OBJECTIVES: To explore pulmonary TB patients' preferences for better TB care using Discrete Choice Experiment

METHODS: Using the results of a review of published literature and conducting qualitative patient interviews, we designed a discrete choice experiment (DCE). The choice experiment was completed by 133 participants aged 18 years or above with pulmonary TB. Participants were recruited from 20 public TB treatment centers in Chitwan between December 2022 and February 2023. The DCE study included six characteristics (attributes) of TB care (patient card, sex of healthcare provider, provision of transportation incentives, provision of psychosocial support, waiting time, and types of TB care provider). In 24 choice tasks, participants selected their preferred option from 2 hypothetical care models. As part of the study, participants' socio-demographic characteristics including their health status, such as smoking and HIV status, were also collected. The analysis used McFadden's conditional logit regression model to quantify the individual preference utility associated with each attribute.

RESULTS: Among 133 patients who participated in DCE (97% response rate, mean age of 47 years, 71% male), 83% had pulmonary bacteriologically confirmed (PBC) TB, and 32% were in the intensive phase of treatment. Patient card with instructions, provision of psychosocial support, and waiting time were the significant attributes associated with TB care. Patients highly valued TB care services that have the provision of psychosocial support (β=0.621, p<0.001), followed by improved patient card (β=0.497, p<0.001), and the waiting time for TB care within half an hour (β=0.251, p=0.002).

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