Table 3 Expert panel’s comments and decisions on attributes and levels for antiretroviral therapy service in Northwest Ethiopia, 2022
Initial attribute name | Initial levels | Comments by experts | New attribute name | New levels |
|---|---|---|---|---|
1. Buddy system (others take drugs to home in place of a client) | Buddy system in place | The attribute was correlated with the ‘ART refill appointment’ and ‘location of ART refill’ attributes. Therefore, the attribute was dropped | Attribute dropped due to inter-attribute correlation | |
No buddy system in place | ||||
2. Participants/others seen at the same visit | Individual | The attribute was retained as it was salient. For easier understanding, the attribute name was changed to “ART refill appointment” The levels were realistic and understandable thereby their names were maintained as they are | ART refill appointment | Individual |
Group | Group | |||
3. Current ART packaging | Patients have privacy issue | The panel determined that given the era of global action to lessen HIV related stigma and discrimination, this attribute (visual identification, bulkiness, and the rattling noise produced by ART pill bottles) was not important to the enhancement of HIV services. Rather continued support, health education and counselling on matters related to stigma in HIV infected patients is critical as such information may influence individual behaviour (lessen anticipated HIV stigma) and improve patient adherence. The attribute was therefore eliminated because it was irrelevant to the decision context | Attribute dropped as it was not relevant to decision context | |
Patients have no privacy issue | ||||
4. ARV drug administration | Form of a liquid | This attribute was viewed to be non-plausible based on the current policy, technology and economic context of Ethiopia | Attribute dropped as it was not plausible to the Ethiopian context | |
Capsule | ||||
Injection | ||||
5. ART room labelling | Not branded as HIV clinic in any way | This attribute was viewed by the panel to be non-salient in the struggle against HIV stigma in HIV infected patients. Therefore, the attribute was dropped as it was not relevant to the decision context | Attribute dropped as it was not pertinent to decision context | |
Discretely branded as HIV clinic | ||||
Clearly branded as HIV clinic | ||||
6. Distance from residence to the clinic | 5 km | The attribute was highly correlated with the ‘Location of ART refill’ attribute. Therefore, the attribute was dropped | Attribute dropped due to inter-attribute correlation | |
10 km | ||||
20 km | ||||
7. Location of service delivery | Health facility/clinic close to home or workplace (10 min travel) | The attribute was viewed as salient to patients and providers. Location of service delivery was viewed as a complex word. Therefore, the attribute name was changed to “Location of ART refill”. The panel decided that the levels “Health facility/clinic close to home or workplace (10 min travel)” and “Health facility/clinic further from home or workplace (45 min travel)” needed to be simplified to be understandable to patients and providers | Location of ART refill | Health facility (health center, hospital) |
Health facility/clinic further from home or workplace (45 min travel) | Community | |||
Community-based service | Home | |||
At home | ||||
8. Preferences on involvement in treatment decision-making | Patient only | The panel decided that the current practice and policy recommendation is to have a shared decision making activity in a decision of healthcare condition including ART service. Therefore, the attribute was dropped as it was not relevant to the study objectives and decision context | The attribute was dropped due to its non-relevance to the study’s objective and decision context | |
Provider only | ||||
Patient and provider jointly | ||||
9. Type of service provider | Professional health worker who is respectful and understanding, or | The attribute was viewed as salient. Type of service provider was viewed as a complex word. Therefore, the attribute name was changed to “person providing ART refill” The levels were simplified by removing the words “respectful/not respectful”, “understanding/not understanding”. The level “peer/layperson” was replaced by the new level named as “Experienced HIV patient” | Person providing ART refill | Healthcare provider |
Professional health worker who is not respectful and understanding | Health extension worker | |||
Peer/layperson who is respectful and understanding | Experienced HIV patient | |||
Peer/layperson who is not respectful and understanding | ||||
10. Staff attitude | Nice | The attribute was highly correlated with the ‘Person providing ART refill’ attribute. Therefore, the attribute was dropped | Attribute dropped due to inter-attribute correlation | |
Rude | ||||
11. The spatial arrangement of the ART room | Separate building | This attribute was viewed by the panel to be non-salient to the HIV service improvement in the era of global action to reduce HIV stigma and discrimination. Therefore, the attribute was dropped as it was not relevant to the decision context | Attribute dropped as it was not relevant to decision context | |
Building in connection with other service delivery rooms | ||||
