Does Preference-based HIV Testing Increase Uptake in High Risk Populations?
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 1/14/2018 |
| Start Date: | January 3, 2018 |
| End Date: | December 31, 2019 |
| Contact: | Jan Ostermann, PhD |
| Email: | jano@mailbox.sc.edu |
| Phone: | 919-339-1110 |
Despite worldwide efforts to promote HIV Counseling and Testing (HCT), rates of testing
remain low. Understanding how high risk groups decide to test and adapting available testing
options to their preferences has the potential to broadly improve HCT uptake and
cost-effectiveness. This study proposes to use a Discrete Choice Experiment, a survey method
increasingly used by health economists for the design of patient-centered health care
options, to rigorously quantify HIV testing preferences among two high-risk populations,
identify their preferred testing options, and evaluate, in a pragmatic randomized controlled
trial (RCT), the effect of a preference-based HIV counseling and testing (PB-HCT)
intervention on testing uptake. At a time of heightened focus on health preferences research
and patient-centered care, this study evaluates the critical link between preference-based
intervention design and efficacy. If the RCT indicates that PB-HCT increases testing rates,
the testing options evaluated in this R01 can be offered to high-risk populations in the
study area, and the preference elicitation method and tools can be used to inform the design
of testing options that better match the preferences of other high-risk populations and in
other settings.
remain low. Understanding how high risk groups decide to test and adapting available testing
options to their preferences has the potential to broadly improve HCT uptake and
cost-effectiveness. This study proposes to use a Discrete Choice Experiment, a survey method
increasingly used by health economists for the design of patient-centered health care
options, to rigorously quantify HIV testing preferences among two high-risk populations,
identify their preferred testing options, and evaluate, in a pragmatic randomized controlled
trial (RCT), the effect of a preference-based HIV counseling and testing (PB-HCT)
intervention on testing uptake. At a time of heightened focus on health preferences research
and patient-centered care, this study evaluates the critical link between preference-based
intervention design and efficacy. If the RCT indicates that PB-HCT increases testing rates,
the testing options evaluated in this R01 can be offered to high-risk populations in the
study area, and the preference elicitation method and tools can be used to inform the design
of testing options that better match the preferences of other high-risk populations and in
other settings.
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. Yet, testing rates are plateauing
and rates of repeat-testing among those with ongoing risk remain low. Thus, there is a need
to better understand and address deterrents of HIV testing.
Evaluations of population preferences for testing have typically focused on the acceptability
of specific venue-based testing options, such as home-based, provider-initiated, or workplace
testing, usually without consideration or offer of other options. Results from these
assessments do not probe the potential diversity in testing preferences of target
populations; they do not ascertain how individuals value diverse characteristics of testing
options; nor can they identify combinations of testing options that could maximize uptake of
testing. The investigators posit that systematically designed HIV testing interventions,
matched specifically to the heterogeneous preferences of diverse target populations, hold
potential to greatly improve uptake of testing.
In this study the investigators will extend the use of the DCE method to design an HIV
testing intervention that is matched to the specific preferences of two high-risk populations
and to establish, in a pragmatic randomized controlled trial, whether a Preference-Based HIV
Counseling and Testing (PB-HCT) intervention increases uptake of HIV testing. In short, the
investigators are adapting concepts from health and behavioral economics, marketing, and
patient-centered care to apply a groundbreaking, client-focused perspective to the context of
HIV testing.
This application will address the following Specific Aims:
Aim 1. Quantitatively describe the HIV testing preferences of two high-risk populations.
Hypothesis: HIV testing preferences differ between different high-risk populations. The
investigators will develop and conduct DCE surveys with 200 female barworkers and 200 male
Kilimanjaro mountain porters, two of the highest HIV risk populations in Moshi, Tanzania, in
order to describe their preferences for actionable characteristics of HIV testing options.
DCEs will quantify the relative importance of characteristics such as home-based vs.
facility-based testing, venipuncture vs. finger prick vs. oral swab, individual vs. couples
counseling, weekday vs. weekend testing, or the availability of services such as health
check-ups, for individuals' testing decisions.
Aim 2. Compare the HIV testing preferences within each high-risk population to the
characteristics of existing testing options and identify feasible, more preferred
alternatives. Hypothesis: Multiple distinct and feasible testing options can be identified
that are predicted to better match the preferences of high-risk populations. The
investigators will use latent class analysis of DCE choice data from Aim 1 to identify
distinct sets of testing preferences within each high-risk population. Comparisons of each
risk group's preferences with the characteristics of existing testing options will be used to
identify, separately for each group, a set of two or more feasible new testing options, or
variations of existing testing options, that are predicted to be more preferred and whose
uptake can be evaluated in a randomized controlled trial (RCT) in Aim 3.
Aim 3. Conduct an RCT to evaluate whether an HIV testing intervention, designed to match the
testing preferences of two high-risk populations, increases testing uptake relative to a
default option. Hypothesis: A preference-based HCT intervention increases the uptake of
testing. Representative samples of 600 female barworkers and 600 male mountain porters will
be randomized into two groups. Group A participants will be offered the set of predicted
more-preferred PB-HCT options identified in Aim 2 and a default option; Group B participants
will be offered an equal number of predicted less-preferred options and the default option.
