Eliciting Preferences for HIV Prevention Technologies: A Systematic Review

Beckham, S. Wilson; Crossnohere, Norah L.; Gross, Margaret; Bridges, John F.P.

doi:10.1007/s40271-020-00486-9

Cited by 37 publications

(31 citation statements)

References 115 publications

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“…The majority (86.4%) of the included studies are conducted amongst users of the service under study. This is similar to what was found in a systematic review on WTP for HIV prevention technologies [43].…”

Section: Discussionsupporting

confidence: 90%

Willingness to pay (WTP) for HIV and AIDS services in Africa: A systematic review

Byabagambi

Limmer

Hollingsworth

2022

Preprint

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Background: While Africa is the continent most affected by HIV and AIDS, its response to HIV and AIDS remains largely donor supported. However, in the face of declining donor support, alternative ways to sustainably support HIV and AIDS responses in Africa are paramount. This systematic review explores the willingness to pay (WTP) for HIV services in Africa as a potentially more sustainable HIV and AIDS service cost recovery approach. Methods: A comprehensive systematic search for literature was conducted in electronic databases and websites of HIV and AIDS organisations for studies that reported on the willingness to pay for HIV services in Africa. Preference studies that did not use the WTP approach and that were conducted outside Africa were excluded. Information on the HIV service, the methods used in the studies and factors that influence WTP were extracted. A descriptive thematic analysis was undertaken. The findings are summarised in tables and graphs. Results: A total of 5,139 records were returned and screened for eligibility from the initial search. After screening and removal of duplicates, twenty-two articles from 10 countries with 19,611 study participants were included in the final review. There is an uneven distribution of WTP studies across different types of HIV services and across countries. There is evidence of a willingness to pay for HIV services, with the proportion of people reported in individual studies that are willing to pay, ranging from 34.3% to 97.1%. However, inthe majority of studies (71.4%, 15/21), the amount people are willing to pay cannot cover the cost of the full service in an open market. Factors associated with WTP include socioeconomic status, beliefs, and knowledge about HIV services. Conclusion: The current systematic review presents evidence of cost recovery from HIV programs. The main finding is that other resources, beyond out-of-pocket payments, are needed to meet the full cost of any service. This has implications for the provision of (nondonor-funded) services on a sustainable level in the long term. Systematic review registration: PROSPERO, registration number CRD42021275215

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Section: Discussionsupporting

confidence: 90%

Willingness to pay (WTP) for HIV and AIDS services in Africa: A systematic review

Byabagambi

Limmer

Hollingsworth

2022

Preprint

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Section: Discussionmentioning

confidence: 99%

“…We acknowledge the limitations of the PREFS scale as a measure of study quality [ 41 , 65 , 66 ]. However, findings from the current study paint a more promising picture of PREFS’ validity than have other systematic reviews [ 67 ]. Furthermore, PREFS has some utility as it allows comparisons to previously published norms for other methods and health-focused literature.…”

Section: Discussionmentioning

confidence: 99%

“…Scores range from zero to five. Limitations of PREFS have been previously noted [ 41 ], such as that it does not include several important criteria for assessing the quality of health-related stated preference studies, such as heterogeneity assessment, sample size, or patient centricity, and that it may lack specificity to discriminate across studies.…”

Section: Methodsmentioning

confidence: 99%

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Best–Worst Scaling and the Prioritization of Objects in Health: A Systematic Review

