Does preference-based HIV testing increase uptake in high risk populations?

基于偏好的艾滋病毒检测是否会增加高危人群的接受率？

• 批准号: 8921717
• 负责人: Jan Ostermann
• 金额: $ 33.61万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-01 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8921717
• 关键词: AIDS prevention; Address; Africa South of the Sahara; Area; Awareness; Caring; Characteristics; Client; Counseling; Couples; Data; Evaluation; Female; Fingers; General Population; Generations; HIV; HIV risk; Health; Health Services Accessibility; Healthcare; Home environment; Human immunodeficiency virus test; Individual; Intervention; Link; Marketing; Methods; Oral; Participant; Patient-Centered Care; Policy Maker; Population; Population Heterogeneity; Populations at Risk; Provider; Public Health; Randomized; Randomized Controlled Trials; Relative (related person); Research; Risk; Sampling; Structure; Survey Methodology; Surveys; Swab; Tanzania; Target Populations; Testing; Time; Treatment Efficacy; United States; Variant; Venipunctures; Work; Workplace; base; behavioral economics; cost effective; cost effectiveness; design; effective intervention; health economics; high risk; implementation research; improved; innovation; male; meetings; novel; novel strategies; patient oriented; preference; public health relevance; research study; therapy design; tool; uptake

 DESCRIPTION (provided by applicant): HIV counseling and testing (HCT) is a highly cost-effective intervention for increasing serostatus awareness, a point of entry into HIV care and treatment, and an important means of primary and secondary HIV prevention. Public health officials have called for dramatic increases in HIV testing to achieve an HIV-free generation. However, testing rates are plateauing, and repeat testing rates among those with ongoing risk remain low. Novel approaches are needed to increase the uptake of HCT, especially among high-risk groups. Evaluations of HIV testing uptake in sub-Saharan Africa, including our own, have typically focused on the acceptability of specific venue-based testing options. These narrow assessments do not probe the potential diversity in testing preferences of target populations and cannot characterize testing options that will maximize uptake among heterogeneous groups. Our HIV Testing Preferences in Tanzania study (Multi-PI Ostermann, Thielman, 5R21MH096631) demonstrated that the Discrete Choice Experiment (DCE), a form of stated preference survey research, is a robust tool for identifying which characteristics of HIV testing options are most preferred by different populations and which tradeoffs individuals make in evaluating testing options. Building on the R21, a decade of productive HCT research in this region, and strong relationships with policy makers and implementers, we propose to test the hypothesis that offering HIV testing options that reflect the specific preferences of high-risk populations will significantly increase rates of testing among these groups. In Aim 1 we will characterize the HIV testing preferences of two high risk populations. DCEs with samples of 200 female barworkers and 200 male mountain porters, two high-risk groups in Moshi, Tanzania, will be used to identify the relative importance of diverse HIV testing characteristics. In Aim 2, we will compare existing testing options to the preferences of each high-risk group and identify feasible, more preferred testing alternatives, taking into consideration that one-size-fits-all approaches cannot meet the heterogeneous preferences of these populations. In Aim 3 we will conduct a pragmatic randomized controlled trial to evaluate the effect of a preference-based HIV counseling and testing (PB-HCT) intervention on testing uptake. Representative samples of 600 female barworkers and 600 male mountain porters will be randomized into two groups. Group A participants will be offered the set of predicted more- preferred PB-HCT options identified in Aim 2 and a default alternative; Group B participants will be offered predicted less-preferred alternatives and a default alternative. Uptake of testing and the cost effectiveness of a preference-based HCT intervention compared to a default testing offer will be assessed after 6 and 12 months. The proposed study will identify the effect of an HIV-testing intervention designed using a novel, preference- based strategy. If successful, this work will demonstrate the utility of DCEs as a tool to replace the costly practice of iteratively implementing narrowly focused interventions with a structured approach for developing interventions matched to the specific preferences of intended target populations.

 描述（由适用提供）：HIV咨询和测试（HCT）是提高血清意识，进入HIV护理和治疗点的高度成本效益的干预措施，以及预防初级和中学HIV的重要手段。公共卫生官员呼吁在艾滋病毒测试中急剧增加，以实现无艾滋病毒的一代。但是，测试率的稳定状态，并且患有持续风险的人的重复测试率仍然很低。需要采用新颖的方法来增加HCT的吸收，尤其是在高风险群体中。撒哈拉以南非洲（包括我们自己的）艾滋病毒测试吸收的评估通常集中在特定基于场地的测试方案的可接受性上。这些狭窄的评估不能探测目标人群的测试偏好的潜在多样性，并且无法表征测试选项，从而最大程度地提高了异质群体之间的吸收。我们在坦桑尼亚研究中的HIV测试偏好（Multi-Pi Ostermann，Thielman，5R21MH096631）表明，离散选择实验（DCE）是一种既定偏好调查研究的一种形式，是一种可靠的工具，是一种可确定HIV测试选项的强大工具，可以识别HIV测试选项是不同群体最喜欢的人群和评估的人，并且评估了哪些人在评估中。在R21的基础上，在该地区进行了十年的生产性HCT研究，以及与政策制定者和实施者的牢固关系，我们建议测试以下假设：提供反映高风险人群的特定偏好的HIV测试方案将显着提高这些群体的测试率。在AIM 1中，我们将表征两个高风险人群的HIV测试偏好。 DCE的样品由200名女酒吧工作者和200名男性山搬运工，坦桑尼亚莫西的两个高危群体，将用于确定艾滋病毒分歧测试特征的相对重要性。在AIM 2中，我们将对现有的测试选项与每个高风险组的偏好进行比较，并确定可行的，更偏爱的测试替代方案，考虑到单一适合的方法无法满足这些人群的异质偏好。在AIM 3中，我们将进行一项务实的随机对照试验，以评估基于偏好的HIV咨询和测试（PB-HCT）干预对测试摄取的影响。 600名女性酒吧工作人员和600个男性山地搬运工的代表性样本将被随机分为两组。 A组将获得AIM 2和默认替代方案中确定的预测的更优选的PB-HCT选项。将为B组参与者提供预测的较低的替代方案和默认替代方案。测试的吸收和成本效益 与默认测试要约相比，基于偏好的HCT干预将在6个月和12个月后评估。拟议的研究将确定采用新型基于偏好策略设计的HIV测试干预措施的效果。如果成功的话，这项工作将证明DCE作为一种工具，以替代迭代实施狭义的干预措施的昂贵实践，以结构化的方法来开发与预期目标人群的特定偏好相匹配的干预措施。