Biomedical subjects

Ron D Hays

Publications and source records attributed to Ron D Hays.

At least 91 records · Page 5Linked to original sources

PubMed2003

Psychometric properties of the Consumer Assessment of Health Plans Study (CAHPS) 2.0 adult core survey.

OBJECTIVE: To estimate the reliability and validity of survey measures used to evaluate health plans and providers from the consumer's perspective. DATA SOURCES: Members (166,074) of 306 U.S. health plans obtained from the National CAHPS Benchmarking Database 2.0, a voluntary effort in which sponsors of CAHPS surveys contribute data to a common repository. STUDY DESIGN: Members of privately insured health plans serving public and private employers across the United States were surveyed by mail and telephone. Interitem correlations and correlations of items with the composite scores were estimated. Plan-level and internal consistency reliability are estimated. Multivariate associations of composite measures with global ratings are also examined to assess construct validity. Confirmatory factor analysis is used to examine the factor structure of the measure. FINDINGS: Plan-level reliability of all CAHPS 2.0 reporting composites is high with the given sample sizes. Fewer than 170 responses per plan would achieve plan-level reliability of .70 for the five composites. Two of the composites display high internal consistency (Cronbach's alpha > or = .75), while responses to items in the other three composites were not as internally consistent (Cronbach's alpha from .58 to .62). A five-factor model representing the CAHPS 2.0 composites fits the data better than alternative two- and three-factor models. CONCLUSION: Two of the five CAHPS 2.0 reporting composites have high internal consistency and plan-level reliability. The other three summary measures were reliable at the plan level and approach acceptable levels of internal consistency. Some of the items that form the CAHPS 2.0 adult core survey, such as the measure of waiting times in the doctor's office, could be improved. The five-dimension model of consumer assessments best fits the data among the privately insured; therefore, consumer reports using CAHPS surveys should provide feedback using five composites.

Benchmarking↗

PubMed2003

Methodological challenges associated with patient responses to follow-up longitudinal surveys regarding quality of care.

OBJECTIVE: To illustrate, using empirical data, methodological challenges associated with patient responses to longitudinal surveys regarding the quality of process of care and health status, including overall response rate, differential response rate, and stability of responses with time. DATA SOURCES/STUDY SETTING: Primary patient self-report data were collected from 30,308 patients in 1996 and 13,438 patients in 1998 as part of a two-year longitudinal study of quality of care and health status of patients receiving care delivered by 63 physician organizations (physician groups) across three West Coast states. STUDY DESIGN: We analyzed longitudinal, observational data collected by Pacific Business Group on Health (PBGH) from patients aged 18-70 using a four-page survey in 1996 and a similar survey in 1998 to assess health status, satisfaction, use of services, and self-reported process of care. A subset of patients with self-reported chronic disease in the 1996 study received an enriched survey in 1998 to more fully detail processes of care for patients with chronic disease. DATA COLLECTION/EXTRACTION METHODS: We measured response rate overall and separately for patients with chronic disease. Logistic regression was used to assess the impact of 1996 predictors on response to the follow-up 1998 survey. We compared process of care scores without and with nonresponse weights. Additionally, we measured stability of patient responses over time using percent agreement and kappa statistics, and examined rates of gender inconsistencies reported across the 1996 and 1998 surveys. PRINCIPAL FINDINGS: In 1998, response rates were 54 percent overall and 63 percent for patients with chronic disease. Patient demographics, health status, use of services, and satisfaction with care in 1996 were all significant predictors of response in 1998, highlighting the importance of analytic strategies (i.e., application of nonresponse weights) to minimize bias in estimates of care and outcomes associated with longitudinal quality of care and health outcome analyses. Process of care scores weighted for nonresponse differed from unweighted scores (p<.001). Stability of responses across time was moderate, but varied by survey item from fair to excellent. CONCLUSIONS: Longitudinal analyses involving the collection of data from the same patients at two points in time provide opportunities for analysis of relationships between process and outcomes of care that cannot occur with cross-sectional data. We present empirical results documenting the scope of the problems and discuss options for responding to these challenges. With increasing emphasis in the United States on quality reporting and use of financial incentives for quality in the health care market, it is important to identify and address methodological challenges that potentially threaten the validity of quality-of-care assessments.

Adult↗

PubMed2003

The impact of HIV on oral health and subsequent use of dental services.