et al. 2022

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Background and ObjectiveBest-worst scaling is a theory-driven method that can be used to prioritize objects in health. We sought to characterize all studies of best-worst scaling to prioritize objects in health, to assess trends of using best-worst scaling in prioritization over time, and to assess the relationship between a legacy measure of quality (PREFS) and a novel assessment of subjective quality and policy relevance. Methods A systematic review identified studies published through to the end of 2021 that applied best-worst scaling to study priorities in health (PROSPERO CRD42020209745), updating a prior review published in 2016. The PubMed, EBSCOhost, Embase, Scopus, APA PsychInfo, Web of Science, and Google Scholar databases were used and were supplemented by a hand search. Data describing the application, development, design, administration/analysis, quality, and policy relevance were summarized and we tested for trends by comparing articles before and after 1 January, 2017. Multivariate statistics were then used to assess the relationships between PREFS, subjective quality, policy relevance, and other possible indicators. Results From a total of 2826 unique papers identified, 165 best-worst scaling studies were included in this review. Applications of best-worst scaling to study priorities in health have continued to grow (p < 0.01) and are now used in all regions of the world, most often to study the priorities of patients/consumers (67%). Several key trends can be observed over time: increased use of pretesting (p < 0.05); increased use of online administration (p < 0.01), and decreased use of paper selfadministered surveys (p = 0.02); increased use of heterogeneity analysis (p = 0.02); an increase in having a clearly stated purpose (p < 0.01); and a decrease in comparing respondents to non-respondents (p = 0.01). The average sample size has more than doubled, from 228 to 472 respondents, but formal sample size justifications remain low (5.3%) and unchanged over time (p = 0.68). While the average PREFS score remained unchanged at 3.1/5, both subjective quality and policy relevance trended up, but changes were not statistically significant (p = 0.06 and p = 0.13). Most of the variation in subjective quality was driven by PREFS (R 2 = 0.42), but it was also positively assosciated with policy relevance, heterogeneity analysis, and using a balanced incomplete block design, and was negatively associated with not using developmental methods and an increasing sample size. Conclusions Using best-worst scaling to prioritize objects is now commonly used around the world to assess the priorities of patients and other stakeholders in health. Best practices are clearly emerging for best-worst scaling. Although legacy measures (PREFS) to measure study quality are reasonable, there may need to be new tools to assess both study quality and policy relevance.

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“…Non-medical OOPE and time costs frequently pose barriers to PrEP use. Reducing user costs could help reduce the risk of underutilizing HIV prevention related to a potentially low willingness to pay for prevention [ 23 , 49 ]. Subsidizing transport expenses, lowering the distance to a PrEP provider, and/or reducing the time required in a clinic for PrEP might offer ways to address these known barriers.…”

Section: Discussionmentioning

confidence: 99%

Out-of-pocket Expenses and Time Spent on Clinic Visits Among HIV Pre-exposure Prophylaxis Users and Other Clinic Attendees in Eswatini

Köhler

Dalal

Hettema³

et al. 2022

AIDS Behav

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User costs constitute a barrier to the uptake of HIV pre-exposure prophylaxis (PrEP), but their magnitude appears rarely assessed. In this prospective observational study, we assessed self-reported out-of-pocket expenses (OOPE) and time spent on clinic visits during a PrEP demonstration project in Eswatini. At six public primary care clinics, 240 PrEP users and other clinic attendees were interviewed after a clinic visit. Among the 79.2% of clinic attendees reporting any medical OOPE (e.g., expenses for consultations or drugs) and/or non-medical OOPE (e.g., expenses for transport, food, or phone use), the median total OOPE was $1.36 (IQR 0.91–1.96). Non-medical OOPE occurred mostly due to transport expenses. The median travel time for a clinic visit was 1.0 h (IQR 0.67–2.0). The median time spent in the clinic was 2.0 h (IQR 1.15–3.0). The median opportunity cost of a clinic visit was $7.54 (IQR 5.42–11) when valuing time spent on a clinic visit with Eswatini’s per-capita gross domestic product. Our findings can guide measures to reduce the user costs of PrEP in Eswatini and other contexts in which oral PrEP is provided through health care facilities.

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Eliciting Preferences for HIV Prevention Technologies: A Systematic Review

Cited by 37 publications

References 115 publications

Willingness to pay (WTP) for HIV and AIDS services in Africa: A systematic review

Willingness to pay (WTP) for HIV and AIDS services in Africa: A systematic review

Best–Worst Scaling and the Prioritization of Objects in Health: A Systematic Review

Out-of-pocket Expenses and Time Spent on Clinic Visits Among HIV Pre-exposure Prophylaxis Users and Other Clinic Attendees in Eswatini

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