Centre for Sexual Health & HIV AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe.
Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
J Int AIDS Soc. 2019 Mar;22 Suppl 1(Suppl Suppl 1):e25245. doi: 10.1002/jia2.25245.
INTRODUCTION: New HIV testing strategies are needed to reach the United Nations' 90-90-90 target. HIV self-testing (HIVST) can increase uptake, but users' perspectives on optimal models of distribution and post-test services are uncertain. We used discrete choice experiments (DCEs) to explore the impact of service characteristics on uptake along the testing cascade. METHODS: DCEs are a quantitative survey method that present respondents with repeated choices between packages of service characteristics, and estimate relative strengths of preferences for service characteristics. From June to October 2016, we embedded DCEs within a population-based survey following door-to-door HIVST distribution by community volunteers in two rural Zimbabwean districts: one DCE addressed HIVST distribution preferences; and the other preferences for linkage to confirmatory testing (LCT) following self-testing. Using preference coefficients/utilities, we identified key drivers of uptake for each service and simulated the effect of changes of outreach and static/public clinics' characteristics on LCT. RESULTS: Distribution and LCT DCEs surveyed 296/329 (90.0%) and 496/594 (83.5%) participants; 81.8% and 84.9% had ever-tested, respectively. The strongest distribution preferences were for: (1) free kits - a $1 increase in the kit price was associated with a disutility (U) of -2.017; (2) door-to-door kit delivery (U = +1.029) relative to collection from public/outreach clinic; (3) telephone helpline for pretest support relative to in-person or no support (U = +0.415); (4) distributors from own/local village (U = +0.145) versus those from external communities. Participants who had never HIV tested valued phone helplines more than those previously tested. The strongest LCT preferences were: (1) immediate antiretroviral therapy (ART) availability: U = +0.614 and U = +1.052 for public and outreach clinics, respectively; (2) free services: a $1 user fee increase decreased utility at public (U = -0.381) and outreach clinics (U = -0.761); (3) proximity of clinic (U = -0.38 per hour walking). Participants reported willingness to link to either location; but never-testers were more averse to LCT. Simulations showed the importance of availability of ART: ART unavailability at public clinics would reduce LCT by 24%. CONCLUSIONS: Free HIVST distribution by local volunteers and immediately available ART were the strongest relative preferences identified. Accommodating LCT preferences, notably ensuring efficient provision of ART, could facilitate "resistant testers" to test while maximizing uptake of post-test services.
简介:需要新的艾滋病毒检测策略来实现联合国的 90-90-90 目标。艾滋病毒自我检测(HIVST)可以提高检测率,但用户对最佳分发模式和检测后服务的看法尚不确定。我们使用离散选择实验(DCE)来探索服务特征对检测级联中检测的影响。
方法:DCE 是一种定量调查方法,它在服务特征的套餐之间为受访者提供重复选择,并估计对服务特征的偏好的相对强度。2016 年 6 月至 10 月,我们在津巴布韦两个农村地区通过社区志愿者进行基于人群的 HIVST 分发后,在基于人群的调查中嵌入了 DCE:一个 DCE 解决了 HIVST 分发偏好问题;另一个则解决了自我检测后与确认性检测(LCT)相关联的偏好问题。使用偏好系数/效用,我们确定了每个服务的关键采用驱动因素,并模拟了外展和静态/公共诊所特征变化对 LCT 的影响。
结果:分发和 LCT DCE 调查了 296/329(90.0%)和 496/594(83.5%)的参与者;分别有 81.8%和 84.9%的人有过检测。最强的分发偏好是:(1)免费试剂盒-试剂盒价格每增加 1 美元,不满意度(U)为-2.017;(2)上门送试剂盒(U=+1.029),与从公共/外展诊所领取相比;(3)电话热线咨询预测试支持,与面对面或无支持相比(U=+0.415);(4)来自自己/当地村庄的分发人员(U=+0.145)与来自外部社区的分发人员相比。从未接受过 HIV 检测的参与者比以前接受过检测的参与者更重视电话热线。最强的 LCT 偏好是:(1)立即获得抗逆转录病毒治疗(ART):U=+0.614 和 U=+1.052,适用于公共和外展诊所;(2)免费服务:用户费用增加 1 美元,会降低公共(U=-0.381)和外展诊所(U=-0.761)的效用;(3)诊所的接近程度(每小时步行 0.38 美元)。参与者报告愿意与任何一个地点联系;但从未接受过检测的人更不愿意进行 LCT。模拟表明了获得 ART 的重要性:公共诊所的 ART 不可用将使 LCT 减少 24%。
结论:当地志愿者免费分发 HIVST 和立即获得的 ART 是确定的相对偏好。为了满足 LCT 的偏好,特别是确保 ART 的有效提供,可以促进“有抵抗力的测试者”进行测试,同时最大限度地提高检测后服务的利用率。
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