Patient preferences for long-acting antiretroviral treatment among people with HIV in Kenya: a discrete choice experiment

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BACKGROUND: For people with HIV (PWH), long-acting antiretroviral therapies (LA-ART) are promising treatment alternatives to daily oral regimens, with potential to improve adherence and achieve viral suppression. Understanding patient preferences is crucial for successful and efficient implementation and scaling of LA-ART in resource-limited settings such as Kenya. We conducted a discrete choice experiment (DCE) to elicit preferences for LA-ART attributes among PWH in Kenya. METHODS: We recruited 700 PWH taking daily oral ART from Kenyatta National Hospital and two Sex Workers Outreach Program clinics in Nairobi. In 17 choice scenarios, participants chose between their current daily oral regimen and two hypothetical LA-ART alternatives defined by seven attributes: delivery mode (long-acting oral, subcutaneous or intramuscular injection, implant), administration location (clinic, chemist, home), frequency (weekly, every 1, 2, 3, 6, or 12 months), delivery-site pain (none, mild, moderate), pre-treatment viral suppression (required, not required), pre-treatment negative reaction testing (required, not required), and late-dose leeway (short, long). We used conditional logistic regressions with interactions between mode and pain to determine the relative importance in participants' choices across attributes. RESULTS: Participants had a median age of 36 years (interquartile range [IQR]: 28-46); 64% were female, 83% were virally suppressed, 51% were from key populations (e.g., sex workers or men who have sex with men), and median time on ART was 9 years (IQR: 5-15). Participants generally preferred the hypothetical LA-ART options over their current daily oral ART, and the interaction of delivery mode and pain was the most important attribute combination. Oral LA-ART was the most preferred mode; 1-year implants with mild pain was the next preferred option. Participants favored administration at clinics to chemists or home and preferred less frequent dosing. CONCLUSIONS: LA-ART would be highly acceptable in Kenya, with oral LA-ART and administration at clinics as the preferred formulation and location. Our findings provide valuable evidence to guide the development of novel LA-ART products. Future research should evaluate preference heterogeneity and investigate ways to effectively scale LA-ART in Kenya and similar settings, while taking into account patient preferences. CLINICAL TRIAL NUMBER: Not applicable.

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