12. Times (days and hours) of operation | Workweek only (standard hours: 8 am–4 pm) | The attribute was maintained as it was salient. To avoid ambiguity in the name of the attribute, the word “health facility” was added to the attribute name The levels were maintained in the same number but the wordings related to the beginning and ending of health facility operation were slightly modified | Time of health facility operation (hours and days) | Monday–Friday only (8:30 am–5:30 pm) |
Workweek with early morning hours (opens at 5 am) | Monday–Friday (8:30 am–5:30 pm) plus early morning hours (opens at 6 am) | |||
Workweek with evening hours (open until 8 pm) | Monday–Friday (8:30 am–5:30 pm) plus evening hours (open until 8 pm) | |||
Workweek + weekend hours (7 days a week, 8 am–4 pm) | Monday–Friday (8:30 am–5:30 pm) plus Saturday and Sunday | |||
13. Time spent at clinics in ART pick ups | 1 h total, or | The attribute was highly correlated with the ‘location of ART refill’ attribute. Therefore, the attribute was dropped | Attribute dropped due to inter-attribute correlation | |
3 h total | ||||
6 h total | ||||
14. Time spent seeing healthcare provider | 1 h total, 3 h total, or 5 h total | The attribute was highly correlated with the ‘person providing ART refill’ attribute. Therefore, the attribute was dropped | Attribute dropped due to inter-attribute correlation | |
15. The total cost of the visit including transportation, direct medical costs (e.g., consultation or booking fee, lab costs if not available at a public facility, non-ARV drug costs), costs of childcare | Free | The attribute name was retained as it was salient and would enable calculation of marginal willingness to pay estimates The levels were reduced to three. The levels “50 Birr” and “150 Birr” were merged to bring a new level “250 Birr” considering for realistic application to policy in ART service. The currency was in Ethiopian Birr. The base level was set to “Free”. The levels were plausible and capable of being traded | Total cost, including transportation, direct medical costs (e.g., non-ARV drug costs) | Free |
50 Birr | 250 Birr | |||
150 Birr | 500 Birr | |||
500 Birr | ||||
16. Frequency of receiving ART refills | 6 months | The attribute name was maintained as it was salient. The levels “3 months” and “6 months” were retained with slight modification as “every 3 months” and “every 6 months” to be understandable by respondents. The level “yearly” was viewed as far apart. Therefore, the level was dropped. A new level “monthly” was added to make the preference evaluation more realistic | Frequency of receiving ART refills | Monthly |
3 months | Every 3 months | |||
Yearly | Every 6 months | |||
17. ARV drug efficacy | Efficacious | This attribute was viewed by the panel to be more of a drug development issue rather than ART service attribute. Therefore, the attribute was dropped as it was not relevant to the decision context | Attribute dropped as it was not relevant to decision context | |
Less efficacious | ||||
18. Side and or long-term effects | No effects | The panel felt that this attribute was more of a drug development concern than an ART service characteristic. The attribute was therefore eliminated because it was non-relevant to the decision context | Attribute dropped as it was not relevant to decision context | |
Reduced effects | ||||
Moderate to severe effects | ||||
19. Drug–drug interaction | No interaction | This attribute was viewed by the panel to be more of a drug development issue rather than ART service attribute. Therefore, the attribute was dropped as it was not relevant to the decision context | Attribute dropped as it was not relevant to decision context | |
Reduced interaction | ||||
20. Convenience of drug swallowing with social life, food requirement, time in taking drugs, and child care activity | Convenient | The panel felt that this attribute was more of a drug development concern than an ART service characteristic. The attribute was therefore eliminated because it was non-relevant to the decision context | Attribute dropped as it was not relevant to decision context | |
Inconvenient | ||||
21. Novel ART delivery methods (including coformulation of ARV with chronic diseases drugs and injectable drug options) | Needed by patients | This attribute was viewed by the panel to be more of a drug development issue rather than ART service attribute. Therefore, the attribute was dropped as it was not relevant to the decision context | Attribute dropped as it was not relevant to decision context | |
Not needed by patients | ||||
22. Source of information on ART | Healthcare providers | The attribute was viewed as non-salient to policy and decision making in the context of ART service as multiple source of information are required to better assist people living with HIV/AIDS. Hence, the attribute was dropped as it was not relevant to the decision context | Attribute dropped as it was not relevant to decision context | |
Media | ||||
23. ARV drug pill burden | No burden | The panel decided that ARV drug pill burden is not an issue in today’s world as drugs are available in combined fixed dose. The attribute therefore was dropped as it was not relevant to the decision context | Attribute dropped as it was not relevant to decision context | |
Minimal burden | ||||
Large pill burden | ||||