Heterogeneity of patient preferences for long-acting HIV treatment among people with HIV in Kenya

Long-acting ART (LA-ART) regimens available or in development are emerging alternatives to daily oral HIV treatment, designed to improve adherence. We explored preference heterogeneity for LA-ART among people living with HIV (PLWH) in Kenya and investigated their association with sociodemographic and psychosocial characteristics.

We designed a discrete choice experiment (DCE) to elicit preferences for LA-ART attributes among 700 PLWH recruited from three clinics in Nairobi Kenya (January 2023-February 2024). Each participant answered 17 choice-tasks, each with 2 hypothetical LA-ART alternatives and current daily oral therapy. Each LA-ART profile was defined by mode (long-acting pills, injections under the skin, injections into the muscle, and implants), pain, frequency, location of treatment, pre-treatment time undetectable, pre-treatment negative reaction testing, and late-dose leeway. Participants answered demographic and psychosocial questions and provided consent to link their clinical data. We fitted a latent-class model to the DCE data, assigned class membership to each participant, and estimated a multinomial logit model to explore associations between participant characteristics and class membership.

We found three classes in our DCE data and labeled them based on which hypothetical LA-ART formulation they preferred over their current daily oral therapy: LA-Implant (41% of the sample), LA-Injection-or-Oral (subcutaneous or intramuscular injection; 38%) and LA-Oral (21%) classes. All classes preferred "clinic" of over "home" for treatment location. Compared to LA-Oral participants, the other two classes had more experience with and less aversion to injections and had started ART more recently. LA-Implant participants were more likely to have housing insecurity. LA-Injection-or-Oral participants were less likely to be a female sex worker and to have a monthly income; and more likely to be a man who has sex with men or male sex worker, to have private insurance, and to have easier access to a clinic.

Results provide a deeper understanding of the LA-ART preference landscape. Understanding PLWH preferences for these therapies is crucial to increasing their acceptance and uptake as regimens become available and could aid in the development of preference-informed interventions.