OBJECTIVE: This study examined differences in health and access to dental services among a nationally representative sample of patients with HIV using Andersen's Behavioral Model of Health Services Use. METHODS: This investigation is a longitudinal study that used structural equation modeling to analyze data from the HIV Cost and Services Utilization Study, a probability sample of 2,864 adults under treatment for HIV infection. Key predisposing variables included sex, drug use, race/ethnicity, education, and age. Enabling factors included income, insurance, and regular source of care. Need factors included mental, physical, and oral health. Dependent variables included whether a respondent utilized dental services and number of visits. RESULTS: More education, dental insurance, usual source of dental care, and poor oral health predicted a higher probability of having a dental visit. African Americans, Hispanics, those exposed to HIV through drug use or heterosexual contact, and those in poor physical health were less likely to have a dental visit. Of those who visited dental professionals, older persons, those with dental insurance, and those in worse oral health had more visits. African Americans and persons in poor mental health had fewer visits. CONCLUSIONS: Persons with more HIV-related symptoms and a diagnosis of AIDS have a greater need for dental care than those with fewer symptoms and without AIDS, but more pressing needs for physical and mental health services limit their access to dental services. Providers should better attend to the oral health needs of persons with HIV who are in poor physical and mental health.

Adolescent↗

PubMed2003

The tripartite model of anxiety and depression: symptom structure in depressive and hypertensive patient groups.

The structure of self-reported symptoms representative of the tripartite model was examined using data drawn from the Medical Outcomes Study (Tarlov et al., 1989). Participants were persons who had been diagnosed 48 months previously as suffering from either depression (N = 315) or hypertension (N = 403). Results of confirmatory factor analyses were broadly consistent with the tripartite model (L. A. Clark & Watson, 1991). Factors emerged corresponding to each of the 3 posited first-order dimensions of negative affect, positive affect, and physiologic arousal. Nonetheless, some discrepancies were found between the observed data and the hypothesized tripartite model. First, the obtained physiologic arousal factor was best viewed as reflecting nonspecific somatic distress rather than physiologic arousal. Finally, although differentiable in the strictest statistical sense, all three domains were significantly correlated (.36 to.86, absolute value). In particular, contrary to the tripartite model, positive and negative affect covaried markedly (-.81 to -.86). Findings raise issues concerning the utility of the tripartite model as a heuristic framework for enhancing understanding of individual differences in normal mood as well as mood disorders.

Adult↗

PubMed2002

Comparing the alcohol-related problems survey (ARPS) to traditional alcohol screening measures in elderly outpatients.

Older drinkers may incur alcohol-related risks at low consumption levels, but commonly used screening measures do not address alcohol's effects among persons with declining health and increased medication use. We compared the newly developed Alcohol-Related Problems Survey (ARPS) to three validated alcohol screens: the Cut down, Annoyed, Guilty, Eye-opener (CAGE), Short-Michigan Alcohol Screening Test (SMAST), and Alcohol-Use Identification Test (AUDIT). The ARPS classifies drinking as non-hazardous, hazardous or harmful. Non-hazardous drinking is defined as consumption with no known risks for adverse physical or psychological health events. Hazardous drinking is consumption with such risks. Harmful drinking results in adverse events. The AUDIT screens for hazardous and harmful drinking; the CAGE and SMAST identify abusive (e.g. failure to fulfill social obligations) and dependent (e.g. having withdrawal symptoms) drinkers. In this study of 574 current drinkers 65 years and older who completed the ARPS and AUDIT in primary care clinics, half were randomly assigned to complete the CAGE and half, the SMAST. Drinkers who screened positive on the CAGE, SMAST or AUDIT were correctly classified by the ARPS as hazardous or harmful drinkers 91, 75, and 100% of the time, respectively. The majority of ARPS-identified hazardous or harmful drinkers did not screen positive on the CAGE, SMAST or AUDIT. These drinkers had medical conditions or used medications that placed them at risk for adverse health events, none of which was addressed in these three screens. In this study, the ARPS identified nearly all drinkers detected by the CAGE, SMAST, and AUDIT and detected hazardous and harmful drinkers not identified by these measures.

Journal Article↗

PubMed2002

Effects of CAHPS health plan performance information on plan choices by New Jersey Medicaid beneficiaries.

