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

基于偏好的艾滋病毒检测是否会增加高危人群的接受率？

• 批准号: 9197853
• 负责人: Jan Ostermann
• 金额: $ 46.61万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9197853
• 关键词: Does; preference; based; HIV; testing

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.

描述：艾滋病毒咨询和测试（HCT）是提高血清意识，进入艾滋病毒护理和治疗点的高度成本效益的干预措施，以及预防初级和中等艾滋病毒的重要手段。公共卫生官员呼吁在艾滋病毒测试中急剧增加，以实现无艾滋病毒的一代。但是，人口测试率的稳定幅度很高，患有持续风险的人的重复测试率仍然很低。需要采用新颖的方法来增加HCT的摄取。 撒哈拉以南非洲（包括我们自己的）艾滋病毒测试吸收的评估通常集中在特定基于场地的测试方案的可接受性上。这些狭窄的评估不能探测目标人群的测试偏好的潜在多样性，并且无法表征测试选项，从而最大程度地提高了异质群体之间的吸收。我们在坦桑尼亚研究中的HIV测试偏好（Multi-Pi Ostermann，Thielman，5R21MH096631）表明，离散选择实验（DCE）是一种既定偏好调查研究的一种形式，是一种可靠的工具，是一种可确定HIV测试选项的强大工具，可以识别HIV测试选项是不同群体最喜欢的人群和评估的人，并且评估了哪些人在评估中。在R21的基础上，在该地区进行了十年的生产性HCT研究，以及与政策制定者和实施者的牢固关系，我们建议测试以下假设：提供与高风险人群的特定偏好相匹配的HIV测试方案将显着提高这些群体的测试率。 在AIM 1中，我们将表征两个高风险人群的HIV测试偏好。 DCE有200名女性酒吧工作人员和200名男性山地搬运工，坦桑尼亚莫西的两个高风险群体，将用于确定各种HIV测试特征的相对重要性，以决定是否，何时和何时测试。在AIM 2中，我们将在考虑到单一适合的方法无法满足这些人群的异质偏好时，将现有测试选项的特征与每个高风险组的偏好进行比较，并确定可行的，更喜欢的测试替代方案。在AIM 3中，我们将进行一项随机对照试验，以评估基于偏好的HIV咨询和测试（PB-HCT）对测试摄取的影响。 600名女性酒吧工作人员和600个男性山地搬运工的代表性样本将被随机分为两组。 A组将获得其个人最受欢迎的PB-HCT选项； B组参与者将获得预测的较少偏爱的替代方案。这两个组还将提供一个默认的测试选项。在6个月和12个月后，将评估测试的吸收。 拟议的研究将确定基于偏好的HIV测试报价对两个高风险人群的测试率的影响。更一般而言，这项工作将证明DCEs作为一种工具，以替代狭窄的重点干预措施的迭代反复试验实施的昂贵实践，并采用结构化方法来基于预期目标人群的特定偏好来制定干预措施。