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Block Ngaybe MG, Ravi P, Rosales A, Camarena JL, Madhivanan P. Systematic review study protocol of literature from 2018 to end of 2022 of stated preference studies about HIV care and prevention services around the world. BMJ Open 2024; 14:e072661. [PMID: 38548370 PMCID: PMC10982804 DOI: 10.1136/bmjopen-2023-072661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/12/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND There are currently over 38 million individuals around the globe living with the HIV and AIDS. As many HIV prevention and care services emerging for public use services become available to a wider audience, there is a growing need for more information about willingness to engage in these care and services. Stated preference research methods have been shown to be useful methods to help predict factors that influence health behaviours in the future. RESEARCH QUESTION This is a systematic review of findings from stated preference studies regarding the choices of people living with HIV or people at risk of contracting HIV to engage in HIV prevention or care. METHODS Our team plans to compile stated preference studies studying the choice to engage in HIV prevention or care services. Studies will be included from 1 January 2018 until 28 October 2022. There will be no restrictions on the language or location of the study. We will search databases including PubMed, PsycINFO, Embase, Scopus, Tufts CEA registry and CINAHL. Two researchers will review each article's title, abstract, then full-text and finally extract relevant data based on a predetermined process. Data will be presented in a narrative review and in an exploratory meta-analysis by subgroups of studies. ETHICS AND DISSEMINATION OF RESEARCH There is no need for an ethical review process of this study since all data used is available publicly. The findings of this study will be reported in relevant conferences and submitted for publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023397785.
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Affiliation(s)
- Maiya G Block Ngaybe
- Department of Health Promotion Sciences, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Priyanka Ravi
- Department of Health Promotion Sciences, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Arturo Rosales
- Department of Epidemiology, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Jose L Camarena
- Department of Epidemiology, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
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Dubov A, Altice FL, Gutierrez JI, Wickersham JA, Azwa I, Kamarulzaman A, Gautam K, Shrestha R. Pre-exposure prophylaxis service among men who have sex with men in Malaysia: findings from a discrete choice experiment. Sci Rep 2023; 13:14200. [PMID: 37648731 PMCID: PMC10468492 DOI: 10.1038/s41598-023-41264-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023] Open
Abstract
Men who have sex with men (MSM) in Malaysia are disproportionately affected by HIV. As pre-exposure prophylaxis (PrEP) is being introduced, we assessed population-based PrEP delivery preferences among MSM in Malaysia. We conducted a discrete choice experiment through an online survey among 718 MSM. The survey included 14 choice tasks presenting experimentally varied combinations of five attributes related to PrEP delivery (i.e., cost, dosing strategy, clinician interaction strategy, dispensing venue, and burden of visits to start PrEP). We used latent class analysis and Hierarchical Bayesian modeling to generate the relative importance of each attribute and preference across six possible PrEP delivery programs. PrEP dosing, followed by cost, was the most important attribute. The participants were clustered into five preference groups. Two groups (n = 290) most commonly preferred on-demand, while the other three preferred injectable PrEP. One group (n = 188) almost exclusively considered cost in their decision-making, and the smallest group (n = 86) was substantially less interested in PrEP for reasons unrelated to access. In simulated scenarios, PrEP initiation rates varied by the type of program available to 55·0% of MSM. Successful PrEP uptake among Malaysian MSM requires expanding beyond daily oral PrEP to on-demand and long-acting injectable PrEP, especially at affordable cost.
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Affiliation(s)
- Alex Dubov
- School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA
| | - Frederick L Altice
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - José I Gutierrez
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey A Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Iskandar Azwa
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Rd, Unit 1101, Storrs, CT, 06269, USA
| | - Roman Shrestha
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Rd, Unit 1101, Storrs, CT, 06269, USA.
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Ung M, Martin S, Terris-Prestholt F, Quaife M, Tieosapjaroen W, Phillips T, Lee D, Chow EPF, Medland N, Bavinton BR, Pan SW, Mao L, Ong JJ. Preferences for HIV prevention strategies among newly arrived Asian-born men who have sex with men living in Australia: A discrete choice experiment. Front Public Health 2023; 11:1018983. [PMID: 36992887 PMCID: PMC10040803 DOI: 10.3389/fpubh.2023.1018983] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 02/16/2023] [Indexed: 03/14/2023] Open
Abstract
The HIV epidemic in Australia is changing with higher risk for HIV among newly-arrived Asian-born men who have sex with men (MSM) compared to Australian-born MSM. We evaluated the preferences for HIV prevention strategies among 286 Asian-born MSM living in Australia for <5 years. A latent class analysis uncovered three classes of respondents who were defined by their preferences: “PrEP” (52%), “Consistent condoms” (31%), and “No strategy” (17%). Compared to the “No strategy” class, men in the “PrEP” class were less likely to be a student or ask their partner for their HIV status. Men in the “Consistent condoms” class were more likely to get information about HIV from online, and less likely to ask their partner for their HIV status. Overall, PrEP was the preferred HIV prevention strategy for newly arrived migrants. Removing structural barriers to access PrEP can accelerate progress toward ending HIV transmission.
