Latent class analysis of acceptability and willingness to pay for self‐HIV testing in a United States urban neighbourhood with high rates of HIV infection

Nunn, Amy; Brinkley‐Rubinstein, Lauren; Rose, Jennifer; Mayer, Kenneth H.; Stopka, Thomas J.; Towey, Caitlin; Harvey, Julia; Santamaria, Karina; Sabatino, Kelly; Trooskin, Stacey; Chan, Philip A.

doi:10.7448/ias.20.1.21290

Cited by 20 publications

(15 citation statements)

References 20 publications

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“…Our results suggest that the main barrier to remote testing use was its purchase cost, followed by the length of window period. Existing studies among MSM and other populations have drawn similar conclusions [10,11,31–34], but our findings additionally suggest that most people would still prefer HCP to remote testing even if the latter was free and available with a 4-week window period. This is because the majority of participants placed such a high value on HCP testing over and above the specific test characteristics that we investigated.…”

Section: Discussionsupporting

confidence: 84%

Preferences for HIV testing services among men who have sex with men in the UK: A discrete choice experiment

et al. 2019

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Background In the UK, approximately 4,200 men who have sex with men (MSM) are living with HIV but remain undiagnosed. Maximising the number of high-risk people testing for HIV is key to ensuring prompt treatment and preventing onward infection. This study assessed how different HIV test characteristics affect the choice of testing option, including remote testing (HIV self-testing or HIV self-sampling), in the UK, a country with universal access to healthcare. Methods and findings Between 3 April and 11 May 2017, a cross-sectional online-questionnaire-based discrete choice experiment (DCE) was conducted in which respondents who expressed an interest in online material used by MSM were asked to imagine that they were at risk of HIV infection and to choose between different hypothetical HIV testing options, including the option not to test. A variety of different testing options with different defining characteristics were described so that the independent preference for each characteristic could be valued. The characteristics included where each test is taken, the sampling method, how the test is obtained, whether infections other than HIV are tested for, test accuracy, the cost of the test, the infection window period, and how long it takes to receive the test result. Participants were recruited and completed the instrument online, in order to include those not currently engaged with healthcare services. The main analysis was conducted using a latent class model (LCM), with results displayed as odds ratios (ORs) and probabilities. The ORs indicate the strength of preference for one characteristic relative to another (base) characteristic. In total, 620 respondents answered the DCE questions. Most respondents reported that they were white (93%) and were either gay or bisexual (99%). The LCM showed that there were 2 classes within the respondent sample that appeared to have different preferences for the testing options. The first group, which was likely to contain 86% of respondents, had a strong preference for face-to-face tests by healthcare professionals (HCPs) compared to remote testing (OR 6.4; 95% CI 5.6, 7.4) and viewed not testing as less preferable than remote testing (OR 0.10; 95% CI 0.09, 0.11). In the second group, which was likely to include 14% of participants, not testing was viewed as less desirable than remote testing (OR 0.56; 95% CI 0.53, 0.59) as were tests by HCPs compared to remote testing (OR 0.23; 95% CI 0.15, 0.36). In both classes, free remote tests instead of each test costing £30 was the test characteristic with the largest impact on the choice of testing option. Participants in the second group were more likely to have never previously tested and to be non-white than participants in the first group. The main study limitations were that the sample was recruited solely via social media, the study advert was viewed only by people expressing an interest in online material used by MSM, and the choices in the experiment were hypothetical rather...

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Section: Discussionsupporting

confidence: 84%

Preferences for HIV testing services among men who have sex with men in the UK: A discrete choice experiment

et al. 2019

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“…Prior research documents a willingness to self‐test . Nunn and colleagues showed that among the participants surveyed in predominantly African American U.S. neighbourhoods with 3% HIV prevalence, nearly 90% were likely or very likely to accept a free HIV self‐test, and 55% were willing to purchase a test; however, only 23% were willing to pay the market price ($40/test) . Therefore, public sector funding may be critical for the adoption of HIV self‐testing among high‐risk populations.…”

