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Acceptability and preferences for HIVST in Zambia: A population-based formative study using a discrete choice experiment


Author
Zanolini et al.

Publication year
2016

Country

Type of approach
Community-based

Type of assistance
n/a

Specimen
Oral-fluid

Study population
General population

Study design
Feasibility/acceptability

Sample size
1617

UNAIDS HIV prevalence (2017)
12.9 [12.3 - 13.4]

Methodology
Households in Lusaka Province were randomly selected to participate in a household survey and one member aged 16 years or older randomly selected as a respondent. Respondents were asked about perceptions and preferences around HIVST after receiving information about the oral fluid-based test. Preferences were assessed through a Discrete Choice Experiment (DCE). The DCE contained a full factorial design with cost (free, 10 Kwacha or 25 Kwacha), location to obtain the test (from voluntary counseling and testing departments in clinics; outpatient departments within clinics, and private chemists) and pre-counseling (provided or not) as attributes. Participants were asked to choose between two different HIVST models but also had an opt-out option to choose conventional modes of HIV testing or no testing. We used mixed logit regressions to analyze the DCE results.

Summary of findings
Among 1617 participants, 47% had not tested in the past year. 74% reported feeling comfortable with HIVST and 76% of those who have not tested in the past year reported they would definitely test if given a self-test. Only 2% reported having concerns serious enough to not recommend HIVST in Zambia. In the Discrete Choice Experiment, 73% of those who had tested in the past year chose HIVST over conventional modes of testing, and 88% of those who had tested in the past year chose HIVST over not testing. The most predictive attribute for a choice was presence of counseling, followed by lower cost especially for regular testers. The lowest relative preference was for location. When considering only two types of HIVST and excluding the optout option, participants had a negative preference for obtaining the test at a voluntary counselling and testing site, a location found to be highly stigmatized.

Acceptability
0.76

Acceptability details
74% reported feeling comfortable with HIVST and 76% of those who have not tested in the past year reported they would definitely test if given a self-test.

Willingness to pay
n/a

Willingness to pay details
The most predictive attribute for a choice was presence of counseling, followed by lower cost, especially for regular testers.

Sensitivity
n/a

Specificity
n/a

Concordance
n/a

HIV positivity
n/a

Accuracy details
n/a

Social harm
n/a

Linkage to prevention, care and treatment
n/a


Study status
Completed