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Affiliation(s)
- Megan Ung
- Department of Infectious Diseases and Microbiology, Concord Hospital, Sydney, NSW, Australia
| | - Sarah Martin
- Canberra Sexual Health Centre, Canberra, ACT, Australia
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew Quaife
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Warittha Tieosapjaroen
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Tiffany Phillips
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - David Lee
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia
| | - Eric P. F. Chow
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Nick Medland
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Stephen W. Pan
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
- University of Liverpool, Liverpool, United Kingdom
| | - Limin Mao
- Centre for Social Research and Health, University of Sydney, Sydney, NSW, Australia
| | - Jason J. Ong
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- *Correspondence: Jason J. Ong
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Rodriguez CA, Mitchell JW. Use of Stated Preference Methods in HIV Treatment and Prevention Research in the United States: A Systematic Review. AIDS Behav 2023; 27:2328-2359. [PMID: 36809490 DOI: 10.1007/s10461-022-03962-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 02/23/2023]
Abstract
Stated preference (SP) methods are increasingly being applied to HIV-related research and continuously provide researchers with health utility scores of select healthcare products or services that populations consider important. Following PRISMA guidelines, we sought to understand how SP methods have been applied in HIV-related research. We conducted a systematic review to identify studies meeting the following criteria: SP method is clearly stated, conducted in the United States, was published between 01/01/2012 and 02/12/2022, and included adults aged 18 and over. Study design and SP method application were also examined. We identified six SP methods (e.g., Conjoint Analysis, Discrete Choice Experiment) across 18 studies, which were categorized into one of two groups: HIV prevention and HIV treatment-care. Categories of attributes used in SP methods largely focused on: administration, physical/health effects, financial, location, access, and external influences. SP methods are innovative tools capable of informing researchers on what populations consider most beneficial when deciding on treatment, care, or prevention options for HIV.
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Affiliation(s)
- Christofer A Rodriguez
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC-5 Ste. 405, Miami, FL, 33199, USA.
| | - Jason W Mitchell
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC-5 Ste. 405, Miami, FL, 33199, USA
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Guigayoma J, Becker SJ, Ong JJ, Kanamori M, Hickson D, Ward LM, Biello KB, Wray T. Addressing key issues in HIV self-test program implementation for Black and Latino sexual minority men in the Southern United States: a multiphase study protocol. Implement Sci Commun 2023; 4:14. [PMID: 36782303 PMCID: PMC9926573 DOI: 10.1186/s43058-023-00395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 01/30/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Black and Latino sexual minority men in the Southern United States have the highest HIV infection rates in the country. Increased HIV testing can help decrease onward HIV transmission through detecting previously undiagnosed infections. HIV self-testing is an evidence-based strategy to increase HIV testing among sexual minority men, but the implementation of this intervention in the Southern United States is limited. One implementation barrier is the lack of knowledge of Black and Latino sexual minority men's preferences for various HIV self-testing program characteristics and their willingness to pay for these preferences. In addition, little is known about facilitators and barriers to initiating HIV self-testing programs from the perspectives of HIV prevention implementation decision-makers in this region. METHODS We will conduct an online discrete choice experiment among Black and Latino sexual minority men in the Southern United States (n = 300) to estimate this population's preferences for the following HIV self-testing program characteristics: delivery strategy (home delivery, peer delivery, clinic pickup); delivery speed (same day, next day, 3 days, and 5 days); support (instructions only, during test, and 1 week after delivery); and price ($0, $20, $40, $50, $60). We will also use this choice data to generate willingness-to-pay estimates for each program characteristic. Guided by the Consolidated Framework for Implementation Research, we will then conduct semi-structured interviews (n = 30) with HIV prevention program decision-makers at various health organizations serving Black and Latino sexual minority men in the region to further understand facilitators and barriers to implementation of the most preferred HIV self-testing program design. DISCUSSION By gaining perspectives on HIV self-testing implementation from patients and providers, this project will build a roadmap for the initiation of HIV self-testing programs to decrease HIV incidence among one of the most disproportionately impacted populations in the USA.
