Comparing Client and Provider Preferences for HIV Care Coordination Program Features using Discrete Choice Experiments
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Introduction
The New York City (NYC) HIV Care Coordination Program (CCP) is designed to promote care engagement and treatment adherence among the people with HIV (PWH) who struggle the most with these key components of managing their health. We assessed preferences for CCP components among PWH enrolled in the program (“clients”) and among providers of CCP services. In this report we compare the preferences between clients and providers, previously analyzed separately.
Methods
We used a discrete choice experiment to assess preferences for four CCP features (“attributes”): Help with Adherence to Antiretroviral Therapy (ART), Help with Primary Care Appointments, Help with Issues other than Primary Care, and Where Program Visits Happen. Each of these attributes had three to four variants (“levels”). In the original surveys, levels within Where Program Visits Happen varied by participant type (client versus provider). We re-coded the levels by visit location (VL) or by travel time (TT) to make them comparable, and report results from both approaches. Preferences were quantified using the relative importance of the attributes and utility of the levels.
Results
January 2020 to March 2021, 152 providers and 181 clients completed the survey. In both the VL and TT analyses, clients were most influenced by Help with Adherence to ART, preferring medication reminders via phone or text, and Where Program Visits Happen, preferring visits via phone or video chat. In the VL analysis, providers were most influenced by Help with Adherence to ART, valuing directly observed therapy most highly, and Help with Issues other than Primary Care, valuing helping clients with connections to specialty medical care. In the TT analysis, providers were most influenced by Where Program Visits Happen, preferring to meet at clients’ homes, and Help with Issues other than Primary Care, again preferring helping clients make connections to specialty medical care.
Conclusions
Client and provider preferences clearly diverged with regard to CCP service intensity: in the aggregate, clients tended to prefer lower-intensity services, whereas providers endorsed higher-intensity services. These results highlight the importance of engaging clients as partners in decisions about program services so that they are aligned with client values.
