Physical Activity, Life Expectancy Improvements Are Most Valued HIV Treatment Outcomes, Colombian Study Says

Of 5 HIV treatment effects evaluated in a recent study, short-term efficacy on physical activity ability and long-term efficacy on life expectancy were the top preferences and valued the most by younger (<38 years) and older (>38 years) patients, respectively, according to study results out of Bogotá, Colombia, published in Journal of Medical Economics.

The remaining 3 effects evaluated were risk of moderate adverse effects, accessibility to clinic, and economic costs to access controls. For the 129 questionnaires included for data analysis, the mean (SD) respondent age was 38.4 (12.4) years, 42% classified themselves as heterosexual, and 47% said they were homosexual. Most patients had up to a secondary school education (45.1%) and lived in a rural location (63.5%).

The study authors investigated HIV-positive patient treatment preference among a rural population in Colombia for 2 hypothetical treatments through an online and a waiting-room questionnaire. Using a discrete choice experiment format, they attempted to gain a more complete picture of the trade-offs these persons choose to make under the country’s free, universal health care system, and to better understand their behaviors toward treatment in hopes of improving antiretroviral therapy adherence.

“Assessing the patients’ preferences of the rural population in particular and assessing the differences in patients’ preferences between a rural and urban setting may lead to new insights,” the authors stated. They used a 2-step process that involved a PubMed literature review and a focus group at Assistencia Cientifica de Alta Complejidad, an HIV clinic in Bogotá, to come up with the attributes and levels they would evaluate among patients with HIV in Colombia.

In addition to physical activity (27.5%) and life expectancy (26.0%) for younger and older patients, a travel time to clinic of less than 2 hours was the top choice for treatment accessibility (22.1%). Economic costs (7.6%) were the least important characteristic overall, and risk of adverse effects fell right in the middle (16.7%).

Subgroup analyses for education revealed that patients with a low level of education (secondary and primary education at most) placed the highest value on treatment accessibility and costs, assigning the lowest preference to adverse effects, which the authors believe is connected to the expenses associated with traveling long distances. In comparison, high-education patients (engineer degree [technologist] or university degree) placed the highest value on life expectancy and physical activity.

“Our study revealed that HIV treatment benefits (i.e. effect on physical activity and the effect on life expectancy), risks, but also costs and the access to the clinics are important for patients,” the authors concluded. “Optimizing these treatment characteristics could lead to optimizing treatment adherence.”

Strengths of the present study include its use of a focus group of patients with HIV to evaluate the treatment attributes that were investigated and researchers who were present during data collection to ensure questions were completed. Limitations include selection and sampling biases and lack of generalizability to all of Colombia’s population, because the study was conducted at just 1 clinic in Bogotá.

Reference

Goossens AJM, Cheung KL, Sijstermans E, Conde R, Gonzalez JGR, Hiligsman M. A discrete choice experiment to assess patients’ preferences for HIV treatment in the rural population in Colombia. J Med Econ. 2020;8:803-811. doi:10.1080/13696998.2020.1735398