Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania.
Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania.
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DOI：
10.1186/s13561-015-0060-8
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发表时间：
2015-12
影响因子：
2.4
通讯作者：
Thielman N
中科院分区：
文献类型：
--
作者：
Ostermann J;Brown DS;Mühlbacher A;Njau B;Thielman N
尽管为增加艾滋病毒检测作出了大量公共卫生努力，但许多国家的检测率已趋于稳定，对持续存在风险的人进行重复检测的比率很低。为了告知旨在增加艾滋病毒检测的政策，我们在坦桑尼亚莫希的一般人群样本和两个高危人群中确定了与个人愿意接受（WTA）艾滋病毒检测相关的特征。总共有721人，包括随机选择的社区成员（N = 402），女性酒吧工作者（N = 135）和男性基利曼哈罗山搬运工（N = 184），被问到一个双重边界或有估价格式，如果他们愿意测试艾滋病毒，以换取2000，5000或10,000先令（分别约为1.30美元、3.20美元和6.40美元）。该研究于2012年9月至2013年2月进行。超过四分之一的参与者（196; 27%）表示，他们愿意测试坦桑尼亚先令（TSH）2000，而七分之一（98; 13.6%）需要超过TSH 10，000。平均WTA估计值为TSH 4564（95%置信区间：TSH 4201至4927）。按性别、艾滋病毒风险因素和其他特征分列的WTA估计数的显著差异，合理地反映了个人对检测的益处和障碍的评价的差异。男性的WTA估计值高于女性。在男性中，报告有艾滋病毒症状的人的WTA比没有症状的人低近三分之一。在女性中，WTA的估计值因受访者的教育程度、自己和伴侣的艾滋病毒检测史以及终生性交易报告而异。对于两种性别而言，观察到的最重要的关联是受访者对艾滋病毒检测准确性的看法;那些认为艾滋病毒检测完全准确的人愿意比他们的同行少检测大约三分之一。在这项研究中确定的平均WTA估计表明，在研究人群中，激励普遍的HIV检测可能会发现未诊断的HIV感染，激励成本为每流行感染150美元，每事件感染1400美元，每质量调整生命年（QALY）的相应成本为流行70美元，事件HIV感染620美元。研究结果支持了有关艾滋病毒检测准确性的信息的价值，并表明相对适度的资金可能足以激励高危人群进行检测。
Despite substantial public health efforts to increase HIV testing, testing rates have plateaued in many countries and rates of repeat testing for those with ongoing risk are low. To inform policies aimed at increasing uptake of HIV testing, we identified characteristics associated with individuals’ willingness-to-accept (WTA) an HIV test in a general population sample and among two high-risk populations in Moshi, Tanzania. In total, 721 individuals, including randomly selected community members (N = 402), female barworkers (N = 135), and male Kilimanjaro mountain porters (N = 184), were asked in a double-bounded contingent valuation format if they would test for HIV in exchange for 2000, 5000 or 10,000 Shillings (approximately $1.30, $3.20, and $6.40, respectively). The study was conducted between September 2012 and February 2013. More than one quarter of participants (196; 27 %) stated they would be willing to test for Tanzania Shilling (TSH) 2000, whereas one in seven (98; 13.6 %) required more than TSH 10,000. The average WTA estimate was TSH 4564 (95 % Confidence Interval: TSH 4201 to 4927). Significant variation in WTA estimates by gender, HIV risk factors and other characteristics plausibly reflects variation in individuals’ valuations of benefits of and barriers to testing. WTA estimates were higher among males than females. Among males, WTA was nearly one-third lower for those who reported symptoms of HIV than those who did not. Among females, WTA estimates varied with respondents’ education, own and partners’ HIV testing history, and lifetime reports of transactional sex. For both genders, the most significant association was observed with respondents’ perception of the accuracy of the HIV test; those believing HIV tests to be completely accurate were willing to test for approximately one third less than their counterparts. The mean WTA estimates identified in this study suggest that within the study population, incentivized universal HIV testing could potentially identify undiagnosed HIV infections at an incentive cost of $150 per prevalent infection and $1400 per incident infection, with corresponding costs per quality adjusted life year (QALY) gained of $70 for prevalent and $620 for incident HIV infections. The results support the value of information about the accuracy of HIV testing, and suggest that relatively modest amounts of money may be sufficient to incentivize at-risk populations to test.