HIV Treatment and Program Preferences Among Ryan White Clients in New York City in the Era of Long-Acting Injectable ART - Abstract

Q: What was the study’s main goal regarding HIV treatment options?

To identify preferences for daily pill versus long-acting injectable (LAI) ART and preferences for specific treatment package features among Ryan White Medical Case Management clients.

Q: How were participant preferences measured?

Using a discrete choice experiment (DCE) with four attributes, analyzed via latent class multinomial logit to estimate preferences and explore preference heterogeneity.

Q: What did the results show about preference for LAI compared with daily pills?

A majority of participants preferred LAI regimens over daily pills. Preferences for service location/mode, supports, and rewards were similar across the latent classes.

Q: Why do the authors conclude that education and decision tools are needed?

Because clients showed limited self-reported experience with LAI ART and heterogeneous but distinct regimen-type preferences, indicating the need to support informed regimen selection and implementation.

Sep 14, 2026

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Preference for long-acting injectable (LAI) versus daily pill antiretroviral therapy (ART) was investigated among people with HIV (PWH) enrolled in Ryan White HIV/AIDS Program Part A Medical Case Management programs in New York City and surrounding eligible counties. A discrete choice experiment (DCE) assessed ART medication type alongside service location/mode, support, and rewards. Latent class multinomial logit identified distinct preference groups, with most participants preferring LAI regimens. Those preferring LAI ART were younger and showed higher familiarity with LAI treatment. The study highlights limited awareness among clients and informs patient education and decision-support tools for real-world, equitable implementation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages27

Reading Time1 h 8 min

AccessFree to download

Introduction

Methods

Results

Conclusions

medRxiv preprint doi: [https://doi.org/10.64898/2026.02.13.26346257](https://doi.org/10.64898/2026.02.13.26346257); this version posted February 16, 2026. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . HIV Treatment and Program Preferences Among Ryan White Clients in New York City in the Era of Long-Acting Injectable ART: A Discrete Choice Experiment Rebecca Zimba 1,2,* , Elizabeth A. Kelvin 1,2 , Sarah Kulkarni1 , Jennifer Carmona3 , Tigran Avoundjian 1,4 , Connor Emmert4 , Meghan Peterson4 , Mary Irvine4 , Denis Nash 1,2 Affiliations 1. Institute for Implementation Science in Population Health, City University of New York, Graduate School of Public Health and Health Policy, New York, NY 2. Department of Epidemiology and Biostatistics, City University of New York, Graduate School of Public Health and Health Policy, New York, NY 3. Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY 4. Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, Queens, NY *Corresponding author: Rebecca Zimba, [rebecca.zimba@sph.cuny.edu](rebecca.zimba@sph.cuny.edu) Keywords: HIV, antiretroviral therapy, long-acting injectable, medical case management, discrete choice experiment, New York City Abstract Introduction Despite improvements in treatment for people living with HIV (PWH), adherence remains a challenge for many. In this study we aimed to identify preferences for daily pill or long-acting injectable (LAI) antiretroviral therapy (ART) and for possible treatment package features, among PWH enrolled in Ryan White HIV/AIDS Program Part A (RWPA) Medical Case Management (MCM) programs. Methods Participants were recruited from six MCM programs from across the New York RWPA eligible metropolitan area (the five boroughs of New York City and Rockland, Putman, and Westchester counties) . We developed a discrete choice experiment (DCE) with four attributes: (1) Type of ART Medication (daily pills or LAI), (2) Service Location and Mode, (3) Support, and (4) Rewards. We used an alternative-specific design in which the levels for the last three attributes were dependent on levels within the first (Type of ART) . Latent class multinomial logit analysis (LCA) was used for preference estimation and hypothesis-free investigation of preference heterogeneity. Results From June 2022 through January 2023, 200 New York RWPA MCM clients completed the DCE. We selected a two-group LCA solution. A majority of participants had a higher preference for LAI regimens compared to daily pills (n=114 [57%] versus n=86 [43%]) . Those who preferred LAI ART were younger (median age 49 versus 58.5 years, p<0 .001), less likely to identify as straight/heterosexual (69% versus 82%, p=0 .03), and more likely to identify as Latino/a (54% versus 30%; p<0 .001) . Preferences for service locations/mode, supports, and rewards were similar across LCA groups. Participants who preferred LAI ART were more likely to have heard of LAI ART before the survey (59% versus 41%, p=0 .012) . Overall, only 4% of participants self-reported having tried LAI ART. Conclusions Assessing preferences among groups under-represented in clinical trials is essential to effective and equitable real-world implementation of innovative treatment options. Our study found that there were distinct groups that differed in their preferred ART regimen type and that New York RWPA MCM clients had limited familiarity with LAI ART. To inform regimen selection, we began pilot-testing educational materials and a patient-provider decision-making tool in 2023. 1 NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical pra

FAQs

What was the study’s main goal regarding HIV treatment options?

To identify preferences for daily pill versus long-acting injectable (LAI) ART and preferences for specific treatment package features among Ryan White Medical Case Management clients.

How were participant preferences measured?

Using a discrete choice experiment (DCE) with four attributes, analyzed via latent class multinomial logit to estimate preferences and explore preference heterogeneity.

What did the results show about preference for LAI compared with daily pills?

A majority of participants preferred LAI regimens over daily pills. Preferences for service location/mode, supports, and rewards were similar across the latent classes.

Why do the authors conclude that education and decision tools are needed?

Because clients showed limited self-reported experience with LAI ART and heterogeneous but distinct regimen-type preferences, indicating the need to support informed regimen selection and implementation.

Sep 14, 2026

Upload by Liam