OBJECTIVE: To assess the effects of CAHPS health plan performance information on plan choices and decision processes by New Jersey Medicaid beneficiaries. DATA SOURCES/STUDY SETTING: The study sample was a statewide sample of all new Medicaid cases that chose Medicaid health plans during April 1998. The study used state data on health maintenance organization (HMO) enrollments and survey data for a subset of these cases. STUDY DESIGN: An experimental design was used, with new Medicaid cases randomly assigned to experimental or control groups. The experimental group received a CAHPS report along with the standard enrollment materials, and the control group did not. DATA COLLECTION: The HMO enrollment data were obtained from the state in June 1998, and evaluation survey data were collected from July to October 1998. PRINCIPAL FINDINGS: No effects of CAHPS information on HMO choices were found for the total sample. Further examination revealed that only about half the Medicaid cases said they received and read the plan report and there was an HMO with dominant Medicaid market share but low CAHPS performance scores. The subset of cases who read the report and did not choose this dominant HMO chose HMOs with higher CAHPS scores, on average, than did those in an equivalent control group. CONCLUSIONS: Health plan performance information can influence plan choices by Medicaid beneficiaries, but will do so only if they actually read it. These findings suggest a need for enhancing dissemination of the information as well as further education to encourage informed choices.

Adult↗

PubMed2002

How well do clinicians estimate patients' adherence to combination antiretroviral therapy?

OBJECTIVE: Adherence to combination antiretroviral therapy is critical for clinical and virologic success in HIV-infected patients. To combat poor adherence, clinicians must identify nonadherent patients so they can implement interventions. However, little is known about the accuracy of these assessments. We sought to describe the accuracy of clinicians' estimates of patients' adherence to combination antiretroviral therapy. SETTING: Public HIV clinic. DESIGN: Prospective cohort study. During visits, we asked clinicians (nurse practitioners, residents and fellows, and their supervising attending physicians) to estimate the percentage of antiretroviral medication taken by patients over the last 4 weeks and predicted adherence over the next 4 weeks. Adherence was measured using electronic monitoring devices, pill counts, and self-reports, which were combined into a composite adherence measure. PATIENTS AND PARTICIPANTS: Clinicians estimated 464 episodes of adherence in 82 patients. RESULTS: Among the 464 adherence estimates, 264 (57%) were made by principal care providers (31% by nurse practitioners, 15% by fellows, 6% by residents, and 5% by staff physicians) and 200 (43%) by supervising attending physicians. Clinicians' overestimated measured adherence by 8.9% on average (86.2% vs 77.3%). Greater clinician inaccuracy in adherence prediction was independently associated with higher CD4 count nadir (1.8% greater inaccuracy for every 100 CD4 cells, P=.005), younger patient age (3.7% greater inaccuracy for each decade of age, P=.02), and visit number (P=.02). Sensitivity of detecting nonadherent patients was poor (24% to 62%, depending on nonadherence cutoff). The positive predictive value of identifying a patient as nonadherent was 76% to 83%. CONCLUSIONS: Clinicians tend to overestimate medication adherence, inadequately detect poor adherence, and may therefore miss important opportunities to intervene to improve antiretroviral adherence.

Adult↗

PubMed2002

A prospective study of predictors of adherence to combination antiretroviral medication.

OBJECTIVE: Adherence to complex antiretroviral therapy (ART) is critical for HIV treatment but difficult to achieve. The development of interventions to improve adherence requires detailed information regarding barriers to adherence. However, short follow-up and inadequate adherence measures have hampered such determinations. We sought to assess predictors of long-term (up to 1 year) adherence to newly initiated combination ART using an accurate, objective adherence measure. DESIGN: A prospective cohort study of 140 HIV-infected patients at a county hospital HIV clinic during the year following initiation of a new highly active ART regimen. MEASURES AND MAIN RESULTS: We measured adherence every 4 weeks, computing a composite score from electronic medication bottle caps, pill count and self-report. We evaluated patient demographic, biomedical, and psychosocial characteristics, features of the regimen, and relationship with one's HIV provider as predictors of adherence over 48 weeks. On average, subjects took 71% of prescribed doses with over 95% of patients achieving suboptimal (<95%) adherence. In multivariate analyses, African-American ethnicity, lower income and education, alcohol use, higher dose frequency, and fewer adherence aids (e.g., pillboxes, timers) were independently associated with worse adherence. After adjusting for demographic and clinical factors, those actively using drugs took 59% of doses versus 72% for nonusers, and those drinking alcohol took 66% of doses versus 74% for nondrinkers. Patients with more antiretroviral doses per day adhered less well. Participants using no adherence aids took 68% of doses versus 76% for those in the upper quartile of number of adherence aids used. CONCLUSIONS: Nearly all patients' adherence levels were suboptimal, demonstrating the critical need for programs to assist patients with medication taking. Interventions that assess and treat substance abuse and incorporate adherence aids may be particularly helpful and warrant further study.

