title: Time Preferences Predict Mortality among HIV-Infected Adults Receiving Antiretroviral Therapy in Kenya.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department 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.|Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
authors.forename: Harsha
authors.initials: H
authors.lastname: Thirumurthy
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
authors.forename: Kami
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: RAND Corporation, Santa Monica, CA, United States of America.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Linnemayr
authors.affiliation: Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States of America.|Academic Model Providing Access to Healthcare, Eldoret, Kenya.
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Vreeman
authors.affiliation: Department of Psychology, University of Iowa, Iowa City, IA, United States of America.
authors.forename: Irwin P
authors.initials: IP
authors.lastname: Levin
authors.affiliation: Center for Global Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence; D057240:Patient Preference; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents