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The role of material deprivations in determining ART adherence: Evidence from a conjoint analysis among HIV-positive adults in Uganda

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  • Uzaib Saya
  • Zachary Wagner
  • Barbara Mukasa
  • Peter Wabukala
  • Lillian Lunkuse
  • Sebastian Linnemayr

Abstract

Despite sustained global scale-up of antiretroviral therapy (ART), adherence to ART remains low. Less than half of those in HIV care in Uganda achieve 85% adherence to their ART medication required for clinically meaningful viral suppression, leaving them at higher risk of transmission. Key barriers to ART adherence include poverty-related structural barriers that are inter-connected and occur simultaneously, making it challenging to examine and disentangle them empirically and in turn design effective interventions. Many people living with HIV (PLWH) make tradeoffs between these various barriers (e.g., between expenses for food or transportation) and these can influence long-term health behavior such as adherence to ART. To be able to estimate the distinct influence of key structural barriers related to poverty, we administered a conjoint analysis (CA) to 320 HIV-positive adults currently taking ART at an urban clinic in Uganda between July 2019 and September 2020. We varied the levels of four poverty-related attributes (food security, sleep deprivation, monthly income, and physical pain) that occur simultaneously and asked respondents how they would adhere to their medication under different combinations of attribute levels. This allows us to disentangle the effect of each attribute from one another and to assess their relative importance. We used regression analysis to estimate the effects of each attribute level and found that food security impacts expected adherence the most (treatment effect = 1.3; 95% CI 1.11–1.49, p

Suggested Citation

  • Uzaib Saya & Zachary Wagner & Barbara Mukasa & Peter Wabukala & Lillian Lunkuse & Sebastian Linnemayr, 2022. "The role of material deprivations in determining ART adherence: Evidence from a conjoint analysis among HIV-positive adults in Uganda," PLOS Global Public Health, Public Library of Science, vol. 2(8), pages 1-20, August.
    • Handle: RePEc:plo:pgph00:0000374
    DOI: 10.1371/journal.pgph.0000374
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    References listed on IDEAS

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    1. Esther W. de Bekker‐Grob & Mandy Ryan & Karen Gerard, 2012. "Discrete choice experiments in health economics: a review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 21(2), pages 145-172, February.
    2. Hainmueller, Jens & Hopkins, Daniel J. & Yamamoto, Teppei, 2014. "Causal Inference in Conjoint Analysis: Understanding Multidimensional Choices via Stated Preference Experiments," Political Analysis, Cambridge University Press, vol. 22(1), pages 1-30, January.
    3. repec:plo:pmed00:1002183 is not listed on IDEAS
    4. Ingrid Eshun-Wilson & Anke Rohwer & Lynn Hendricks & Sandy Oliver & Paul Garner, 2019. "Being HIV positive and staying on antiretroviral therapy in Africa: A qualitative systematic review and theoretical model," PLOS ONE, Public Library of Science, vol. 14(1), pages 1-30, January.
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