Adult↗

PubMed2002

Seizure reduction and quality of life improvements in people with epilepsy.

PURPOSE: Previous research suggests that seizure freedom may be necessary to improve health-related quality of life (HRQOL) for epilepsy surgery patients, but little is known regarding the seizure-frequency reduction needed to improve HRQOL among medically treated individuals. METHODS: With data from 134 adults with refractory complex partial seizures participating in a randomized controlled antiepileptic drug (AED) trial, we compared the change in HRQOL across groups having different levels of change in seizure frequency: 100%, 75-99%, 50-74% reduction, and 0-50% increase or decrease. Changes over time within each seizure-reduction group also were assessed. HRQOL was measured by the QOLIE-31, QOLIE-89, and SF-36. RESULTS: Subjects who became seizure free reported significantly more positive change than those who did not on the QOLIE-31 and QOLIE-89 overall scores, the QOLIE-89 mental health, physical health, and epilepsy-targeted composites, as well as the SF-36 mental health summary score. Changes over time in overall QOLIE-31 and QOLIE-89 scores were significantly more positive for subjects who achieved seizure freedom (i.e., 100% reduction in seizure frequency) than for those who did not. No significant change in QOLIE-31 and QOLIE-89 overall scores was observed for subjects who did not achieve seizure freedom. CONCLUSIONS: In this study, HRQOL improvement occurred primarily among patients who achieved complete seizure freedom. Many AED trials use a 50% seizure-frequency reduction criterion as a trial end point, but measurable impacts of this degree of reduction in seizure frequency on HRQOL in this sample were not observed. These results further support striving for seizure freedom as an epilepsy care goal.

Adolescent↗

PubMed2002

The alcohol-related problems survey: identifying hazardous and harmful drinking in older primary care patients.

OBJECTIVES: Older adults can incur problems at low levels of alcohol consumption because of age-related physiological changes, declining health and functional status, and medication use. We have developed and tested a screening measure specifically for older people, the Alcohol-Related Problems Survey (ARPS), to identify older adults with these risks. DESIGN: Survey. SETTING: Academic and community primary care clinics. PARTICIPANTS: Five hundred forty-nine current drinkers aged 65 and older, mostly white with high school or more education. MEASURES: Alcohol use was classified as harmful, hazardous, or nonhazardous depending upon consumption alone or combined with selected comorbidities and medication use. Harmful drinking (including alcohol abuse or dependence) means the presence of problems (e.g., hypertension, adverse drug events, legal problems) due to drinking. Hazardous drinking means risks for problems are likely. Nonhazardous drinking poses no known risks for problems. RESULTS: Eleven percent of subjects were harmful drinkers and 35% were hazardous drinkers. Harmful drinking was more common in men than women and in persons younger than 75 than those aged 75 and older. Similar proportions of men and women and younger and older age groups were hazardous drinkers. Most harmful drinkers were identified by their use of alcohol with their comorbidity, whereas most hazardous drinkers were identified by their use of alcohol with medications. Test-retest reliability was substantial (kappa = 0.65). CONCLUSION: Physicians are urged to screen for alcohol-related problems in older persons. The ARPS reliably identifies harmful, hazardous, and nonhazardous drinking in older adults resulting most often from the interaction between alcohol and disease and medication use.

Age Factors↗

PubMed2002

Do older adults expect to age successfully? The association between expectations regarding aging and beliefs regarding healthcare seeking among older adults.

