvenient	26 (25)
	Inconvenient	9 (8.65)
	Very inconvenient	2 (1.92)
Services currently used for HIV treatment N (%)*	Pharmacy	55 (52.88)
	General Practitioner	42 (40.38)
	HIV specialist	74 (71.15)
	District nursing service	2 (1.92)
	Community based clinic	16 (15.38)
Co-morbidities N (%)*	Diabetes	7 (6.73)
	Cardiovascular disease	6 (5.77)
	Hepatitis C	10 (9.62)
	Hepatitis B	11 (10.58)
	Dyslipidaemia	2 (1.92)
	Chronic obstructive pulmonary disease	3 (2.88)
	Chronic kidney disease	4 (3.85)
	Liver disease	3 (2.88)
	Depression	42 (40.38)
	Other	15 (14.42)
	Do not know/not sure	5 (4.81)
	None of the above	36 (34.62)
Number of pills taken daily excluding HIV treatment, mean (SD)		2.67 (3.24)

Note: *Multiple response question - may add to more than 100%.

Abbreviations: M (SD), mean (standard deviation); HIV, human immunodeficiency virus; N(%), number(percentage); AU$, All $ are in Australian dollars.

Table 3 LCM Model Output

Class/Segment Proportions	Symbol	Segment 1 0.638			Segment 2 0.362
Utility Parameters		Parameter	SE	T-Ratio	Parameter	SE	T-Ratio
Constants
Current treatment (general)	sq_g	1.273*	0.558	2.280	−2.126*	0.356	−5.970
(Reference category: injection (general))
Current treatment (concession)	sq_c	1.887*	0.573	3.290	−1.940*	0.395	−4.910
(Reference category: injection (concession))
Location of administration
GP clinic	loc_gp	−0.744	0.517	−1.440	0.710*	0.268	2.650
Community based clinic	loc_cc	−1.279*	0.552	−2.310	0.358	0.257	1.390
District nursing service	loc_dn	−1.541*	0.541	−2.850	−0.222	0.227	−0.980
(Reference category: Specialist clinic)
Number of injections
One injection	Inj_1	1.725*	0.444	3.880	0.090	0.157	0.570
(Reference category: two injections)
Injection side effects
Medium risk (20%)	i_sem	−0.314	0.429	−0.730	−0.309	0.188	−1.650
High risk (25%)	i_seh	−0.905*	0.421	−2.150	−0.555*	0.242	−2.300
(Reference category: Low risk 15%)
Adherence
1 week of allowance after a missed dose	adh	−0.110	0.417	−0.260	0.336	0.180	1.860
(Reference category: Ongoing adherence required)
Cost
Out-of-pocket costs (general)	cost_g	−0.088	0.018	−4.990	−0.020*	0.003	−6.160
Out-of-pocket costs (concession)	cost_c	−0.066	0.019	−3.520	−0.052*	0.008	−6.210
Cost in dollars (continuous)

Notes: *Significant at the 5%-level. Log-likelihood: −596.85; Restricted log-likelihood: −2128.61; Number of respondents: 99; Number of choice observations: 1188.

Abbreviations: SE, standard error; GP, general practitioner.

Figure 2 Relative attribute importance. (A) General patient. (B) Concession patients.