IDEAS home Printed from https://ideas.repec.org/a/plo/pgph00/0000374.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000374
    Download Restriction: no
    File URL: https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0000374&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pgph.0000374?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    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.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Lisanne de Blok & Max Heermann & Julian Schuessler & Dirk Leuffen & Catherine E. de Vries, 2024. "All on board? The role of institutional design for public support for differentiated integration," European Union Politics, , vol. 25(3), pages 593-604, September.
    2. Chavez, Daniel E. & Palma, Marco A. & Nayga, Rodolfo M. & Mjelde, James W., 2020. "Product availability in discrete choice experiments with private goods," Journal of choice modelling, Elsevier, vol. 36(C).
    3. Chaikaew, Pasicha & Hodges, Alan W. & Grunwald, Sabine, 2017. "Estimating the value of ecosystem services in a mixed-use watershed: A choice experiment approach," Ecosystem Services, Elsevier, vol. 23(C), pages 228-237.
    4. Mahieu, Pierre-Alexandre & Andersson, Henrik & Beaumais, Olivier & Crastes dit Sourd, Romain & Hess, François-Charles & Wolff, François-Charles, 2017. "Stated preferences: a unique database composed of 1657 recent published articles in journals related to agriculture, environment, or health," Review of Agricultural, Food and Environmental Studies, Institut National de la Recherche Agronomique (INRA), vol. 98(3), November.
    5. Henrik Serup Christensen & Lauri Rapeli, 2021. "Immediate rewards or delayed gratification? A conjoint survey experiment of the public’s policy preferences," Policy Sciences, Springer;Society of Policy Sciences, vol. 54(1), pages 63-94, March.
    6. Jennifer A Whitty & Simon Stewart & Melinda J Carrington & Alicia Calderone & Thomas Marwick & John D Horowitz & Henry Krum & Patricia M Davidson & Peter S Macdonald & Christopher Reid & Paul A Scuffh, 2013. "Patient Preferences and Willingness-To-Pay for a Home or Clinic Based Program of Chronic Heart Failure Management: Findings from the Which? Trial," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-8, March.
    7. Okada, Isamu, 2024. "What procedures matter to social acceptance of mining? A conjoint experiment in Peru," World Development, Elsevier, vol. 183(C).
    8. Nikita Arora & Matthew Quaife & Kara Hanson & Mylene Lagarde & Dorka Woldesenbet & Abiy Seifu & Romain Crastes dit Sourd, 2022. "Discrete choice analysis of health worker job preferences in Ethiopia: Separating attribute non‐attendance from taste heterogeneity," Health Economics, John Wiley & Sons, Ltd., vol. 31(5), pages 806-819, May.
    9. Chen, Gang & Ratcliffe, Julie & Milte, Rachel & Khadka, Jyoti & Kaambwa, Billingsley, 2021. "Quality of care experience in aged care: An Australia-Wide discrete choice experiment to elicit preference weights," Social Science & Medicine, Elsevier, vol. 289(C).
    10. Wietzke, Frank-Borge, 2024. "Perceptions of social class in Africa. Results from a conjoint experiment," World Development, Elsevier, vol. 178(C).
    11. Robert Kubinec, 2018. "Patrons or Clients? Measuring and Experimentally Evaluating Political Connections of Firms in Morocco and Jordan," Working Papers 1280, Economic Research Forum, revised 26 Dec 2018.
    12. Heap, Shaun P. Hargreaves & Koop, Christel & Matakos, Konstantinos & Unan, Asli & Weber, Nina Sophie, 2021. "We Cannot Disagree Forever! Reality Polarization and Citizens’ Post-Pandemic Fiscal Adjustment Preferences," SocArXiv 69tup, Center for Open Science.
    13. E. Keith Smith & Dennis Kolcava & Thomas Bernauer, 2024. "Stringent sustainability regulations for global supply chains are supported across middle-income democracies," Nature Communications, Nature, vol. 15(1), pages 1-12, December.
    14. Vrânceanu, Alina & Dinas, Elias & Heidland, Tobias & Ruhs, Martin, 2023. "The European refugee crisis and public support for the externalisation of migration management," Open Access Publications from Kiel Institute for the World Economy 279441, Kiel Institute for the World Economy (IfW Kiel).
    15. Catherine L. Kling & Daniel J. Phaneuf & Jinhua Zhao, 2012. "From Exxon to BP: Has Some Number Become Better Than No Number?," Journal of Economic Perspectives, American Economic Association, vol. 26(4), pages 3-26, Fall.
    16. Beber, Bernd & Ebert, Cara & Sievert, Maximiliane, 2024. "Is intent to migrate irregularly responsive to recent German asylum policy adjustments?," Ruhr Economic Papers 1071, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    17. John Buckell & Vrinda Vasavada & Sarah Wordsworth & Dean A. Regier & Matthew Quaife, 2022. "Utility maximization versus regret minimization in health choice behavior: Evidence from four datasets," Health Economics, John Wiley & Sons, Ltd., vol. 31(2), pages 363-381, February.
    18. Dunsch, Felipe Alexander & Velenyi, Edit, 2019. "Job Preferences of Frontline Health Workers in Ghana - A Discrete Choice Experiment," SocArXiv bqx5k, Center for Open Science.
    19. Lichtin, Florian & Smith, E. Keith & Axhausen, Kay W. & Bernauer, Thomas, 2024. "“How much should public transport services be expanded, and who should pay? Experimental evidence from Switzerland”," Transport Policy, Elsevier, vol. 158(C), pages 64-74.
    20. Brouwers, Jonas & Cox, Bianca & Van Wilder, Astrid & Claessens, Fien & Bruyneel, Luk & De Ridder, Dirk & Eeckloo, Kristof & Vanhaecht, Kris, 2021. "The future of hospital quality of care policy: A multi-stakeholder discrete choice experiment in Flanders, Belgium," Health Policy, Elsevier, vol. 125(12), pages 1565-1573.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pgph00:0000374. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: globalpubhealth (email available below). General contact details of provider: https://journals.plos.org/globalpublichealth .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.