Preferences of people living with HIV for treatment regimen attributes: a qualitative interview study

To develop effective HIV treatments, including long-acting injectables, understanding the treatment attributes and personal factors that are significant to people living with HIV is essential.

We conducted individual qualitative interviews with people living with HIV and healthcare providers (HCP) in the United States to evaluate treatment preferences if considering a hypothetical treatment switch. We performed a targeted literature review and identified five attributes related to HIV treatment: (1) administration mode, (2) administration setting, (3) administration frequency, (4) location of injection on the body, and (5) side effects. We also recorded any spontaneously mentioned attributes and other factors influencing treatment decisions. A thematic analysis was conducted using MAXQDA, with dual independent coding of 20% of transcripts and third-party reconciliation by the qualitative lead. Spanish-language transcripts were reviewed in both the original and translated versions to preserve meaning.

We interviewed 50 people living with HIV and 5 HCPs. Among people living with HIV, 60% were male, 62% had no prior injection treatment experience, and median (interquartile range) age was 50 (39.8-55.8) years. Side effects emerged as the highest priority attribute for people living with HIV and for HCPs, followed by administration frequency and mode. Most participants expressed a clear preference for injectable over oral administration when all injection forms (intramuscular, subcutaneous, intravenous, combinations) were considered together. Among HCP-administered injection options, 4- and 6-month intervals were widely preferred, driven by alignment with existing appointment schedules and relationships with providers.

When considering treatment options, the highest priorities for people living with HIV are reducing side effects and administration frequency. A planned quantitative discrete choice experiment will evaluate generalizability of our results and provide evidence to support stakeholder decisions.