Effect of Prices, Distribution Strategies, and Marketing on Demand for HIV Self-testing in Zimbabwe

Chang, Wei; Matambanadzo, Primrose; Takaruza, Albert; Hatzold, Karin; Cowan, Frances M; Sibanda, Euphemia L; Thirumurthy, Harsha

doi:10.1001/jamanetworkopen.2019.9818

Cited by 26 publications

(45 citation statements)

References 31 publications

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“…The fact that we find substantial demand at low prices among a relatively representative sample of health clinic/pharmacy attendees suggests a low degree of “information avoidance” in this population, a behavior in which individuals pay to avoid receiving information, including health information (e.g., see Golman, Hagmann, & Loewenstein, , for a review). , Second, despite substantial demand at positive prices relative to previous self‐testing studies, we find that demand is at least as price elastic as that found in previous studies (e.g., Chang et al, ; Cohen et al, ; Thirumurthy et al, ) and that this is true over a wide range of prices. Third, we present results from a study sample—youth, men, and women attending pharmacies/clinics—that comprises a substantial portion of the general population and offers a touchpoint for this population, complementing HIV self‐test WTP estimates from antennal/postnatal clinic attendees and their male partners (Masters et al, ; Thirumurthy et al, ; Thirumurthy et al, ).…”

Section: Introductioncontrasting

confidence: 75%

“…44 The implied elasticity in Thirumurthy et al (2018) is 1.5. The implied elasticity in Chang et al (2019) over the full range of prices (i.e., US$0 to US $3) is 0.95, yet it is inelastic demand near a price of zero that is driving this result. The elasticities at higher prices are higher.…”

Section: Discussionmentioning

confidence: 97%

“…The small body of evidence on elasticity of demand for self‐tests suggests a broad range of possible elasticities, including inelastic and elastic demand. The implied elasticities at prices upwards of zero in Cohen et al (), Thirumurthy et al (), and Chang et al ()—the only three existing self‐test studies that appear to measure demand at positive prices—are approximately 0.8, 1.5, and 0.95, respectively. , ,…”

Section: Introductionmentioning

confidence: 95%

“…Thirumurthy et al (2018) measures WTP using stated preference among 284 respondents in Kisumu, Kenya, and finds take-up of at least 88% at zero price. Chang et al (2019) measures take-up at zero price in a sample of 3,996 individuals in Zimbabwe and find 33% redeemed their vouchers for an HIV self-test.…”

mentioning

confidence: 99%

“…Thirumurthy et al (2018) use stated preference (i.e., nonincentivized) willingness to pay, measuring demand at all prices. Chang et al (2019) measure demand at five prices: US$0.00, US$0.50, US $1.00, US$2.00, and US$3.00. 8 Another broadly related study is Thornton (2008), a study in Malawi that subsidized the price for an individual to get their HIV test results conditional on taking a survey-based HIV test from a baseline of $0 to approximately minus $1 (equivalent to one day's wage).…”

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confidence: 99%

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Demand for self‐tests: Evidence from a Becker–DeGroot–Marschak mechanism field experiment

et al. 2020

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Self‐tests offer one approach for reducing frictions underlying low demand for preventive health inputs, yet there is little evidence on demand for self‐tests. We used the Becker–DeGroot–Marschak mechanism—an incentive‐compatible approach—to elicit exact willingness to pay (WTP) for HIV self‐tests in a field experiment with 822 participants at 66 health clinics/pharmacies in Kenya. Our analysis reveals substantial demand at low prices and highly elastic demand at a wide range of prices above this range. We find few participants with nonpositive WTP. We examine correlates of WTP and discuss policy and research implications of our findings.

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Section: Introductioncontrasting

confidence: 75%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 95%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Demand for self‐tests: Evidence from a Becker–DeGroot–Marschak mechanism field experiment

et al. 2020

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The Enduring Debate Over Cost Sharing for Essential Public Health Tools

