Time preferences predict mortality among HIV-infected adults receiving antiretroviral therapy in Kenya

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

Research output: Contribution to journalArticle

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Abstract

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 HIVinfected 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.

Original languageEnglish (US)
Article numbere0145245
JournalPLoS One
Volume10
Issue number12
DOIs
StatePublished - Dec 1 2015

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Kenya
Health
HIV
drug therapy
therapeutics
Mortality
Monitoring
monitoring
Economics
Health Behavior
Logistics
psychology
Therapeutics
Logistic Models
odds ratio
socioeconomics
mechanism of action
risk factors
Health Facilities
Research

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Thirumurthy, H., Hayashi, K., Linnemayr, S., Vreeman, R., Levin, I. P., Bangsberg, D. R., & Brewer, N. T. (2015). Time preferences predict mortality among HIV-infected adults receiving antiretroviral therapy in Kenya. PLoS One, 10(12), [e0145245]. https://doi.org/10.1371/journal.pone.0145245

Time preferences predict mortality among HIV-infected adults receiving antiretroviral therapy in Kenya. / Thirumurthy, Harsha; Hayashi, Kami; Linnemayr, Sebastian; Vreeman, Rachel; Levin, Irwin P.; Bangsberg, David R.; Brewer, Noel T.

In: PLoS One, Vol. 10, No. 12, e0145245, 01.12.2015.

Research output: Contribution to journalArticle

Thirumurthy, H, Hayashi, K, Linnemayr, S, Vreeman, R, Levin, IP, Bangsberg, DR & Brewer, NT 2015, 'Time preferences predict mortality among HIV-infected adults receiving antiretroviral therapy in Kenya', PLoS One, vol. 10, no. 12, e0145245. https://doi.org/10.1371/journal.pone.0145245
Thirumurthy H, Hayashi K, Linnemayr S, Vreeman R, Levin IP, Bangsberg DR et al. Time preferences predict mortality among HIV-infected adults receiving antiretroviral therapy in Kenya. PLoS One. 2015 Dec 1;10(12). e0145245. https://doi.org/10.1371/journal.pone.0145245
Thirumurthy, Harsha ; Hayashi, Kami ; Linnemayr, Sebastian ; Vreeman, Rachel ; Levin, Irwin P. ; Bangsberg, David R. ; Brewer, Noel T. / Time preferences predict mortality among HIV-infected adults receiving antiretroviral therapy in Kenya. In: PLoS One. 2015 ; Vol. 10, No. 12.
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abstract = "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 HIVinfected 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.",
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