OBJECTIVES: To measure expectations regarding aging among community-residing-older adults, identify characteristics associated with having low expectations regarding aging, and examine whether expectations regarding aging are associated with healthcare-seeking beliefs for age-associated conditions. DESIGN: Self-administered mail survey. SETTING: Greater Los Angeles. PARTICIPANTS: Four hundred twenty-nine of 588 (73%) randomly selected community-residing adults aged 65 to 100 (mean age 76) cared for by 20 primary care physicians; 54% were women, and 76% were white. MEASUREMENTS: The Expectations Regarding Aging Survey, a validated survey measuring expectations regarding aging; 13 items measuring care seeking beliefs; and validated measures of health status. RESULTS: More than 50% of participants felt it was an expected part of aging to become depressed, to become more dependent, to have more aches and pains, to have less ability to have sex, and to have less energy. After adjusting for sociodemographic and health characteristics using multivariate regression, older age was independently associated with lower expectations regarding aging (P <.001), as was having lower physical and mental health-related quality of life. Having lower expectations regarding aging was independently associated with placing less importance on seeking health care (P =.049). CONCLUSIONS: Most older adults in this sample did not expect to achieve the model of successful aging in which high cognitive and physical functioning is maintained. Older age was independently associated with lower expectations regarding aging. Furthermore, having low expectations regarding aging was independently associated with not believing it important to seek health care.

Age Factors↗

PubMed2002

Health-related quality of life, depressive symptoms, anemia, and malnutrition at hemodialysis initiation.

BACKGROUND AND METHODS: We administered the Kidney Disease Quality of Life (KDQOL) short form and a three-item depression screening measure derived from the Diagnostic Interview Schedule to 422 new patients with end-stage renal disease (ESRD; incident cohort) who began maintenance hemodialysis (HD) therapy at 151 outpatient dialysis facilities across the United States. RESULTS: At HD therapy initiation, 56% of patients had hemoglobin levels less than 10 g/dL (100 g/L), and 52% had albumin levels of 3.5 g/dL (35 g/L) or less. The 36-Item Short Form Health Survey (SF-36) scores (part of the KDQOL) for this incident cohort were significantly lower than those of a prevalent HD cohort and a severe chronic disease cohort (P < 0.01 to 0.001), and physical health scores were among the lowest ever reported. SF-36 summary scores were 2 SDs below those of an age- and sex-adjusted US general population in physical health and half an SD below those in mental health. Patients who screened positive for depression (45% of sample) scored even lower on all eight SF-36 scale scores and 9 of 12 of the KDQOL kidney disease-targeted scales (P < 0.05 to 0.01), but did not differ from nondepressed patients on demographic, clinical, or laboratory study variables. CONCLUSION: The extent to which the profound impairment documented in this study can be improved by more timely high-quality predialysis care requires further investigation. Nevertheless, the high prevalence of anemia, hypoalbuminemia, and depressive symptoms at dialysis therapy initiation suggests the need for more aggressive and broader spectrum pre-ESRD care.

Adolescent↗

PubMed2002

Use of the SF-36 and other health-related quality of life measures to assess persons with disabilities.

This article evaluates the appropriateness of existing approaches to the assessment of health-related quality of life (HRQOL) for persons with disabilities. We compare the conceptual model of HRQOL from the Medical Outcomes Study with the World Health Organization's International Classification of Functioning, Disability and Health. In addition, we examine the attitudes toward disease "burden" that arise from these 2 models. We note how values or the importance attached to domains of health can change with fluctuations in physical health. Further, we summarize arguments in favor of developing targeted measures of persons with disabilities. Finally, we discuss some methodologic issues in assessing physical functioning, attributions to health versus disability, and mode of administration. We conclude that users of "standard" HRQOL measures need to be aware of their limitations for assessing persons with disabilities.

Attitude to Health↗

PubMed2002

Development, reliability, and validity of the expectations regarding aging (ERA-38) survey.

PURPOSE: To develop a reliable and valid instrument to measure older adults' expectations regarding aging. DESIGN AND METHODS: Using focus groups, cognitive interviews, and multitrait scaling analysis, we developed a 38-item survey to measure expectations regarding aging (ERA-38). The survey consisted of 10 scales, each representing a domain of expectations. We mailed the survey to 588 English-speaking patients aged 65 years and older cared for by University of California, Los Angeles-affiliated physicians. RESULTS: Four hundred twenty-nine participants (73%) completed the survey. The mean age was 76 years; 54% were women. Most were White (76%). All scales other than Pain demonstrated good internal consistency reliability (alpha > or =.73) and item discrimination (> or =.80). Sixty-eight percent of respondents stated that all or most of the ERA-38 addressed things that were important. Construct validity was supported by correlations with age, activities of daily living, the Medical Outcomes Study Short Form-12 physical and mental component scores, and the Geriatric Depression Scale. IMPLICATIONS: Considerable support for the reliability and construct validity of the ERA-38 was obtained in this field study of 429 older adults. This instrument should be useful to investigators interested in measuring expectations regarding aging among older adults.

