Heterogeneous HIV testing preferences in an urban setting in Tanzania: results from a discrete choice experiment

Jan Ostermann, Bernard Njau, Derek S Brown, Axel Mühlbacher, Nathan Thielman, Jan Ostermann, Bernard Njau, Derek S Brown, Axel Mühlbacher, Nathan Thielman

Abstract

Background: Efforts to reduce Human Immunodeficiency Virus (HIV) transmission through treatment rely on HIV testing programs that are acceptable to broad populations. Yet, testing preferences among diverse at-risk populations in Sub-Saharan Africa are poorly understood. We fielded a population-based discrete choice experiment (DCE) to evaluate factors that influence HIV-testing preferences in a low-resource setting.

Methods: Using formative work, a pilot study, and pretesting, we developed a DCE survey with five attributes: distance to testing, confidentiality, testing days (weekday vs. weekend), method for obtaining the sample for testing (blood from finger or arm, oral swab), and availability of HIV medications at the testing site. Cluster-randomization and Expanded Programme on Immunization (EPI) sampling methodology were used to enroll 486 community members, ages 18-49, in an urban setting in Northern Tanzania. Interviewer-assisted DCEs, presented to participants on iPads, were administered between September 2012 and February 2013.

Results: Nearly three of five males (58%) and 85% of females had previously tested for HIV; 20% of males and 37% of females had tested within the past year. In gender-specific mixed logit analyses, distance to testing was the most important attribute to respondents, followed by confidentiality and the method for obtaining the sample for the HIV test. Both unconditional assessments of preferences for each attribute and mixed logit analyses of DCE choice patterns suggest significant preference heterogeneity among participants. Preferences differed between males and females, between those who had previously tested for HIV and those who had never tested, and between those who tested in the past year and those who tested more than a year ago.

Conclusion: The findings suggest potentially significant benefits from tailoring HIV testing interventions to match the preferences of specific populations, including males and females and those who have never tested for HIV.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Sample choice task.
Figure 1. Sample choice task.
Choice task shown to participants during the iPad-based presentation of the discrete choice experiment, in English (left) and Kiswahili (right).
Figure 2. Participant enrollment.
Figure 2. Participant enrollment.
Flowchart summarizing enrollment of a random community sample for participation in the discrete choice experiment.
Figure 3. Scaled estimates of HIV testing…
Figure 3. Scaled estimates of HIV testing preferences by gender, prior HIV testing status and time since the last HIV test.
Gender-specific estimates of the effect of each attribute level on HIV testing preferences, separately for prior testers vs. those who never tested (Panels A and B), and those who tested in the past year vs. those who tested more than 1 year ago (Panels C and D). Models included correlated random main effects and fixed interactions between attribute levels and participants' HIV testing histories. p-values indicate statistically significant differences between the respective groups, as measured by the interaction terms. Coefficients were re-scaled to range from 0 to 10.

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