Syringe Services Participants' Preferences for Wound Care, HIV/HCV Screening, and Opioid Use Disorder Treatment: A Discrete Choice Experiment.
Academic Article
Overview
abstract
OBJECTIVE: People who inject drugs (PWID) underutilize primary and preventive health services. To inform strategies for improving PWID healthcare engagement, we elicited PWID preferences for receiving wound care, HIV and hepatitis C virus (HCV) screening, and buprenorphine treatment for opioid use disorder using discrete choice experiments (DCEs). METHODS: We conducted DCEs with PWID at 14 syringe services programs (SSPs) in the United States. The DCEs presented 10 service-specific pairs of random combinations of care delivery attributes (e.g., location), with various levels (e.g., SSP, urgent care), with an opt-out alternative. Participants completed the HIV/HCV screening DCE if not seropositive , and the buprenorphine DCE if they self-reported buprenorphine treatment history or interest; all completed the wound care DCE. We identified latent classes and estimated measures of preference using multinomial logit. RESULTS: We selected three-group latent class solutions for each DCE. Across all services, participants valued shorter travel times, wait times, and waitlists; ≥1 group per DCE strongly preferred receiving services at SSPs. Wound care (n=546) groups differed by their strength of preferences for service location and care comprehensiveness. All HIV/HCV screening (n=403) groups preferred walk-in appointments and on-site fingerstick screening; groups differed by strength of preferences for locations and travel times. All buprenorphine (n=261) groups preferred less punitive consequences for positive urine toxicology results and differed by their preferences for locations. CONCLUSIONS: Most participants strongly preferred shorter travel times and wait times; for all services ≥1 group preferred SSP settings. By addressing PWID preferences, these findings can help improve healthcare engagement.
