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

 描述(由申请人提供)：艾滋病毒咨询和检测(HCT)是一种提高血清状态认识的高成本效益的干预措施，是进入艾滋病毒护理和治疗的切入点，也是艾滋病毒一级和二级预防的重要手段。公共卫生官员呼吁大幅增加艾滋病毒检测，以实现无艾滋病毒的一代。然而，检测率处于平稳状态，持续风险人群的重复检测率仍然很低。需要新的方法来增加对HCT的吸收，特别是在高危人群中。对撒哈拉以南非洲地区，包括我们自己的艾滋病毒检测接受情况的评估，通常侧重于特定地点检测选择的可接受性。这些狭隘的评估没有探索目标人群测试偏好的潜在多样性，也无法确定将在不同类别的群体中最大限度地吸收的测试选项的特征。我们的坦桑尼亚艾滋病毒检测偏好研究(Multi-Pi Ostermann，Thielman，5R21MH096631)表明，离散选择实验(DCE)是一种声明的偏好调查研究形式，是确定不同人群最喜欢艾滋病毒检测选项的哪些特征以及个人在评估检测选项时做出的权衡的强大工具。在R21的基础上，我们建议检验这样一种假设，即提供反映高危人群特定偏好的艾滋病毒检测选项将显著提高这些群体的检测率。R21是该地区十年来富有成效的HCT研究，并与决策者和实施者建立了牢固的关系。在目标1中，我们将描述两个高危人群的艾滋病毒检测偏好。对坦桑尼亚莫西的两个高危群体--200名女性调酒师和200名男性登山搬运工--进行的DCES将用于确定不同艾滋病毒检测特征的相对重要性。在目标2中，我们将把现有的测试选择与每个高危群体的偏好进行比较，并确定可行的、更受欢迎的测试选择，同时考虑到一刀切的方法不能满足这些人群的不同偏好。在目标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咨询和检测(PB-HCT)干预对检测摄取的影响。600名女性调酒师和600名男性登山搬运工的代表性样本将被随机分为两组。A组参与者将获得AIM 2中确定的一组预测较偏好的PB-HCT选项和一个默认备选方案；B组参与者将获得一个预测较不偏好的备选方案和一个默认备选方案。测试的采用和成本效益 将在6个月和12个月后评估基于偏好的HCT干预与默认测试方案的比较。这项拟议的研究将确定使用一种新的、基于偏好的策略设计的艾滋病毒检测干预的效果。如果成功，这项工作将证明DCES作为一种工具的效用，它可以用一种结构化的方法来取代重复实施狭隘干预措施的昂贵做法，以制定与预期目标人群的特定偏好相匹配的干预措施。

 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.