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Optimizing Differentiated HIV Treatment Models in Urban Zimbabwe: Assessing Patient Preferences Using a Discrete Choice Experiment

  • Strauss, Michael1
  • George, Gavin1
  • Mantell, Joanne E.2
  • Mapingure, Munyaradzi3
  • Masvawure, Tsitsi B.4
  • Lamb, Matthew R.5, 6
  • Zech, Jennifer M.5
  • Musuka, Godfrey3
  • Chingombe, Innocent3
  • Msukwa, Martin7
  • Boccanera, Rodrigo8
  • Gwanzura, Clorata9
  • Apollo, Tsitsi9
  • Rabkin, Miriam5, 6
  • 1 University of KwaZulu Natal,
  • 2 The New York State Psychiatric Institute and Columbia University Irving Medical Center,
  • 3 ICAP at Columbia University, Harare, Zimbabwe
  • 4 College of the Holy Cross,
  • 5 ICAP at Columbia University,
  • 6 Columbia University Mailman School of Public Health,
  • 7 ICAP at Columbia University, Pretoria, South Africa
  • 8 Health Resources and Services Administration (HRSA),
  • 9 Ministry of Health and Child Care,
Published Article
AIDS and Behavior
Publication Date
Aug 18, 2020
DOI: 10.1007/s10461-020-02994-z
PMID: 32812124
PMCID: PMC7846512
PubMed Central
  • Original Paper


Differentiated service delivery holds great promise for streamlining the delivery of health services for HIV. This study used a discrete choice experiment to assess preferences for differentiated HIV treatment delivery model characteristics among 500 virally suppressed adults on antiretroviral therapy in Harare, Zimbabwe. Treatment model characteristics included location, consultation type, healthcare worker cadre, operation times, visit frequency and duration, and cost. A mixed effects logit model was used for parameter estimates to identify potential preference heterogeneity among participants, and interaction effects were estimated for sex and age as potential sources of divergence in preferences. Results indicated that participants preferred health facility-based services, less frequent visits, individual consultations, shorter waiting times, lower cost and, delivered by respectful and understanding healthcare workers. Some preference heterogeneity was found, particularly for location of service delivery and group vs. individual models; however, this was not fully explained by sex and age characteristics of participants. In urban areas, facility-based models, such as the Fast Track model requiring less frequent clinic visits, are likely to better align with patient preferences than some of the other community-based or group models that have been implemented. As Zimbabwe scales up differentiated treatment models for stable patients, a clear understanding of patient preferences can help in designing services that will ensure optimal utilization and improve the efficiency of service delivery. Electronic supplementary material The online version of this article (10.1007/s10461-020-02994-z) contains supplementary material, which is available to authorized users.

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