'We want it all': ART preferences assessed by Desirability of Outcome Ranking

Understanding how people living with HIV (PLWH) view antiretroviral therapy (ART) prescribing choices is fundamental to patient-centred care. We used the Desirability of Outcome Ranking (DOOR) approach to explore patient ART preferences.

Seventy-four PLWH entered the study, 20 into the 'pilot study', and 54 in the 'comparative study'. Participants ranked five different hypothetical patient stories by desirability. Each story comprised five narrative lines, each line addressing one treatment characteristic drawn from one of five pre-selected domains (treatment failure, treatment difficulty, adverse effects, long-term complications, life events). Narrative lines could be favourable or adverse. In the pilot study the number of adverse domains varied from one to five. Comparative study stories were fixed at two adverse versus three favourable domains, to test the relative ranking of different domains.

The pilot study identified a relationship between the number of adverse domains and rank (R²  = 0.54; p < 0.0001, Friedman test), however pairwise differences in ranking were not significant beyond three adverse domains. In the comparative study, all domains were ranked equally across the cohort (p = 0.88; Friedman test). In pre-defined demographic subgroup analyses, women ranked the 'treatment failure' domain significantly less desirable than men (p = 0.0014, Mann-Whitney test).

People living with HIV appear to care equally about all aspects of ART. The observation that male and female PLWH have different treatment priorities merits further investigation in larger studies. Interindividual differences highlight the importance of individualized shared decision-making and treatment personalization. DOOR may have a role as a pre-treatment assessment tool as well as a research technique.