INFORMING HIV SELF-TESTING SERVICES IN MALAWI USING DISCRETE CHOICE - - PowerPoint PPT Presentation

UNITAID PSI

HIV SELF-TESTING AFRICA

INFORMING HIV SELF-TESTING SERVICES IN MALAWI USING DISCRETE CHOICE EXPERIMENTS

PITCHAYA INDRAVUDH, MALAWI-LIVERPOOL-WELLCOME TRUST CLINICAL RESEARCH PROGRAMME

MARC D’ELBEE, MOSES KUMWENDA, AUGUSTINE CHOKO, DOREEN SAKALA, THOKOZANI KALUA, CHERYL JOHNSON, KARIN HATZOLD, ELIZABETH CORBETT, FERN TERRIS-PRESTHOLT Conference on Retroviruses and Opportunistic Infections 15 Feb. 2017 #895

§ Limited studies on variability in user preferences for HIVST § Discrete choice experiments (DCE): measure strength of user preferences

§ Few DCEs on HIV testing (Tanzania) and self-testing (Zambia)

§ This study adds to evidence on user preferences for HIVST models

BACKGROUND

Ostermann PloS One 2014; Zanolini IAS 2016

§ Objective: To determine relative preferences for delivery of HIVST kits and linkage to further testing and ART initiation and variation by sub-group

§ Formative phase: Literature review, individual interviews, pilot § Data collection: DCE with adults from randomly selected households in rural districts; delivery (n=707) and linkage to care (n=551) § Data analysis: multinomial logistic model; sex, age and prior HIV testing or HIV status interactions

METHODS

Choice: A, B or opt-out

• Price: Negative preference for price
• Lesser degree among men and never-

tested

• Location: Home delivery preferred to

health facilities and mobile clinics.

• Greater degree among never-tested
• Provider: Preference for lay distributors
• ver HCWs and partners
• Assistance: Indifference to pre-test

assistance, but aversion to instruction leaflets for post-test assistance

• Never-tested preferred more extensive

support

RESULTS – DELIVERY

RESULTS – LINKAGE

• Assistance: Indifference to post-test

support following positive self-test

• User fees: Relatively unimportant
• Location: Preference to link at home
• r home of HCWs compared to health

facilities or mobile clinics

• Services: Positive preference for

short waiting time and HIV service- specific waiting rooms

• Greater degree if HIV positive

§ General population:

§ Delivery: preference for home access and low-cost distribution by lay providers with some level of post-test support beyond the instruction leaflet § Linkage to care: preference for services at home or home of HCW with a short waiting time and separate waiting rooms at health facilities

§ Men: less averse to price and instruction leaflet as post-test support § Never-tested: stronger preference for home access and comprehensive pre- and post-test support, less averse to price

CONCLUSION