Divergent preferences for enhanced HIV testing options among high-risk populations in northern Tanzania: a short report

Abstract

To achieve the UNAIDS target of diagnosing 95% of all persons living with HIV, enhanced HIV testing services with greater attractional value need to be developed and implemented. We conducted a discrete choice experiment (DCE) to quantify preferences for enhanced HIV testing features across two high-risk populations in the Kilimanjaro Region in northern Tanzania. We designed and fielded a survey with 12 choice tasks to systematically recruited female barworkers and male mountain porters. Key enhanced features included: testing availability on every day of the week, an oral test, integration of a general health check or an examination for sexually transmitted infections (STI) with HIV testing, and provider-assisted confidential partner notification in the event of a positive HIV test result. Across 300 barworkers and 440 porters surveyed, mixed logit analyses of 17,760 choices indicated strong preferences for everyday testing availability, health checks, and STI examinations. Most participants were averse to oral testing and confidential partner notification by providers. Substantial preference heterogeneity was observed within each risk group. Enhancing HIV testing services to include options for everyday testing, general health checks, and STI examinations may increase the appeal of HIV testing offers to high-risk populations.Trial registration: ClinicalTrials.gov identifier: NCT02714140.

Keywords: HIV counseling and testing; Tanzania; discrete choice experiment; preference heterogeneity; sub-Saharan Africa.

Figure 1.

Sample DCE choice task. Notes: Attributes and levels were introduced individually, prior to the administration of the DCE. After the most preferred option was selected, participants were asked to identify the next best option (“best-best” elicitation format). See Supplemental Material for the DCE survey and information provided to the participant about each attribute and level.

Figure 2.

Distribution of preferences for enhanced HIV counseling and testing features among 300 female barworkers and 440 male mountain porters, Tanzania, 2017. Notes: Results of gender-specific mixed logit models with effects-coded correlated random coefficients. Distributions represent kernel densities of individual-level preference estimates for 300 female barworkers (blue) and 440 male mountain porters (orange). The x-axes represent preferences for (to the right of the black line) or against (left of the black line): (a) everyday testing relative to testing on weekdays only, (b) oral swab relative to the estimated more preferred of either venipuncture or finger prick; (c) a complementary health check or (d) a complementary STI examination relative to HIV testing only; (e) confidential assisted partner notification in the event of a positive test result relative to self-disclosure. Effects-coded (mean) coefficient estimates from gender-specific mixed logit models are indicated by ß_Barworkers and ß_Porters. The statistical significance of differences in the distribution of individual-level preference estimates between risk groups, as evaluated by Student’s t-tests, is indicated by p_Difference.