The effect of partner HIV status on motivation to take antiretroviral and isoniazid preventive therapies: a conjoint analysis

ABSTRACT

Antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) are important to reduce morbidity and mortality among people newly diagnosed of HIV. The successful uptake of ART and IPT requires a comprehensive understanding of patients’ motivation to take such therapies. Partners also play an important role in the decision to be initiated and retained in care. We quantified patients’ motivation to take preventive therapies (ART and IPT) and compared by partner HIV status among people newly diagnosed of HIV. We enrolled and surveyed adults (≥18 years) with a recent HIV diagnosis (<6 months) from 14 public primary care clinics in Matlosana, South Africa. Participants received eight forced-choice tasks comparing two mutually exclusive sub-sets of seven possible benefits related to preventive therapies. A linear probability model was fitted to estimate the probability of prioritizing each benefit. Tests of concordance were conducted across partner HIV status (no partner, HIV- or unknown, or HIV+). A total of 424 people completed surveys. At the time of interview, 272 (64%) were on ART and 334 (79%) had a partner or spouse. Keeping themselves healthy for their family was the most important motivator to take preventive therapies (p < 0.001). Preventing HIV transmission to partners was also highly prioritized among participants with current partners independent of partner’s HIV status (p < 0.001), but it was least prioritized among those without current partners (p = 0.72). Keeping themselves healthy was less prioritized. We demonstrate that social responsibility such as supporting family and preventing HIV transmission to partners may pose greater motivation for ART and IPT initiation and adherence compared to individual health benefits. These messages should be emphasized to provide effective patient-centered care and counseling.

KEYWORDS:

• HIV
• tuberculosis
• patient preference
• conjoint analysis
• South Africa

Acknowledgements

This work was supported by NIAID/NIH R01 AI095014 02S1. We thank all study participants for devoting their time to take part in this study. We thank our study coordinators, Cokiswa Quomfo, Mmabatho Malegotsia and Elvis Rangxa as well as all study staff who helped in data collection.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Hae-Young Kim http://orcid.org/0000-0002-5124-1555

Additional information

Funding

This work was supported by NIAID/NIH R01 AI095014 02S1.