Aged↗

PubMed2002

CAHPS in practice: the Iowa demonstration.

This article evaluates the usefulness of the Consumer Assessment of Health Plan Study (CAHPS) surveys and reports in a demonstration and evaluation with three health care purchasers in Iowa. The CAHPS survey detected significant differences between health plans in several domains of health care. Both paper- and Web-based consumer reports were developed and distributed to consumers and stakeholders. There was some agreement on the value of these reports, but areas for improvement were noted.

Consumer Behavior↗

PubMed2002

HIV patients' experiences with inpatient and outpatient care: results of a national survey.

CONTEXT: Little is known about HIV patients' care experiences. OBJECTIVE: To assess HIV patients' experiences with inpatient and outpatient care, and to assess the relationship and relative influence of patient characteristics and site of care on care experiences. DESIGN: Cohort study. SETTING: Patients with HIV receiving care outside of emergency rooms, prisons, or the military throughout the continental United States. One thousand seventy-four patients provided ratings of an inpatient stay and 2204 rated an outpatient visit; 818 patients provided evaluations of both inpatient and outpatient care. PATIENTS: A national probability sample of persons in care for HIV from the HIV Cost and Services Utilization Study. MEASUREMENTS: Outcome variables were rates of problems with, and global ratings of, inpatient and outpatient care. RESULTS: Mean problem rates were 20.9% and 8.4% (lower score means fewer problems) for inpatient and outpatient care, respectively. On 9 of 10 of the individual inpatient report items, 15% or more of respondents reported problems. Global ratings of inpatient and outpatient care were 65.3 and 75.0 (0-100 scale, higher scores indicate better ratings), respectively. In multivariable models that controlled for site effects, the only patient characteristic that was consistently associated with problem rates and global ratings of care was mental health (P <0.0001 for both inpatient and outpatient care). Models including site effects explained two to four times as much variance as models excluding site effects. CONCLUSIONS: Inpatients with HIV reported higher problem rates with inpatient than outpatient care. Better provider-patient communication during inpatient stays is needed. For both inpatient and outpatient care, quality improvement efforts may be most productively focused on providers and processes of care at sites rather than on specific patient subgroups.

Adult↗

PubMed2002

Effect of CAHPS performance information on health plan choices by Iowa Medicaid beneficiaries.

This evaluation tested if Consumer Assessment of Health Plans Study (CAHPS) information on plan performance affected health plan choices by new beneficiaries in Iowa Medicaid. New cases entering Medicaid in selected counties during February through May 2000 were assigned randomly to experimental or control groups. The control group received standard Medicaid enrollment materials, and the experimental group received these materials plus a CAHPS report. We found that CAHPS information did not affect health plan choices by Iowa Medicaid beneficiaries, similar to previously reported findings for New Jersey Medicaid. However, it did affect plan choice in an earlier laboratory experiment. The value of this information may be limited to a subset of receptive consumers who actively study information received, even then only when (1) ratings of available plans differ greatly, (2) ratings differ from prior beliefs about plan quality, and (3) reports are easy to understand.

Case Management↗

PubMed2002

Patient preferences regarding antiretroviral therapy.

Antiretroviral medications for HIV infection can be combined into dozens of recommended regimens. However, little is known about patient preferences regarding antiretroviral therapy. We assessed the impact of clinician-mutable adherence barriers by conducting four patient focus groups (two English and two Spanish) consisting of 30 patients that focused discussion on antiretroviral treatment preferences. We also surveyed antiretroviral treatment preference from 31 subjects using the method of paired comparisons in which subjects indicated their preferences of regimen potency, pill burden, inconvenience, and side-effects using a 10-point rating scale. We found that most patients would tolerate severe side-effects, inconvenience, and large pill burden to have a potent antiretroviral regimen. In our population, patients generally preferred regimens with fewer side-effects to those with less inconvenience. Pill burden was of least importance among the domains studied. These preferences should be considered when selecting a regimen and developing interventions to improve antiretroviral adherence and patient outcomes.

Adolescent↗