Using Discrete Choice Experiments to Identify HIV Testing Preferences in Tanzania

描述（由申请人提供）：普遍的艾滋病毒检测和立即治疗艾滋病毒感染者可以大大减少艾滋病毒的流行，但艾滋病毒检测在撒哈拉以南非洲的吸收仍然很低。在坦桑尼亚，尽管艾滋病毒检测选择的可获得性有所改善，但近三分之二的成年人从未进行过艾滋病毒检测。专门为满足高风险和难以接触的人群的偏好而设计的新型艾滋病毒检测方案有可能提高艾滋病毒检测的可接受性和接受率。 为了扩展我们以前的工作，评估艾滋病毒自愿咨询和检测（VCT）在坦桑尼亚的基利曼哈罗地区（独立的，移动的，以家庭为基础的，以诊所为基础的VCT）的不同场所的吸收，我们建议采用一种创新的方法，称为离散选择实验（DCE，有时被称为联合分析），在该地区的艾滋病毒检测的偏好诱导。以效用最大化的经济理论为基础，DCE方法确定了艾滋病毒检测方案的关键可修改特征，向调查受访者提供了这些特征的各种组合（每个组合代表一个假设的艾滋病毒检测方案），并要求他们选择自己喜欢的替代方案。响应进行分析，以估计放置在各个测试功能的相对值，并确定哪些功能的组合最影响决策和摄取。 这项为期两年的研究的主要目的是：1）使用定性方法，以确定影响检测决策的艾滋病毒检测程序的关键修改功能; 2）开发一个DCE调查，并从坦桑尼亚基利曼哈罗地区随机选择的800名居民的偏好;和3）估计现有的以及假设的，但可行的，艾滋病毒检测干预措施的偏好。测试偏好之间的人谁从来没有测试过艾滋病毒和那些谁以前测试过艾滋病毒的差异将被描述。 这项研究将由一个多学科研究小组在坦桑尼亚的基利曼哈罗地区实施，该小组将坦桑尼亚成功的艾滋病毒检测研究记录和不同领域的DCEs经验相结合。在这种情况下应用的VCE方法有望确定难以接触和高危人群的艾滋病毒检测偏好，可以为他们设计定制的检测干预措施。这项研究的数据将构成实施研究的基础，研究如何根据预定目标人群的具体偏好调整艾滋病毒检测干预措施的好处。这些干预措施的有效性和成本效益随后可以在随机对照试验中进行评估。 根据撒哈拉以南非洲不同社区的情况调整现有的检测办法，有可能广泛提高艾滋病毒检测的接受率，从而使更多的艾滋病毒/艾滋病感染者得到护理，并使未感染艾滋病毒/艾滋病的人掌握有关艾滋病毒预防的重要信息。

DESCRIPTION (provided by applicant): Universal HIV testing and immediate treatment of HIV-infected individuals could dramatically reduce the HIV epidemic, yet HIV testing uptake in sub-Saharan Africa remains low. In Tanzania, despite improved availability of HIV testing options, nearly two thirds of adults have never tested for HIV. Novel HIV testing options specifically designed to match the preferences of high-risk and hard-to-reach populations hold the potential to improve the acceptability and uptake of HIV testing. To extend our previous work, which assessed uptake of HIV voluntary counseling and testing (VCT) across varied venues in the Kilimanjaro Region of Tanzania (free-standing, mobile, home-based, and clinic-based VCT), we propose to apply an innovative method for preference elicitation known as Discrete Choice Experiments (DCEs, sometimes referred to as conjoint analysis) to HIV testing in this region. Grounded in the economic theory of utility maximization, the DCE method identifies key modifiable features of HIV testing options, presents survey respondents with various combinations of these features (each representing a hypothetical HIV testing option), and asks them to choose their preferred alternatives. Responses are analyzed to estimate the relative value placed on individual testing features, and to determine what combinations of features most influence decision-making and uptake. The primary aims of this two-year study are to: 1) Use qualitative methods to identify key modifiable features of HIV testing programs that influence testing decisions; 2) Develop a DCE survey and elicit preferences from 800 randomly selected residents of the Kilimanjaro Region of Tanzania; and 3) Estimate preferences for existing as well as hypothetical, but feasible, HIV testing interventions. Differences in testig preferences between persons who have never tested for HIV and those who have previously tested for HIV will be described. The study will be implemented in the Kilimanjaro Region of Tanzania by a multidisciplinary research team that combines a track record of successful HIV testing research in Tanzania and experience with DCEs in diverse fields. The DCE method, applied in this context, holds promise to identify HIV testing preferences of hard-to-reach and at-risk populations for whom customized testing interventions can be devised. The data from this study will form the basis for implementation research on the benefits of tailoring HIV testing interventions to the specific preferences of the intended target populations. The effectiveness and cost- effectiveness of such interventions can subsequently be evaluated in a randomized controlled trial. Adapting available testing options to heterogeneous communities in sub-Saharan Africa has the potential to broadly improve the uptake of HIV testing, thereby bringing more persons living with HIV/AIDS into care and equipping persons living without HIV/AIDS with important information about HIV prevention.