Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Department of Psychology, University of Southampton, Southampton, United Kingdom.
PLoS Med. 2019 Apr 11;16(4):e1002779. doi: 10.1371/journal.pmed.1002779. eCollection 2019 Apr.
BACKGROUND: In the UK, approximately 4,200 men who have sex with men (MSM) are living with HIV but remain undiagnosed. Maximising the number of high-risk people testing for HIV is key to ensuring prompt treatment and preventing onward infection. This study assessed how different HIV test characteristics affect the choice of testing option, including remote testing (HIV self-testing or HIV self-sampling), in the UK, a country with universal access to healthcare. METHODS AND FINDINGS: Between 3 April and 11 May 2017, a cross-sectional online-questionnaire-based discrete choice experiment (DCE) was conducted in which respondents who expressed an interest in online material used by MSM were asked to imagine that they were at risk of HIV infection and to choose between different hypothetical HIV testing options, including the option not to test. A variety of different testing options with different defining characteristics were described so that the independent preference for each characteristic could be valued. The characteristics included where each test is taken, the sampling method, how the test is obtained, whether infections other than HIV are tested for, test accuracy, the cost of the test, the infection window period, and how long it takes to receive the test result. Participants were recruited and completed the instrument online, in order to include those not currently engaged with healthcare services. The main analysis was conducted using a latent class model (LCM), with results displayed as odds ratios (ORs) and probabilities. The ORs indicate the strength of preference for one characteristic relative to another (base) characteristic. In total, 620 respondents answered the DCE questions. Most respondents reported that they were white (93%) and were either gay or bisexual (99%). The LCM showed that there were 2 classes within the respondent sample that appeared to have different preferences for the testing options. The first group, which was likely to contain 86% of respondents, had a strong preference for face-to-face tests by healthcare professionals (HCPs) compared to remote testing (OR 6.4; 95% CI 5.6, 7.4) and viewed not testing as less preferable than remote testing (OR 0.10; 95% CI 0.09, 0.11). In the second group, which was likely to include 14% of participants, not testing was viewed as less desirable than remote testing (OR 0.56; 95% CI 0.53, 0.59) as were tests by HCPs compared to remote testing (OR 0.23; 95% CI 0.15, 0.36). In both classes, free remote tests instead of each test costing £30 was the test characteristic with the largest impact on the choice of testing option. Participants in the second group were more likely to have never previously tested and to be non-white than participants in the first group. The main study limitations were that the sample was recruited solely via social media, the study advert was viewed only by people expressing an interest in online material used by MSM, and the choices in the experiment were hypothetical rather than observed in the real world. CONCLUSIONS: Our results suggest that preferences in the context we examined are broadly dichotomous. One group, containing the majority of MSM, appears comfortable testing for HIV but prefers face-to-face testing by HCPs rather than remote testing. The other group is much smaller, but contains MSM who are more likely to be at high infection risk. For these people, the availability of remote testing has the potential to significantly increase net testing rates, particularly if provided for free.
背景:在英国,大约有 4200 名男男性行为者(MSM)携带艾滋病毒但未被诊断。最大限度地增加高危人群接受艾滋病毒检测的人数是确保及时治疗和预防传播的关键。本研究评估了不同的艾滋病毒检测特征如何影响检测选择,包括远程检测(艾滋病毒自我检测或艾滋病毒自我采样),在英国,这是一个普遍获得医疗保健的国家。
方法和发现:2017 年 4 月 3 日至 5 月 11 日期间,进行了一项横断面在线问卷调查离散选择实验(DCE),对表示对 MSM 使用的在线材料感兴趣的受访者进行了调查,他们想象自己有感染艾滋病毒的风险,并在不同的假设艾滋病毒检测选项之间进行选择,包括不检测的选项。描述了各种不同的具有不同定义特征的检测选项,以便对每个特征的独立偏好进行评估。这些特征包括每种检测的进行地点、采样方法、检测的获取方式、是否检测除艾滋病毒以外的感染、检测准确性、检测成本、感染窗口期以及收到检测结果的时间。参与者通过在线方式招募并完成了仪器,以便包括那些目前未参与医疗服务的人。主要分析使用潜在类别模型(LCM)进行,结果显示为优势比(OR)和概率。OR 表示相对于(基础)特征对一个特征的偏好强度。共有 620 名受访者回答了 DCE 问题。大多数受访者报告他们是白人(93%),要么是同性恋者,要么是双性恋者(99%)。LCM 显示,在受访者样本中有 2 个类,它们似乎对检测选项有不同的偏好。第一组可能包含 86%的受访者,他们强烈倾向于由医疗保健专业人员(HCPs)进行面对面的检测,而不是远程检测(OR 6.4;95%CI 5.6,7.4),并且将不检测视为不如远程检测可取(OR 0.10;95%CI 0.09,0.11)。第二组可能包括 14%的参与者,将不检测视为不如远程检测(OR 0.56;95%CI 0.53,0.59),将 HCPs 进行的检测视为不如远程检测(OR 0.23;95%CI 0.15,0.36)。在这两个组中,免费的远程检测而不是每项检测费用 30 英镑是对检测选项选择影响最大的检测特征。第二组的参与者比第一组更有可能从未接受过检测,并且是非白人。主要研究的局限性是,样本仅通过社交媒体招募,研究广告仅被对 MSM 使用的在线材料感兴趣的人查看,实验中的选择是假设的,而不是在现实世界中观察到的。
结论:我们的研究结果表明,在我们所研究的背景下,偏好大致是二分的。一组包含大多数 MSM,他们似乎对艾滋病毒检测感到舒适,但更喜欢由 HCPs 进行面对面的检测,而不是远程检测。另一组要小得多,但包含了更有可能处于高感染风险的 MSM。对于这些人来说,远程检测的可用性有可能大大提高检测率,特别是如果提供免费服务的话。
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