Section: Discussionmentioning

confidence: 99%

Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States

Shrestha

Chavez

Noble³

et al. 2020

J Intern AIDS Soc

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Introduction HIV testing is an essential prerequisite for accessing treatment with antiretroviral therapy or prevention using pre‐exposure prophylaxis. Internet distribution of HIV self‐tests is a novel approach, and data on the programmatic cost of this approach are limited. We analyse the costs and cost‐effectiveness of a self‐testing programme. Methods Men who have sex with men (MSM) reporting unknown or negative HIV status were enrolled from March to August 2015 into a 12‐month trial of HIV self‐testing in the United States. Participants were randomly assigned either to the self‐testing arm or the control arm. All participants received information on HIV testing services and locations in their community. Self‐testing participants received up to four self‐tests each quarter, which they could use themselves or distribute to their social network associates. Quarterly follow‐up surveys collected testing outcomes, including number of tests used and new HIV diagnoses. Using trial expenditure data, we estimated the cost of implementing a self‐testing programme. Primary outcomes of this analysis included total programme implementation costs, cost per self‐test completed, cost per person tested, cost per new HIV diagnosis among those self‐tested and cost per quality adjusted life year (QALY) saved. Results A total of 2665 men were assigned either to the self‐testing arm (n = 1325) or the control arm (n = 1340). HIV testing was reported by 971 self‐testing participants who completed a total of 5368 tests. In the control arm, 619 participants completed 1463 HIV tests. The self‐testing participants additionally distributed 2864 self‐tests to 2152 social network associates. Testing during the trial identified 59 participants and social network associates with newly diagnosed HIV infection in the self‐testing arm; 11 control participants were newly diagnosed with HIV. The implementation cost of the HIV self‐testing programme was $449,510. The cost per self‐test completed, cost per person tested at least once, and incremental cost per new HIV diagnosis was $61, $145 and $9365 respectively. We estimated that self‐testing programme potentially averted 3.34 transmissions, saved 14.86 QALYs and nearly $1.6 million lifetime HIV treatment costs. Conclusions The HIV self‐testing programme identified persons with newly diagnosed HIV infection at low cost, and the programme is cost saving.

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“…Nunn et al investigated the acceptability and the willingness to take and pay for an HIV self-test in a predominately African American neighborhood in the United States. Approximately 90% of respondents were willing to use an HIV self-test and 55% were willing to buy an HIV self-test; however, individuals in the low-risk class were less willing to self-test compared to those with concurrent sexual partners [30]. In another study conducted by Whittington et al to determinate the demand for a hypothetical HIV vaccine in Mexico (Guadalajara), the median WTP value was US$316 [31], which was similar to Cameron et al [26].…”

Section: Discussionmentioning

confidence: 99%

Consumer willingness to pay for a hypothetical Zika vaccine in Brazil and the implications

Júnior

Godói

Reis

et al. 2018

Expert Review of Pharmacoeconomics & Outcomes Research

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Background: Zika virus is a newly emerging infection, associated with increasingly large outbreaks especially in tropical countries such as Brazil. A future Zika vaccine can contribute to decreasing the number of cases and associated complications. Information about consumers' willingness to pay (WTP) for a hypothetical Zika vaccine can help price setting discussions in the future in Brazil, starting with the private market. Methods: A cross-sectional study conducted among residents of Minas Gerais, Brazil, regarding their WTP for a hypothetical Zika Vaccine. The mean effective protection was 80%, with the possibility of some local and systemic sideeffects. Results: 517 people were interviewed. However, 30 would not be vaccinated even if the vaccine was free. Most of the resultant interviewees (489) were female (58.2%), had completed high school (49.7%), were employed (71.2%), had private health insurance (52.7%) and did not have Zika (96.9%). The median individual maximum willingness to pay for this hypothetical Zika vaccine (one dose) was US$31.34 (BRL100.00). Conclusion: Such discussions can contribute to decision-making about prices once a Zika vaccine becomes available in Brazil alongside other ongoing programmes to control the virus.

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Latent class analysis of acceptability and willingness to pay for self‐HIV testing in a United States urban neighbourhood with high rates of HIV infection

Cited by 20 publications

References 20 publications

Preferences for HIV testing services among men who have sex with men in the UK: A discrete choice experiment

Preferences for HIV testing services among men who have sex with men in the UK: A discrete choice experiment

Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States

Consumer willingness to pay for a hypothetical Zika vaccine in Brazil and the implications

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