Abstract

Objectives

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 (eg, location), with various levels (eg, 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 3-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.