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）是一种高成本效益的干预措施，可提高对血清状况的认识，是艾滋病毒护理和治疗的切入点，也是一级和二级艾滋病毒预防的重要手段。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，检测率正在趋于稳定，那些有持续风险的人的重复检测率仍然很低。需要新的方法来增加HCT的摄取，特别是在高危人群中。 对包括我国在内的撒哈拉以南非洲艾滋病毒检测接受情况的评价通常侧重于特定场所检测方案的可接受性。这些狭隘的评估没有探索目标人群在测试偏好方面的潜在多样性，也无法表征将最大限度地提高异质群体吸收率的测试选项。我们在坦桑尼亚的HIV检测偏好研究（Multi-PI Ostermann，Thielman，5 R21 MH 096631）表明，离散选择实验（DCE）是一种陈述偏好调查研究的形式，是一种强大的工具，用于确定不同人群最喜欢的HIV检测选项的特征以及个人在评估检测选项时的权衡。基于R21，该地区十年来富有成效的HCT研究，以及与政策制定者和实施者的密切关系，我们建议测试这一假设，即提供反映高危人群特定偏好的HIV检测选项将显着提高这些人群的检测率。 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。在坦桑尼亚的莫希，200名女性酒吧工作者和200名男性山区搬运工（两个高危群体）的样本的DCE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，我们将比较现有的测试选项与每个高风险群体的偏好，并确定可行的，更首选的测试替代方案，同时考虑到一刀切的方法无法满足这些人群的异质偏好。在目标3中，我们将进行一项实用的随机对照试验，以评估基于偏好的HIV咨询和检测（PB-HCT）干预对检测吸收的影响。将600名女性酒吧工作者和600名男性山区搬运工的代表性样本随机分为两组。A组受试者将获得目标2中确定的一组预测的更优选的PB-HCT选项和一个默认选项; B组受试者将获得预测的不太优选的选项和一个默认选项。采用测试和成本效益， 将在6个月和12个月后评估基于偏好的HCT干预与默认检测的比较。 这项拟议的研究将确定艾滋病毒检测干预的效果，该干预是使用一种新的、基于偏好的策略设计的。如果成功的话，这项工作将表明，作为一种工具，取代昂贵的做法，反复实施狭隘的重点干预措施与结构化的方法，制定干预措施相匹配的具体偏好的预期目标人群的实用程序。

 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.