Prioritizing Patient-Relevant Attributes of HIV Medications: A Mixed Methods Approach

• Published in: Value in health 2017-10, Vol.20 (9), p.A793
• Main Authors: Yelverton, V, Ostermann, J, Hobbie, A, Madut, D, Mühlbacher, AC, Thielman, N
• Format: Article
• Language: English
• Subjects: Antiretroviral drugs; Antiretroviral therapy; Attributes; Combination therapy; Content analysis; Decision making; Diarrhea; Dosage; Efficacy; Health care; HIV; Human immunodeficiency virus; Infections; Long term; Long-term effects; Medical treatment; Mixed methods research; Nausea; Patient participation; Patients; Personal appearance; Priorities; Prioritizing; Qualitative research; Quantitative analysis; Ratings & rankings; Side effects
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.08.2335

OBJECTIVES: Since the advent of highly active combination antiretroviral therapy (ART), HIV infection has been transformed into a life-long manageable disease. As the number of effective therapeutic options has increased, the number of inputs for decision-making has increased, and trade-offs of regimen attributes have become more complex. The study's objective was to identify preference-relevant characteristics of ART and to understand key factors in the ART selection process from provider and patient perspectives. METHODS: A mixed methods approach was used, including interviews with patients and providers and ranking tasks. Participants were enrolled between March 2016 and May 2017 in the Southeastern United States. Interviews were coded following direct content analysis and complemented by quantitative analysis of attribute mentions. Ranking tasks were analyzed via count analysis. RESULTS: 28 interviews (16 patients, 12 healthcare providers) and 26 ranking tasks with patients were conducted. 61.1% of patients were male (mean age: 50.7 years, mean duration on ART: 14.8 years). Providers had 15.5 years of professional experience on average. Qualitative analysis of patient interviews revealed a variety of decision relevant aspects; the majority could be grouped in four categories: side effects (14/16 patients), administration characteristics (14/16 patients), dosing (13/16 patients), long-term effects (12/16 patients), and other considerations, like patient involvement, relationship with provider, and efficacy. The degree of concordance between patients and providers differed across categories. Ranking results showed differences in priorities regarding depression, nausea, diarrhea, changes in physical appearance, and drug interactions. Expectations for the involvement of patients in the ART selection process varied greatly among and between patients and providers. CONCLUSIONS: A large number of relevant attributes were identified and assigned to categories. Study results also indicate considerable heterogeneity in priorities across patients, in providers' perception of patient priorities, and in patients' preferred level of involvement in HIV treatment decisions.