Treatment preferences among people at risk of developing tuberculosis

A discrete choice experiment

Bibliographic Data

ID19590849
AuthorsWala Kamchedzera (0000-0002-6709-4270, University of Liverpool, corresponding author), Matthew Quaife (0000-0001-9291-1511, London School of Hygiene & Tropical Medicine, corresponding author), Wezi Msukwa-Panje (University of Liverpool, corresponding author), Rachael M Burke (0000-0002-2156-5030, London School of Hygiene & Tropical Medicine, corresponding author), Liana Macpherson (0000-0001-6025-0878, MRC Clinical Trials Unit at UCL, corresponding author), Moses Kumwenda (0000-0003-3091-7330, University of Liverpool, corresponding author), Hussein H Twabi (0000-0003-4473-296X, University of Liverpool, corresponding author), Matteo Quartagno (0000-0003-4446-0730, MRC Clinical Trials Unit at UCL, corresponding author), Peter MacPherson (0000-0002-0329-9613, University of Liverpool, corresponding author), Hanif Esmail (0000-0002-4278-9316, MRC Clinical Trials Unit at UCL, corresponding author)
EditorsHannah Hogan Leslie
Year2024
Volume4
Issue7
Pagese0002804
Publication date2024-07-19
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0002804
PMID39028696
OpenAlexW4400810859
LanguageEN
References cited32

Diagnosing and treating people with bacteriologically-negative but radiologically-apparent tuberculosis (TB) may contribute to more effective TB care and reduce transmission. However, optimal treatment approaches for this group are unknown. It is important to understand peoples’ preferences of treatment options for effective programmatic implementation of people-centred treatment approaches. We designed and implemented a discrete choice experiment (DCE) to solicit treatment preferences among adults (≥18 years) with TB symptoms attending a primary health clinic in Blantyre, Malawi. Treatment attributes included in the DCE were as follows: duration of treatment; number of tablets per dose; reduction in the risk of being unwell with TB disease; likelihood of infecting others; adverse effects from the treatment; frequency of follow up; and the annual travel cost to access care. Quantitative choice modelling with multinomial logit models estimated through frequentist and Bayesian approaches investigated preferences for the management of bacteriologically-negative, but radiographically-apparent TB. 128 participants were recruited (57% male, 43.8% HIV-positive, 8.6% previously treated for TB). Participants preferred to take any treatment compared to not taking treatment (odds ratio [OR] 5.78; 95% confidence interval [CI]: 2.40, 13.90). Treatments that reduced the relative risk of developing TB disease by 80% were preferred (OR: 2.97; 95% CI: 2.09, 4.21) compared to treatments that lead to a lower reduction in risk of 50%. However, there was no evidence for treatments that are 95% effective being preferred over those that are 80% effective. Participants strongly favoured the treatments that could completely stop transmission (OR: 7.87, 95% CI: 5.71, 10.84), and prioritised avoiding side effects (OR: 0.19, 95% CI: 0.12, 0.29). There was no evidence of an interaction between perceived TB disease risk and treatment preferences. In summary, participants were primarily concerned with the effectiveness of TB treatments and strongly preferred treatments that removed the risk of onward transmission. Person-centred approaches of preferences for treatment should be considered when designing new treatment strategies. Understanding treatment preferences will ensure that any recommended treatment for probable early TB disease is well accepted and utilized by the public

Confidence interval · Credible interval · Family medicine · Logistic regression · Multinomial logistic regression · Odds · Odds ratio · Pathology · Statistics · Tuberculosis · Demography · Health Systems, Economic Evaluations, Quality of Life · Medicine · Pharmaceutical studies and practices · Tuberculosis Research and Epidemiology · Internal Medicine · Pediatrics