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Affiliation(s)
- John Guigayoma
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St., Providence, RI, 02912, USA.
| | - Sara J Becker
- Center for Dissemination and Implementation Science, Institute for Public Health and Medicine, Northwestern University, 633 N. Saint Clair St., Chicago, IL, 60611, USA
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
- Central Clinical School, Monash University, 99 Commercial Rd., Melbourne, VIC, 3004, Australia
| | - Mariano Kanamori
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 10th St., FL, 33136, Miami, USA
| | - DeMarc Hickson
- Us Helping Us, People Into Living Inc., 3636 Georgia Ave. NW, Washington, DC, 20010, USA
| | - Lori M Ward
- University of Mississippi Medical Center, 2500 North State St., Jackson, MS, 39216, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St., Providence, RI, 02912, USA
- Department of Epidemiology, Brown University School of Public Health, 121 S. Main St., Providence, RI, 02912, USA
- The Fenway Institute, Fenway Health, 1340 Boylston St., Boston, MA, 02215, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 S. Main St., Providence, RI, 02912, USA
| | - Tyler Wray
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St., Providence, RI, 02912, USA
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Choudhary D, Thomas M, Pacheco-Barrios K, Zhang Y, Alonso-Coello P, Schünemann H, Hazlewood G. Methods to Summarize Discrete-Choice Experiments in a Systematic Review: A Scoping Review. THE PATIENT 2022; 15:629-639. [PMID: 35829927 DOI: 10.1007/s40271-022-00587-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Systematic reviews of discrete-choice experiments (DCEs) are being increasingly conducted. The objective of this scoping review was to identify and describe the methodologies that have been used to summarize results across DCEs. METHODS We searched the electronic databases MEDLINE and EMBASE from inception to March 18, 2021, to identify English-language systematic reviews of patient preferences that included at least two DCEs and extracted data on attribute importance. The methods used to summarize results across DCEs were classified into narrative, semi-quantitative, and quantitative (meta-analytic) approaches and compared. Approaches to characterize the extent of preference heterogeneity were also described. RESULTS From 7362 unique records, we identified 54 eligible reviews from 2010 to Mar 2021, across a broad range of health conditions. Most (83%) used a narrative approach to summarize findings of DCEs, often citing differences in studies as the reason for not formally pooling findings. Semi-quantitative approaches included summarizing the frequency of the most important attributes, the frequency of attribute statistical significance, or tabulated comparisons of attribute importance for each pair of attributes. One review conducted a meta-analysis using the maximum acceptable risk. While reviews often commented on the heterogeneity of patient preferences, few (6%) addressed this systematically across studies. CONCLUSION While not commonly used, several semi-quantitative and one quantitative approach for synthesizing results of DCEs were identified, which may be useful for generating summary estimates across DCEs when appropriate. Further work is needed to assess the validity and usefulness of these approaches.
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Affiliation(s)
- Daksh Choudhary
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Megan Thomas
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Sintesis de Evidencias en Salud, Lima, Peru
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Pablo Alonso-Coello
- Instituto de Investigación Biomédica (IIB Sant Pau), Centro Cochrane Iberoamericano, Barcelona, Spain
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Glen Hazlewood
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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Eshun‐Wilson I, Akama E, Adhiambo F, Kwena Z, Oketch B, Obatsa S, Iguna S, Kulzer JL, Nyanga J, Nyandieka E, Scheve A, Geng EH, Bukusi EA, Abougi L. Adolescent and young adult preferences for financial incentives to support adherence to antiretroviral therapy in Kenya: a mixed methods study. J Int AIDS Soc 2022; 25:e25979. [PMID: 36109803 PMCID: PMC9478044 DOI: 10.1002/jia2.25979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/20/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION To develop a patient-centred financial incentive delivery strategy to improve antiretroviral treatment adherence in adolescents and young adults (AYA) living with HIV in Kisumu, Kenya, we conducted a mixed methods study exploring preferences. METHODS A discrete choice experiment (DCE) and focus group discussion (FGD) were conducted simultaneously to identify preferences for five incentive delivery strategy features: value, eligibility, recipient, format and disbursement frequency. We used consecutive sampling to recruit AYA (14-24 years) living with HIV attending three health facilities in Kisumu, Kenya. We calculated mean preferences, willingness to trade, latent class membership and predictors of latent class membership. The FGD