Jennings Larissa, Conserve Donaldson F, Merrill Jamison, Kajula Lusajo, Iwelunmor Juliet, Linnemayr Sebastian, Maman Suzanne
Johns Hopkins Bloomberg School of Public Health, Department of International Health, Social and Behavioral Interventions Program, Baltimore, USA.
University of South Carolina, Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, Columbia, USA.
J AIDS Clin Res. 2017 Aug;8(8). doi: 10.4172/2155-6113.1000725. Epub 2017 Aug 31.
Impoverished men have lower rates of facility-based HIV counseling and testing and higher unknown HIV-positive status than women. Economic theory suggests that individuals will obtain an HIV test if anticipated benefits are greater than anticipated costs. Yet, few studies have investigated the range of financial preferences of HIV self-testing (HIVST) among poor men who decline testing or do not test regularly. Twenty-three interviews were conducted to qualitatively assess perceived costs saved and costs incurred from use of HIVST kits in infrequently- or never-tested Tanzanian men. All men were shown an HIVST kit and video. They were then asked about the costs associated with provider-led HIV testing, financial benefits and concerns of HIVST and willingness to pay for HIVST. Data were transcribed, coded and analyzed using inductive content analyses. We then grouped codes into perceived cost advantages and disadvantages and tabulated the range of prices men were willing to pay for a self-test kit. Perceived cost advantages of HIVST were avoidance of spending money to test in facilities, omission of follow-up fees, affordability relative to private clinics, and increased time for earning income and other activities. Men also discussed the imbalance of the financial benefit of accessing free, public HIV testing with the resources spent for transport, purchasing meals away from home and long wait lines. Perceived cost disadvantages of HIVST were prohibitive kit costs, required prior savings to purchase kits, expenditures relating to death and preferences for free provider-performed testing. Men were also concerned about the psychological costs of inaccurate results. HIVST willingness to pay varied among men. Men's decisions to self-test for HIV takes into account expected financial gains and losses. Demand generation for HIVST among men should consider use of low fees or free HIVST, while emphasizing potential savings from reduced travel, clinical costs, or time way from work. Efforts are also needed to address anticipated emotional costs of HIVST, such as anxiety from kit errors, purchasing "death" or testing alone, which for some men was a substantial barrier.
贫困男性接受基于机构的艾滋病咨询和检测的比例低于女性,且艾滋病病毒呈阳性但身份未知的比例高于女性。经济理论表明,如果预期收益大于预期成本,个人就会进行艾滋病检测。然而,很少有研究调查那些拒绝检测或不定期检测的贫困男性对艾滋病自我检测(HIVST)的财务偏好范围。我们进行了23次访谈,以定性评估坦桑尼亚很少检测或从未检测过的男性使用HIVST试剂盒所节省的感知成本和产生的成本。向所有男性展示了一个HIVST试剂盒和视频。然后询问他们与医疗机构主导的艾滋病检测相关的成本、HIVST的经济收益和担忧,以及为HIVST付费的意愿。使用归纳性内容分析法对数据进行转录、编码和分析。然后,我们将编码分为感知成本优势和劣势,并列出男性愿意为自我检测试剂盒支付的价格范围。HIVST的感知成本优势包括避免在医疗机构花钱检测、省去后续费用、相对于私人诊所的可承受性,以及增加赚取收入和进行其他活动的时间。男性还讨论了获得免费公共艾滋病检测的经济收益与交通费用、外出就餐费用以及长时间排队等待所花费资源之间的不平衡。HIVST的感知成本劣势包括试剂盒成本过高、需要预先储蓄来购买试剂盒、与死亡相关的支出以及对免费的医疗机构检测的偏好。男性还担心检测结果不准确带来的心理成本。男性对HIVST的付费意愿各不相同。男性自我检测艾滋病的决定会考虑预期的经济得失。在男性中推广HIVST应考虑使用低费用或免费的HIVST,同时强调减少出行、临床成本或工作时间所带来的潜在节省。还需要努力解决HIVST预期的情感成本,例如试剂盒错误、购买“死亡”检测或独自检测带来的焦虑,对一些男性来说,这是一个很大的障碍。
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