Patients’ preferences for antiretroviral therapy service provision: a systematic review

Abstract

Background Achieving global targets of adherence to treatment, retention in care, and treatment success remains a challenge. Health system investment to make antiretroviral therapy services more responsive to patients’ needs and values could address these impediments. Appropriate resource allocation to implement differentiated HIV treatment services demands research evidence. This study aimed to provide an overview of the patients’ preferences for antiretroviral therapy service delivery features. Methods Electronic databases (PubMed, Web of Science, Embase, and CINAHL) and search engines (Google and Google Scholar) were searched. This review has followed a convergent segregated approach to synthesis and integration. Data from the included studies were systematically extracted, tabulated, and summarised in a narrative review. Studies that analysed preferences for antiretroviral therapy regardless of the method used and published in the English language in any year across the world and HIV positive clients who were 15 years and above on 4th February 2021 were included for this review. The quality of the included studies was assessed using the mixed methods appraisal tool. A thematic synthesis of the data from the findings section of the main body of the qualitative study was undertaken. ATLAS.ti software version 7 was used for qualitative synthesis. Results From the 1054 retrieved studies, only 23 studies (16 quantitative, three qualitative, and four mixed-methods) fulfilled the inclusion criteria. The median number of attributes used in all included quantitative studies was 6 (Inter Quartile Range 3). In this review, no study has fulfilled the respective criteria in the methodological quality assessment. In the quantitative synthesis, the majority of participants more valued the outcome, whereas, in the qualitative synthesis, participants preferred more the structure aspect of antiretroviral therapy service. The thematic analysis produced 17 themes, of which ten themes were related to structure, three to process, and four to outcome dimension of Donabedian’s quality of care model. The findings from individual quantitative and qualitative syntheses complement each other. Conclusions In this review, participants’ value for antiretroviral therapy service characteristics varied across included studies. Priorities and values of people living with HIV should be incorporated in the policy, practice, research, and development efforts to improve the quality of antiretroviral therapy service hence avoid poor patient outcomes.

Patient experiences and preferences for antiretroviral therapy service provision: implications for differentiated service delivery in Northwest Ethiopia

“…Similarly, participants preferred either a free or subsidized cost of the visit including transportation and medications other than ARV drugs. This is consistent with a previous study [ 12 ]. This has policy implications for increased access to ART service to where people live and work as well as insurance coverage.…”

“…Our analysis followed a hybrid approach of inductive and deductive coding. Initial deductive coding was based on the fixed topics from the literature review [ 12 ], study objectives, and interview guide followed by an inductive, data-driven generation of new codes. Familiarization with the data was done by reading and rereading the transcripts followed by developing the codebook.…”

“…A meta-synthesis of global studies by Hall et al identified stigma and discrimination, fear of HIV status disclosure, task shifting to lay health workers, human resource and institutional challenges, mobile health, family and friend support, intensive case management, and relationships with caregivers as facilitators or barriers for retention in HIV care [ 11 ]. A systematic review of global studies by Belay et al found that patients preferred facility-based ART service over community service, shorter travel distance, reduced waiting time, less frequent clinic visits, good providers’ attitude, having shared decision making with providers, and individualized models [ 12 ].…”

eHealth supported multi-months dispensing of antiretroviral therapy: a mixed-methods preference assessment in rural Lesotho

“…Components of patient-centered care such as facilitated patient-provider communication, shared responsibility, and decision-making are among the key elements of eHealth interventions expected to contributing to favorable HIV outcomes [6, 20-23, 28, 29]. In line with other patient's preference assessments from similar settings, our eHealth supported MMD package revealed encouraged interaction between patients and nurses by telemedical support and stimulated patients' empowerment through direct SMS communication [25,27,[35][36][37][38][39][40][41][42]. In busy clinics, there is often neither privacy nor time for patients to bring up problems or concerns during the ART consultations.…”

Perspectives of people with HIV and HIV clinicians on characteristics of antiretroviral treatment and HIV‐related symptoms

“…Short‐term adverse events also scored high [20]. Some studies have found differences in the preferences of people living with HIV regarding ART service delivery features, such as a place for ART services, a person to deliver ART service, or visit frequency, among others [30]. Therefore, research should investigate the preferences of Spanish patients and the importance of individualizing treatment based on their needs and its impact on their well‐being.…”