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

Abstract

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...

The incorporation of HIV self-testing as an exclusive option among men who have sex with men in Spain: results of an online cross-sectional study

“…Likewise, the fact that those not meeting current testing recommendations (last test > 12 months ago) and those with lower number of previous tests also presented higher probabilities of reporting that HIV-ST would become their exclusive testing option, could suggest that these individuals are not totally comfortable with existing testing options and could switch to remote testing options. The increased probabilities of reporting that HIV-ST would become their exclusive option in higher risk participants, is in line with a UK based study that concluded that the existence of remote testing could increase testing frequency among a small group of especially at risk MSM who favored characteristics of remote testing better than those from healthcare settings [29].…”

Sexual risk and HIV testing disconnect in men who have sex with men (MSM) recruited to an online HIV self‐testing trial

“…Lack of testing may be attributable to structural barriers to obtaining an HIV test (e.g. clinics being difficult to access because of time constraints or capacity issues or distance); lack of knowledge about how to obtain a test; low perceived risk of HIV infection and individual psycho-social issues, including potential fear of the result, fear of needles or medical procedures, and issues around disclosure of homosexual activity and perceived stigma [15,17,27,28]. Individuals enrolled in this cohort in the knowledge that they would participate in an RCT of HIVST.…”

Eliciting Preferences for HIV Prevention Technologies: A Systematic Review

“…Of the 28 studies that employed DCE, several base statistical models were reported, including conditional logit (4, 14%) [27][28][29][30], multinomial logit (5, 18%) [31][32][33][34][35][36], ordinary least-squares regression (2, 7%) [37,38], and logistic regression (1) [39]. Three (11%) reported relative impor-tance scores [32,40,41].…”

“…Several studies also conducted mixed-logit (8, 29%) [33,34,[42][43][44][45][46][47], nested-logit (3, 11%) [35,36,48], or random parameters logit (7, 25%) [32,35,[49][50][51][52][53] (some studies reported more than one model). Most of the DCE studies (24/28, 86%) further measured preference heterogeneity using stratification/subgroup analyses and/or interaction terms (17, 61%), or latent class analysis (6, 21%) [29,33,40,46,51,52]. One study used a blocked design with two different versions of the DCE for the two a priori sub-groups (past HIV testers vs non-testers) [ 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 [24,86,88,91] were also employed, as well as types of regression (linear [92,93], count [94], log binomial [95], ordinary least squares [96], and logit link [97]).…”