Tuberculosis Patients' Preferences for Improving Tuberculosis Care in Chitwan District, Nepal: A Discrete Choice Experiment.

OBJECTIVES

Patient-preferred tuberculosis (TB) care is integral for the patient-centric approach to TB care delivery. This study aimed to ascertain the aspects of TB care that people with TB value most, to inform improvements in TB care in Chitwan District, Nepal.

METHODS

A discrete choice experiment (DCE) survey was developed to elicit the care preferences of TB patients in Chitwan District. The DCE included 6 attributes (patient card, sex of healthcare worker, transport incentive, provision of psychosocial support, waiting time, and type of TB care provider), which were developed through literature review, expert consultations, and patient interviews. Participants were randomly selected from the TB care centers and interviewed face-to-face to complete the survey. Six choice sets were presented to each participant and asked to choose preferred option from 2 hypothetical TB care models labeled as TB Care A and TB Care B. A conditional logit regression model was used to quantify the preference of TB patients.

RESULTS

Among 133 patients who participated in DCE (97% response rate, mean age of 47 years, 71% male), 83% had pulmonary bacteriologically confirmed TB, and 32% were in the intensive phase of treatment. Patients highly valued TB care services that have the provision of psychosocial support (β = 0.62, P < .001), followed by improved patient card (β = 0.50, P < .001), and the waiting time for TB care within half an hour (β = 0.25, P = .002).

CONCLUSIONS

People with TB preferred to be supported by psychosocial interventions, improved patient card, and reduced waiting time in current TB treatment strategy. This study provides evidence for current/future TB control program package to align with the patient's preferences.