Qualitative evaluation of survey questions to assess treatment preference for daily oral or long‑acting injectable antiretroviral therapy among people living with HIV

Treatment of HIV has historically required taking daily oral antiretroviral therapy (ART). A recent alternative to daily oral ART is long-acting injectable ART with cabotegravir plus rilpivirine, administered monthly or every 2 months. The purpose of this qualitative study was to evaluate the concept relevance and interpretability of five previously developed questions: one treatment preference question and four questions designed to assess how the emotional burden associated with HIV treatment impacts treatment preferences. Thirty adults in the United States currently receiving HIV treatment were enrolled in a cross-sectional study involving one-on-one concept confirmation and cognitive debriefing interviews. Concept confirmation interviews included topics, questions, and probes designed to elicit information about the emotional burden of HIV and current perceptions of a participant's treatment regimen. Cognitive debriefing assessed the relevance and clarity of instructions, questions, response options, and recall periods. Transcripts were analyzed with MAXQDA. Mean age of participants was 49 years (range: 29-68), with 60% being male and 40% female. Racial demographics included Blacks (40%), Whites (40%), and other (20%). During concept confirmation, participants endorsed concepts relevant to HIV treatment preference: fear of disclosure of HIV status (47%), forgetting to take daily oral medication (40%), and current treatment regimen as a bothersome daily reminder of HIV status (40%). During cognitive debriefing, participants interpreted the instructions, question, response options, and recall periods as intended for the treatment preference question. Additionally, participants confirmed that the preference question's response options were appropriate and relevant to the experiences of people living with HIV. Participants also consistently interpreted the questions related to fear of disclosure of HIV status, anxiety associated with forgetting to take HIV medication, and HIV medication being an uncomfortable reminder of HIV status; however, participants provided variable responses to the question designed to assess treatment ease of use. These results support the concept relevance and interpretability of the single treatment preference question and three of the four emotional well-being questions among adults living with HIV.