| Titre : | “When to treat” in people living with hepatitis B in Africa: a discrete choice experiment assessing health worker preference |
| Auteurs : | Rewhandamzi Boms ; Ecole des hautes études en santé publique (EHESP) (Rennes, FRA) ; Institut Pasteur. Paris. FRA |
| Type de document : | Mémoire |
| Année de publication : | 2024 |
| Description : | 38p. / fig., tabl. |
| Langues: | Anglais |
| Classement : | MPH/ (Mémoires MPH à partir de 2024) |
| Mots-clés : | Hépatite virale B ; Afrique ; Charge virale ; Thérapeutique ; Observance thérapeutique ; Médicament antiviral |
| Résumé : |
Background: Chronic HBV infection presents silently with no noticeable symptoms and can take decades to lead to complications like hepatocellular carcinoma. Guidelines recommend identifying individuals at high risk and providing them with antiviral therapy. This study assessed health workers’ preferences regarding when to recommend initiating antiviral therapy for people with chronic HBV infection in Africa.
Objectives: To evaluate stated treatment preference, treatment eagerness, and predict acceptance of specific treatment profiles. Method: A single profile discrete choice experiment (DCE) was conducted among African healthcare workers (HCWs) using an online questionnaire survey. The DCE included the following attributes; benefit (number needed to treat, NNT), duration, out-of-pocket costs, and safety. We quantified the utility gain or loss generated by each attribute using a binary logistic model, evaluated treatment eagerness via a choice certainty scale with linear regression, and modeled predicted acceptance of specific treatment profiles. Results: Increase in levels of NNT, treatment duration, cost, and safety all generated significant disutility. The effect size of the highest attribute level relative to the reference was in the order: cost (OR 0.02, 95%CI [0.01; 0.03]), benefit (OR 0.07, 95%CI [0.04; 0.10]), duration (OR 0.35, 95%CI [0.19; 0.35]), safety (OR 0.34, 95%CI [0.26; 0.44]). Attributes’impact on treatment eagerness was similar. 30% of rational participants were pro-treat-all, comprising mainly midwives and public health practitioners. 90% of HCWs will recommend treatment at a monthly cost of up to 100 USD for a benefit of 8 NNT if treatment duration is one year with rare adverse events. Conclusion: Out-of-pocket costs, treatment benefits, duration, and safety significantly influence HCWs recommendations for initiating antiviral therapy, with out-of-pocket medication cost being the most influential factor. |
| Diplôme : | Master MPH of public health |
| Plan de classement simplifié : | Master of Public Health - master international de Santé Publique (MPH) |
| En ligne : | https://documentation.ehesp.fr/memoires/2024/mph/rewhandamzi_boms.pdf |
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