Time Preferences Predict Mortality among HIV-Infected Adults Receiving Antiretroviral Therapy in Kenya
BACKGROUND:
Identifying
characteristics of HIV-infected adults likely to have poor treatment outcomes
can be useful for targeting interventions efficiently. Research in economics
and psychology suggests that individuals' intertemporal time preferences, which
indicate the extent to which they trade-off immediate vs. future cost and
benefits, can influence various health behaviors. While there is empirical
support for the association between time preferences and various non-HIV health
behaviors and outcomes, the extent to which time preferences predict outcomes
of those receiving antiretroviral therapy (ART) has not been examined
previously.
METHODS:
HIV-infected
adults initiating ART were enrolled at a health facility in Kenya.
Participants' time preferences were measured at enrollment and used to classify
them as having either a low or high discount rate for future benefits. At 48
weeks, we assessed mortality and ART adherence, as measured by Medication Event
Monitoring System (MEMS). Logistic regression models adjusting for
socio-economic characteristics and risk factors were used to determine the
association between time preferences and mortality as well as MEMS adherence
≥90%.
RESULTS:
Overall,
44% (96/220) of participants were classified as having high discount rates.
Participants with high discount rates had significantly higher 48-week
mortality than participants with low discount rates (9.3% vs. 3.1%; adjusted
odds ratio 3.84; 95% CI 1.03, 14.50). MEMS adherence ≥90% was similar for
participants with high vs. low discount rates (42.3% vs. 49.6%, AOR 0.70; 95%
CI 0.40, 1.25).
CONCLUSION:
High
discount rates were associated with significantly higher risk of mortality
among HIV-infected patients initiating ART. Greater use of time preference
measures may improve identification of patients at risk of poor clinical
outcomes. More research is needed to further identify mechanisms of action and
also to build upon and test the generalizability of this finding.
Below: Association between time preferences, mortality, and MEMS adherence
- 1Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
- 2Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
- 3Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
- 4RAND Corporation, Santa Monica, CA, United States of America.
- 5Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States of America.
- 6Academic Model Providing Access to Healthcare, Eldoret, Kenya.
- 7Department of Psychology, University of Iowa, Iowa City, IA, United States of America.
- 8Center for Global Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
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