Time Preferences Predict Mortality among HIV-Infected Adults Receiving Antiretroviral Therapy in Kenya

Harsha Thirumurthy; Kami Hayashi; Sebastian Linnemayr; Rachel C Vreeman; Irwin P Levin; David R Bangsberg; Noel T Brewer

doi:10.1371/journal.pone.0145245

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Time Preferences Predict Mortality among HIV-Infected Adults Receiving Antiretroviral Therapy in Kenya

Journal article

Open access

Peer reviewed

Time Preferences Predict Mortality among HIV-Infected Adults Receiving Antiretroviral Therapy in Kenya

Harsha Thirumurthy, Kami Hayashi, Sebastian Linnemayr, Rachel C Vreeman, Irwin P Levin, David R Bangsberg and Noel T Brewer

PloS one, Vol.10(12), p.e0145245

12/18/2015

DOI: 10.1371/journal.pone.0145245

PMCID: PMC4684319

PMID: 26684298

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Abstract

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. 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%. 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). 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.

Adult

Anti-HIV Agents - therapeutic use

Female

Health Knowledge, Attitudes, Practice

HIV Infections - drug therapy

HIV Infections - mortality

Humans

Kenya - epidemiology

Male

Medication Adherence

Patient Preference

Randomized Controlled Trials as Topic

Time Factors

Details

Title: Subtitle: Time Preferences Predict Mortality among HIV-Infected Adults Receiving Antiretroviral Therapy in Kenya
Creators: Harsha Thirumurthy - University of North Carolina at Chapel Hill
Kami Hayashi - University of North Carolina at Chapel Hill
Sebastian Linnemayr - RAND Corporation
Rachel C Vreeman - AMPATH
Irwin P Levin - University of Iowa
David R Bangsberg - Harvard University
Noel T Brewer - University of North Carolina at Chapel Hill
Resource Type: Journal article
Publication Details: PloS one, Vol.10(12), p.e0145245
DOI: 10.1371/journal.pone.0145245
PMID: 26684298
PMCID: PMC4684319
NLM abbreviation: PLoS One
ISSN: 1932-6203
eISSN: 1932-6203
Grant note: K01HD061605 / NICHD NIH HHS P2C HD050924 / NICHD NIH HHS K01 HD061605 / NICHD NIH HHS
Language: English
Date published: 12/18/2015
Academic Unit: Marketing; Psychological and Brain Sciences
Record Identifier: 9984963207602771

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