Cohen

2019

JAMA Netw Open

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In the translation of health technology innovations into actual public health, among the most consequential decisions to be made is what to charge the end user. Achieving sufficient coverage with essential tools to control diseases like HIV and malaria requires price subsidies, particularly in low-income countries. Subsidies are necessary because willingness to pay and ability to pay are both assumed to be low in these settings. Economic theory predicts that willingness to pay will be too low because individual demand for essential health tools will not take community benefits, or externalities, into account. Ability to pay is likely low because of poverty. Owing to their crucial role in attaining high levels of coverage, subsidies for preventive, diagnostic, and treatment technologies make up a substantial portion of donor funding for infectious disease control. 1 While the need for subsidies is clear, the appropriate level of subsidy is not clear, and is often chosen based on guesses and trial and error. Higher subsidies should increase coverage, with the greatest coverage occurring when the subsidy is 100% (ie, the product is free). However, higher subsidies can pose trade-offs with respect to targeting products to the highest-value users. 2 A concern about free distribution of health tools such as insecticide-treated nets to prevent malaria, water purification kits to prevent diarrheal disease, and HIV self-tests is that anyone will take these tools when they are free-including people who do not need them and will not use them. If people who value and need tools most are also the ones most willing to pay, then lower subsidy levels could be a cost-effective approach to allocating scarce resources. Arguments for cost sharing (ie, partial rather than full subsidies) are generally based on this reasoning. However, cost sharing can also screen out the poorest households, who have limited financial resources but need the product most.The optimal subsidy will depend on how sensitive people are to price and how successfully price functions as a targeting mechanism.Chang and coauthors 3 add strong evidence to the growing body of work suggesting that even small amounts of cost sharing for health products can have substantial effects on uptake in low-income countries. 2,4 Chang et al 3 used a randomized trial to evaluate the impact of various distribution strategies-including variation in pricing, distribution point, and messaging-on demand for rapid HIV self-tests in Zimbabwe. Households were given vouchers that could be redeemed for a test, with randomly assigned prices between $0 (full subsidy

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HIV Self-testing and Risk Behaviors Among Men Who Have Sex With Men in 23 US Cities, 2017

et al. 2022

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ImportanceHIV self-testing (HIVST) is a promising strategy to expand the HIV care continuum, particularly among priority populations at high risk of HIV infection. However, little is known about HIVST uptake among men who have sex with men (MSM) outside of clinical trial settings.ObjectiveTo evaluate HIVST use among urban MSM in the US who reported testing within the past 12 months.Design, Setting, and ParticipantsA cross-sectional study of adult MSM in the 2017 National HIV Behavioral Surveillance system, which used venue-based sampling methods to collect data related to HIV testing, receipt of prevention services, and risk factors for HIV, was conducted at 588 venues in 23 urban areas in the contiguous US and Puerto Rico. All participants were offered HIV testing. Adult cisgender MSM who reported HIV-negative or unknown HIV status and obtained HIV testing in the past 12 months were included. Data for this study were collected between June 4, 2017, and December 22, 2017, and analyzed between October 23, 2020, and August 20, 2021.Main Outcomes and MeasuresSelf-reported HIVST in the past year. Adjusted prevalence ratios (aPRs) using survey weights were calculated to assess factors associated with HIVST.ResultsA total of 6563 MSM in 23 urban areas met inclusion criteria, of whom 506 (7.7%) individuals reported HIVST in the past year. The median age of self-testers was 29 (IQR, 25-35) years, 52.8% had completed college, and 37.9% reported non-Hispanic White race. One self-tester reported seroconverting in the prior 12 months, and an additional 10 self-testers were diagnosed with HIV during the survey. HIVST was associated with sexual orientation disclosure (aPR, 10.27; 95% CI, 3.45-30.60; P &lt; .001), perceived discrimination against people with HIV (aPR, 1.53; 95% CI, 1.09-2.03; P = .01), younger age (aPR, 0.74; 95% CI, 0.66-0.84; P &lt; .001), higher educational level (aPR, 1.20; 95% CI, 1.04-1.37; P = .01), and higher income levels (aPR, 1.18; 95% CI, 1.04-1.32; P = .009). No association was noted with condomless anal sex (aPR, 0.96; 95% CI, 0.88-1.06, P = .88), sexually transmitted infections (aPR, 0.96; 95% CI, 0.70-1.30; P = .77), or preexposure prophylaxis use (aPR, 0.99; 95% CI, 0.75-1.30; P = .92).Conclusions and RelevanceIn this study, HIVST was relatively uncommon in this sample of urban MSM. HIVST may not be reaching those with lower socioeconomic status or who have not disclosed their sexual identity. The findings of this study suggest that efforts to increase HIVST should focus on engaging underserved and vulnerable subgroups of MSM.

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Effect of Prices, Distribution Strategies, and Marketing on Demand for HIV Self-testing in Zimbabwe

Cited by 26 publications

References 31 publications

Demand for self‐tests: Evidence from a Becker–DeGroot–Marschak mechanism field experiment

Demand for self‐tests: Evidence from a Becker–DeGroot–Marschak mechanism field experiment

The Enduring Debate Over Cost Sharing for Essential Public Health Tools

HIV Self-testing and Risk Behaviors Among Men Who Have Sex With Men in 23 US Cities, 2017

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