Using Discrete Choice Experiments to Identify HIV Testing Preferences in Tanzania

描述（由申请人提供）：普及艾滋病毒检测和立即治疗艾滋病毒感染者可以大大减少艾滋病毒流行，但撒哈拉以南非洲的艾滋病毒检测使用率仍然很低。在坦桑尼亚，尽管艾滋病毒检测的可得性有所改善，但近三分之二的成年人从未接受过艾滋病毒检测。专门针对高危人群和难以接触人群的偏好而设计的新型艾滋病毒检测方案有可能提高艾滋病毒检测的可接受性和吸收性。我们之前的工作评估了坦桑尼亚乞力马扎罗山地区不同场所（独立、移动、家庭和诊所）对艾滋病毒自愿咨询和检测（VCT）的接受情况，为了扩展我们的工作，我们建议将一种名为离散选择实验（dce，有时也被称为联合分析）的偏好激发创新方法应用于该地区的艾滋病毒检测。基于效用最大化的经济学理论，DCE方法确定了艾滋病毒检测选项的关键可修改特征，向调查对象提供这些特征的各种组合（每个特征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。对响应进行分析，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能影响决策和吸收。这项为期两年的研究的主要目的是：1)使用定性方法确定影响检测决策的艾滋病毒检测程序的关键可修改特征；2)开展DCE调查，随机抽取800名坦桑尼亚乞力马扎罗山地区居民的偏好；3)估计对现有以及假设但可行的艾滋病毒检测干预措施的偏好。将描述从未进行过艾滋病毒检测的人和以前进行过艾滋病毒检测的人在检测偏好方面的差异。这项研究将由一个多学科研究小组在坦桑尼亚的乞力马扎罗州实施，该小组将结合坦桑尼亚成功的艾滋病毒检测研究的记录和在不同领域的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，可以为他们设计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，以确定根据预期目标人群的具体偏好定制艾滋病毒检测干预措施的好处。这些干预措施的有效性和成本效益可随后在随机对照试验中进行评估。使现有的检测方案适应撒哈拉以南非洲的不同社区，有可能广泛改善艾滋病毒检测的接受情况，从而使更多的艾滋病毒/艾滋病感染者得到护理，并使未感染艾滋病毒/艾滋病的人获得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.