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

描述：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，人群检测率处于停滞状态，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。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，即提供与高危人群的特定偏好相匹配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。坦桑尼亚Moshi的两个高危群体--200名女性调酒师和200名男性登山搬运工--的DCES将用于确定不同艾滋病毒检测特征对是否、何时和在哪里进行检测的决定的相对重要性。在目标2中，我们将比较现有测试方案的特点和每个高危群体的偏好，并确定可行的、更受欢迎的测试方案，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，我们将进行一项随机对照试验，以评估基于偏好的HIV咨询和检测(PB-HCT)对检测吸收的影响。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组参与者将被提供他们个人最喜欢的PB-HCT选项；B组参与者将被提供一个预测的不太受欢迎的替代选项。这两组人还将获得一个默认的测试选项。6个月和12个月后将对测试的吸收情况进行评估。这项拟议的研究将确定基于偏好的艾滋病毒检测服务对两个高危人群检测率的影响。更广泛地说，这项工作将证明DCES作为一种工具的效用，用一种结构化的方法取代成本高昂的狭隘重点干预措施反复试错实施的做法，以根据预期目标人群的具体偏好制定干预措施。

DESCRIPTION: 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, population 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. 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 are matched to 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 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 for the decisions of whether, when, and where to test. In Aim 2, we will compare the characteristics of 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 randomized controlled trial to evaluate the effect of preference-based HIV counseling and testing (PB-HCT) 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 their individually most-preferred PB-HCT option; Group B participants will be offered a predicted less-preferred alternative. Both groups will also be offered a default testing option. Uptake of testing will be assessed after 6 and 12 months. The proposed study will identify the effect of a preference-based HIV-testing offer on testing rates in two high-risk populations. More generally, this work will demonstrate the utility of DCEs as a tool to replace the costly practice of iterative trial-and-error implementation of narrowly focused interventions with a structured approach for developing interventions based on the specific preferences of the intended target populations.