Willingness to trade-off years of life for an HIV cure - an experimental exploration of affective forecasting

Ilona Fridman; Nir Eyal; Karen A Scherr; Judith S Currier; Kenneth A Freedberg; Scott D Halpern; Daniel R Kuritzkes; Monica Magalhaes; Kathryn I Pollak; Peter A Ubel

doi:10.1186/s12981-024-00640-5

Willingness to trade-off years of life for an HIV cure - an experimental exploration of affective forecasting

AIDS Res Ther. 2024 Aug 6;21(1):51. doi: 10.1186/s12981-024-00640-5.

Authors

Ilona Fridman¹, Nir Eyal², Karen A Scherr³, Judith S Currier⁴, Kenneth A Freedberg^{5

6}, Scott D Halpern⁷, Daniel R Kuritzkes⁸, Monica Magalhaes⁹, Kathryn I Pollak^{10

11}, Peter A Ubel¹²

Affiliations

¹ Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, Chapel Hill, 450 West Dr, NC, 27599, USA. Ilona_fridman@med.unc.edu.
² School of Public Health, and Philosophy, Rutgers University Institute for Health, 112 Paterson St, NJ, 08901, USA.
³ Department of Family Medicine and Community Health, Duke School of Medicine, 2301 Erwin Rd, Durham, 27710, NC, USA.
⁴ Department of Medicine, University of California Los Angeles, 911 Broxton Ave, Suite 30, Los Angeles, CA, 90095, USA.
⁵ Medical Practice Evaluation Center, Divisions of General Internal Medicine and Infectious Diseases, Massachusetts General Hospital, 100 Cambridge St, Suite 1600, Boston, MA, 02115, USA.
⁶ Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁷ Departments of Medicine, Medical Ethics and Health Policy, and Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
⁸ Division of Infectious Diseases Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne St, Rm 449, Cambridge, MA, 02139, USA.
⁹ Rutgers University Institute for Health, 112 Paterson Street, New Brunswick, NJ, 08901, USA.
¹⁰ Cancer Control and Population Sciences in the Duke Cancer Institute, 2424 Erwin Road, Suite 602, Durham, NC, 27705, USA.
¹¹ Department of Population Health Science, Duke University, 215 Morris St, Durham, NC, 27701, USA.
¹² Department of Population Health Science, Fuqua School of Business, School of Medicine, Sanford School of Public Policy, Duke University, 100 Fuqua Drive., Durham, NC, 27708, USA.

Abstract

Background: In the US, 1.2 million people live with HIV (PWH). Despite having near-normal life expectancies due to antiretroviral therapy (ART), many PWH seek an HIV cure, even if it means risking their lives. This willingness to take risks for a cure raises questions about "affective forecasting biases," where people tend to overestimate the positive impact of future events on their well-being. We conducted a study to test two interventions to mitigate affective forecasting in the decisions of PWH about taking HIV cure medication.

Methods: We recruited PWH to complete a 30-minute survey about their current quality of life (QoL) and the QoL they anticipate after being cured of HIV, and assigned them to either no additional intervention, to one of two interventions intended to reduce affective forecasting bias, or to both interventions: (1) a defocusing intervention designed to broaden the number of life domains people consider when imagining life changes associated with new circumstances (e.g. HIV cure); and (2) an adaptation intervention to help them gauge fading of strong emotions over time. The study design included a 2 × 2 design: defocusing (yes/no) x adaptation (yes/no) intervention. We assessed PWH's willingness to take hypothetical HIV sterilizing cure medication using the Time Trade-Off (TTO) and their quality of life predictions with WHOQOL-HIV.

Results: 296 PWH participated. Counter to what we had hypothesized, neither intervention significantly reduced PWH's willingness to trade time for a cure. Instead, the defocusing intervention increased their willingness to trade time (IRR 1.77, p = 0.03). Exploratory analysis revealed that PWH with lower current quality of life who received the defocusing intervention were more willing to trade time for a cure.

Conclusion: These negative findings suggest that either these biases are difficult to overcome in the settings of HIV curative medication or other factors beyond affective forecasting biases influence willingness to participate in HIV curative studies, such as respondents' current quality of life.

MeSH terms

Adult
Anti-HIV Agents / therapeutic use
Female
Forecasting
HIV Infections* / drug therapy
HIV Infections* / psychology
Humans
Life Expectancy
Male
Middle Aged
Quality of Life*
Surveys and Questionnaires

Substances

Anti-HIV Agents

Abstract

MeSH terms

Substances

Grants and funding