Uptake of testing and the cost-effectiveness of PB-HCT will be assessed at 6 and 12 months.
The findings from this project have significant public health relevance. The proposed study
will a) rigorously characterize the HIV testing preferences of two high-risk populations; b)
identify feasible HIV testing interventions that are predicted to increase HCT uptake; and c)
identify the effect of a preference-informed HIV testing intervention on rates of testing.
More generally, this study evaluates the critical link between an intervention that is
systematically designed to match a population's preferences and the efficacy of that
intervention. If successful, preference assessments among small samples from key populations
could be used widely as an implementation research tool to inform the design of diverse HIV
prevention, testing, and treatment interventions; preference-informed interventions, in turn,
hold potential to broadly increase intervention uptake and efficacy, both internationally and
in the United States.
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. Yet, testing rates are plateauing
and rates of repeat-testing among those with ongoing risk remain low. Thus, there is a need
to better understand and address deterrents of HIV testing.
Evaluations of population preferences for testing have typically focused on the acceptability
of specific venue-based testing options, such as home-based, provider-initiated, or workplace
testing, usually without consideration or offer of other options. Results from these
assessments do not probe the potential diversity in testing preferences of target
populations; they do not ascertain how individuals value diverse characteristics of testing
options; nor can they identify combinations of testing options that could maximize uptake of
testing. The investigators posit that systematically designed HIV testing interventions,
matched specifically to the heterogeneous preferences of diverse target populations, hold
potential to greatly improve uptake of testing.
In this study the investigators will extend the use of the DCE method to design an HIV
testing intervention that is matched to the specific preferences of two high-risk populations
and to establish, in a pragmatic randomized controlled trial, whether a Preference-Based HIV
Counseling and Testing (PB-HCT) intervention increases uptake of HIV testing. In short, the
investigators are adapting concepts from health and behavioral economics, marketing, and
patient-centered care to apply a groundbreaking, client-focused perspective to the context of
HIV testing.
This application will address the following Specific Aims:
Aim 1. Quantitatively describe the HIV testing preferences of two high-risk populations.
Hypothesis: HIV testing preferences differ between different high-risk populations. The
investigators will develop and conduct DCE surveys with 200 female barworkers and 200 male
Kilimanjaro mountain porters, two of the highest HIV risk populations in Moshi, Tanzania, in
order to describe their preferences for actionable characteristics of HIV testing options.
DCEs will quantify the relative importance of characteristics such as home-based vs.
facility-based testing, venipuncture vs. finger prick vs. oral swab, individual vs. couples
counseling, weekday vs. weekend testing, or the availability of services such as health
check-ups, for individuals' testing decisions.
Aim 2. Compare the HIV testing preferences within each high-risk population to the
characteristics of existing testing options and identify feasible, more preferred
alternatives. Hypothesis: Multiple distinct and feasible testing options can be identified
that are predicted to better match the preferences of high-risk populations. The
investigators will use latent class analysis of DCE choice data from Aim 1 to identify
distinct sets of testing preferences within each high-risk population. Comparisons of each
risk group's preferences with the characteristics of existing testing options will be used to
identify, separately for each group, a set of two or more feasible new testing options, or
variations of existing testing options, that are predicted to be more preferred and whose
uptake can be evaluated in a randomized controlled trial (RCT) in Aim 3.
Aim 3. Conduct an RCT to evaluate whether an HIV testing intervention, designed to match the
testing preferences of two high-risk populations, increases testing uptake relative to a
default option. Hypothesis: A preference-based HCT intervention increases the uptake of
testing. Representative samples of 600 female barworkers and 600 male mountain porters will
be randomized into two groups. Group A participants will be offered the set of predicted
more-preferred PB-HCT options identified in Aim 2 and a default option; Group B participants
will be offered an equal number of predicted less-preferred options and the default option.
Uptake of testing and the cost-effectiveness of PB-HCT will be assessed at 6 and 12 months.
The findings from this project have significant public health relevance. The proposed study
will a) rigorously characterize the HIV testing preferences of two high-risk populations; b)
identify feasible HIV testing interventions that are predicted to increase HCT uptake; and c)
identify the effect of a preference-informed HIV testing intervention on rates of testing.
More generally, this study evaluates the critical link between an intervention that is
systematically designed to match a population's preferences and the efficacy of that
intervention. If successful, preference assessments among small samples from key populations
could be used widely as an implementation research tool to inform the design of diverse HIV
prevention, testing, and treatment interventions; preference-informed interventions, in turn,
hold potential to broadly increase intervention uptake and efficacy, both internationally and
in the United States.
Inclusion Criteria:
- Males who work as Kilimanjaro mountain porters, Females who regularly work at a bar,
hotel or restaurant establishment and serve alcohol to patrons.
- Eligible participants will be ages 18+, reside in Moshi, Tanzania and have no plans to
leave the study area.
Exclusion Criteria:
- Participants who are not able to see will be excluded owing to the visual nature of
the survey presented to elicit preferences.
We found this trial at
2
sites
Click here to add this to my saved trials
Click here to add this to my saved trials