Preferences for long-acting antiretroviral therapy among people with HIV: A systematic review of discrete choice experiments.

BACKGROUND

Long-acting antiretroviral therapy (LA-ART) is emerging as a promising strategy to enhance treatment satisfaction and improve the quality of life for people living with HIV (PLWH). A comprehensive understanding of treatment preferences is essential for effectively addressing the needs and expectations of PLWH.

OBJECTIVE

This review intends to delineate and assess the evidence gathered from discrete choice experiments, aiming to unravel the preferences of PLWHs towards LA-ART.

DATA SOURCE: PubMed, Web of Science, Cochrane Library, APA PsychInfo, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) are the data sources.

METHODS

A comprehensive literature search was performed in six databases from inception to 4 January 2026. The PREFS (Purpose, Respondents, Explanation, Findings, Significance) and the International Society for Pharmacoeconomics and Outcomes Research checklist were used to evaluate the quality of the included studies. Data were synthesized narratively. Thematic analysis was applied to categorize attributes into groups. Frequency, significance, relative importance and willingness-to-pay were analysed.

RESULTS

Ten studies from six countries were included. In total, 62 individual attributes were extracted and grouped into three broad categories and eight sub-categories. Among the two studies that included cost, cost ranked highest. Preferences also vary among LA-ARTs at different stages of technical maturity and among PLWH with differing characteristics.

CONCLUSION

In high-income country settings, cost and administration regimens are significant factors influencing PLWH preferences for LA-ART. However, the importance of cost depends on the specific context: it presents a direct barrier in systems with patient co-payments but is less pronounced in publicly funded treatment systems. Current evidence base originates exclusively from high-income countries, limiting the generalizability of these findings to low- and middle-income nations where diverse healthcare system constraints are more prevalent.

REGISTRATION: The protocol for this study was registered with PROSPERO (registration number: CRD420251149075).