Using Discrete Choice Experiments to Identify HIV Testing Preferences in Tanzania

描述(申请人提供)：普遍的艾滋病毒检测和对艾滋病毒感染者的立即治疗可以大大减少艾滋病毒的流行，但撒哈拉以南非洲地区的艾滋病毒检测接受率仍然很低。在坦桑尼亚，尽管艾滋病毒检测方法的可用性有所改善，但近三分之二的成年人从未进行过艾滋病毒检测。专门为符合高危和难以接触人群的喜好而设计的新型艾滋病毒检测选择有可能提高艾滋病毒检测的可接受性和接受度。为了扩展我们之前的工作，评估了坦桑尼亚乞力马扎罗地区不同地点对艾滋病毒自愿咨询和检测(VCT)的接受情况(独立、流动、家庭和诊所VCT)，我们建议将一种称为离散选择实验(DCES，有时被称为联合分析)的创新偏好诱导方法应用于该地区的艾滋病毒检测。DCE方法以效用最大化的经济理论为基础，确定艾滋病毒检测选项的关键可修改特征，向调查受访者提供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选项)，并要求他们选择自己喜欢的替代方案。分析响应以估计放置在单个测试特征上的相对价值，并确定哪些特征组合最大程度地影响决策和理解。这项为期两年的研究的主要目标是：1)使用定性方法确定影响检测决定的艾滋病毒检测项目的关键可修改特征；2)开展DCE调查，并从坦桑尼亚乞力马扎罗地区随机选择的800名居民中获得偏好；3)估计对现有的和假设的但可行的艾滋病毒检测干预措施的偏好。从未检测过艾滋病毒的人和以前检测过艾滋病毒的人之间的偏好差异将被描述。这项研究将由一个多学科研究小组在坦桑尼亚乞力马扎罗地区实施，该小组结合了坦桑尼亚成功的艾滋病毒测试研究的记录和不同领域的DCES经验。在这种情况下应用的DCE方法有望确定难以接触到的高危人群的艾滋病毒检测偏好，为这些人群制定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，研究如何根据预期目标人群的具体偏好调整艾滋病毒检测干预措施的益处。这种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。使现有的检测方法适用于撒哈拉以南非洲的不同社区，有可能广泛提高对艾滋病毒检测的接受程度，从而使更多的艾滋病毒/艾滋病患者得到护理，并向没有艾滋病毒/艾滋病的患者提供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.