HIV counseling and testing (HCT) is a highly cost-effective intervention for increasing serostatus awareness, a point of entry into HIV care and treatment, and an important means of primary and secondary HIV prevention. Public health officials have called for dramatic increases in HIV testing to achieve an HIV-free generation. However, population testing rates are plateauing, and repeat testing rates among those with ongoing risk remain low. Novel approaches are needed to increase the uptake of HCT. Evaluations of HIV testing uptake in sub-Saharan Africa, including our own, have typically focused on the acceptability of specific venue-based testing options. These narrow assessments do not probe the potential diversity in testing preferences of target populations and cannot characterize testing options that will maximize uptake among heterogeneous groups. Our HIV Testing Preferences in Tanzania study (Multi-PI Ostermann, Thielman, 5R21MH096631) demonstrated that the Discrete Choice Experiment (DCE), a form of stated preference survey research, is a robust tool for identifying which characteristics of HIV testing options are most preferred by different populations and which tradeoffs individuals make in evaluating testing options. Building on the R21, a decade of productive HCT research in this region, and strong relationships with policy makers and implementers, we propose to test the hypothesis that offering HIV testing options that are matched to the specific preferences of high-risk populations will significantly increase rates of testing among these groups.
In Aim 1 we will characterize the HIV testing preferences of two high risk populations. DCEs with 200 female barworkers and 200 male mountain porters, two high-risk groups in Moshi, Tanzania, will be used to identify the relative importance of diverse HIV testing characteristics for the decisions of whether, when, and where to test.
In Aim 2, we will compare the characteristics of existing testing options to the preferences of each high-risk group and identify feasible, more preferred testing alternatives, taking into consideration that one-size-fits-all approaches cannot meet the heterogeneous preferences of these populations.
In Aim 3 we will conduct a randomized controlled trial to evaluate the effect of preference-based HIV counseling and testing (PB-HCT) on testing uptake. Representative samples of 600 female barworkers and 600 male mountain porters will be randomized into two groups. Group A participants will be offered their individually most-preferred PB-HCT option; Group B participants will be offered a predicted less-preferred alternative. Both groups will also be offered a default testing option. Uptake of testing will be assessed after 6 and 12 months. The proposed study will identify the effect of a preference-based HIV-testing offer on testing rates in two high-risk populations. More generally, this work will demonstrate the utility of DCEs as a tool to replace the costly practice of iterative trial-and-error implementation of narrowly focused interventions with a structured approach for developing interventions based on the specific preferences of the intended target populations.
Despite worldwide efforts to promote HIV Counseling and Testing (HCT), rates of testing remain low. HCT is the first step for bringing persons living with HIV into care and equips persons living without HIV with important information about prevention. Understanding why and how high risk groups decide to test and adapting available testing options to their preferences has the potential to broadly improve HCT uptake and cost- effectiveness. This study uses Discrete Choice Experiments to quantify the HIV testing preferences of two high-risk populations in the Kilimanjaro Region of Tanzania, identifies the most preferred testing options, and evaluates, in a pragmatic randomized controlled trial, the effect of a preference-based HIV counseling and testing (PB-HCT) strategy on testing uptake.
| Ostermann, Jan; Brown, Derek S; de Bekker-Grob, Esther W et al. (2017) Preferences for Health Interventions: Improving Uptake, Adherence, and Efficiency. Patient 10:511-514 |
