Korte Jeffrey E, Strauss Michael, Ba Aissatou, Buregyeya Esther, Matovu Joseph Kb, Kisa Rose, Musoke William, Chemusto Harriet, Vrana-Diaz Caroline J, Malek Angela M, Wanyenze Rhoda K, George Gavin
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa.
Afr J AIDS Res. 2019 Dec;18(4):332-340. doi: 10.2989/16085906.2019.1686032.
HIV testing rates remain stubbornly low among men - a crucial target population for reaching the ambitious global and regional goals of the HIV programme. In an era of declining donor funding, identifying cost-effective strategies to increase testing rates amongst men remains paramount. Antenatal care is an effective entry-point for the delivery of HIV testing services for women, and partner testing presents an important opportunity to reach their male partners. We present the results of a discrete choice experiment in Uganda, examining preferences among 824 pregnant women and 896 male partners regarding service delivery characteristics of HIV testing. Both men and women preferred nurse administered testing to self-testing (OR = 0.835; < 0.001), oral testing over a finger-prick test (OR = 1.176 < 0.001) and testing with a partner over testing alone (OR = 1.230; < 0.001). Men had a preference for testing at home compared to testing at a clinic (OR = 1.099; = 0.024), but women were indifferent regarding the testing location. The cost of testing had the biggest effect on preferences. Free testing was preferred over a cost of US$2.90 (OR = 0.781; < 0.001) or US$2.00 (OR = 0.670; < 0.001). Offering an incentive of US$3.40 increased men's preferences compared to a free test (OR = 1.168; < 0.001), although this did not affect women's preferences. Partner testing linked to antenatal care is a potential strategy to increase testing coverage among men, particularly given the preference for partner testing - provided costs to clients remain low. Future cost-effectiveness evaluations should investigate the economic impact of reaching men using these strategies.
在男性群体中,艾滋病毒检测率一直维持在较低水平,而男性是实现艾滋病规划雄心勃勃的全球和区域目标的关键目标人群。在捐助资金不断减少的时代,确定具有成本效益的策略以提高男性检测率仍然至关重要。产前护理是为女性提供艾滋病毒检测服务的有效切入点,而性伴侣检测则是接触其男性伴侣的重要契机。我们展示了在乌干达进行的一项离散选择实验的结果,该实验调查了824名孕妇及其896名男性伴侣对艾滋病毒检测服务提供特征的偏好。男性和女性都更倾向于由护士进行检测而非自我检测(比值比=0.835;P<0.001),更倾向于口服检测而非指尖采血检测(比值比=1.176;P<0.001),以及更倾向于与性伴侣一起检测而非单独检测(比值比=1.230;P<0.001)。与在诊所检测相比,男性更倾向于在家中检测(比值比=1.099;P=0.024),但女性对检测地点无差异。检测成本对偏好影响最大。免费检测比2.90美元(比值比=0.781;P<0.001)或2.00美元(比值比=0.670;P<0.001)的成本更受青睐。与免费检测相比,提供3.40美元的激励措施增加了男性的偏好(比值比=1.168;P<0.001),尽管这并未影响女性的偏好。与产前护理相关的性伴侣检测是提高男性检测覆盖率的潜在策略,特别是考虑到对性伴侣检测的偏好——前提是客户成本仍然较低。未来的成本效益评估应调查使用这些策略接触男性的经济影响。
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