Adaptation and pilot testing of a discrete choice experiment and survey on patient preferences for long-acting antiretroviral therapies for HIV in Kenya

Long-acting antiretroviral therapy (LA-ART) could increase viral suppression among people living with HIV (PLWH) by promoting ART uptake and adherence. We adapted and pilot-tested a discrete-choice experiment (DCE) and an associated survey that were previously implemented in the United States, based on key informant interviews with Kenyan HIV experts and research team discussion about changes needed for the Kenyan context. We conducted five waves of pilot-testing, each with 9-11 PLWH receiving care at the Kenyatta National Hospital Comprehensive Care Clinic, iteratively updating the DCE (which elicited participant preferences) and the survey (which collected data on participant characteristics) as required. We enrolled 50 participants (median age 36, 56% male) between May and November 2022. Overall understanding of the DCE instructions and choice tasks was good, with the majority needing no assistance and most others needing minimal assistance. Most edits made during pilot testing were to questions in the survey rather than the DCE text or design. Preliminary results assessed using conditional logistic regression were similar to results of the US DCE: Across all participants, LA-ART alternatives were preferred over current daily oral ART, with the strongest preference for a long-acting oral pill. Full implementation with 700 participants is underway.