explored preferred incentive features, and, after deductive and inductive coding, qualitative findings were triangulated with DCE results. RESULTS Two hundred and seven AYA living with HIV (46% 14-17 years, 54% 18-24 years; 33% male sex, 89% viral load <50 copies/ml) were recruited to the study (28 October-16 November 2020). Two distinct preference phenotypes emerged from the DCE analysis (N = 199), 44.8% of the population fell into an "immediate reward" group, who wanted higher value cash or mobile money distributed at each clinic visit, and 55.2% fell into a "moderate spender" group, who were willing to accept lower value incentives in the form of cash or shopping vouchers, and accrued payments. The immediate reward group were willing to trade up to 200 Kenyan Shillings (KSH)-approximately 2 US dollars (USD)-of their 500 KSH (∼5 USD) incentive to get monthly as opposed to accrued yearly payments. The strongest predictor of latent class membership was age (RR 1.45; 95% CI: 1.08-1.95; p = 0.006). Qualitative data highlighted the unique needs of those attending boarding school and confirmed an overwhelming preference for cash incentives which appeared to provide the greatest versatility for use. CONCLUSIONS Providing small financial incentives as cash was well-aligned with AYA preferences in this setting. AYA should additionally be offered a choice of other incentive delivery features (such as mobile money, recipient and disbursement frequency) to optimally align with the specific needs of their age group and life stage.
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Affiliation(s)
- Ingrid Eshun‐Wilson
- Division of Infectious Diseases, Department of MedicineWashington University in St. LouisSt. LouisMissouriUSA
| | - Eliud Akama
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Fridah Adhiambo
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Zachary Kwena
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Bertha Oketch
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Sarah Obatsa
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Sarah Iguna
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Jayne L. Kulzer
- Department of Obstetrics, Gynecology, and Reproductive ServicesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - James Nyanga
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Everlyne Nyandieka
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Ally Scheve
- Division of Infectious Diseases, Department of MedicineWashington University in St. LouisSt. LouisMissouriUSA
| | - Elvin H. Geng
- Division of Infectious Diseases, Department of MedicineWashington University in St. LouisSt. LouisMissouriUSA
| | - Elizabeth A. Bukusi
- Research Care Training Program, Centre for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Lisa Abougi
- Division of PediatricsUniversity of ColoradoBoulderColoradoUSA
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Neary J, Bulterys MA, Ogutu EA, O’Malley G, Otieno AA, Omondi VO, Wang Y, Zhai X, Katz DA, Oyiengo L, Wamalwa DC, Slyker JA, John-Stewart GC, Njuguna IN, Wagner AD. Brief Report: Pediatric Saliva-Based HIV Testing: Health care Worker and Caregiver Acceptability. J Acquir Immune Defic Syndr 2022; 90:517-523. [PMID: 35499505 PMCID: PMC9283261 DOI: 10.1097/qai.0000000000003004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric HIV testing remains suboptimal. The OraQuick test [saliva-based test (SBT)] is validated in pediatric populations ≥18 months. Understanding caregiver and health care worker (HCW) acceptability of pediatric SBT is critical for implementation. METHODS A trained qualitative interviewer conducted 8 focus group discussions (FGDs): 4 with HCWs and 4 with caregivers of children seeking health services in western Kenya. FGDs explored acceptability of pediatric SBT and home- and facility-based SBT use. Two reviewers conducted consensus coding and thematic analyses of transcripts using Dedoose. RESULTS Most HCWs but few caregivers had heard of SBT. Before seeing SBT instructions, both had concerns about potential HIV transmission through saliva, which were mostly alleviated after kit demonstration. Noted benefits of SBT included usability and avoiding finger pricks. Benefits of facility-based pediatric SBT included shorter client waiting and service time, higher testing coverage, and access to HCWs, while noted challenges included ensuring confidentiality. Benefits of caregivers using home-based SBT included convenience, privacy, decreased travel costs, increased testing, easier administration, and child comfort. Perceived challenges included not receiving counseling, disagreements with partners, child neglect, and negative emotional response to a positive test result. Overall, HCWs felt that SBT could be used for pediatric HIV testing but saw limited utility for caregivers performing SBT without an HCW present. Caregivers saw utility in home-based SBT but wanted easy access to counseling in case of a positive test result. CONCLUSIONS SBT was generally acceptable to HCWs and caregivers and is a promising strategy to expand testing coverage.
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Affiliation(s)
- Jillian Neary
- Department of Epidemiology, University of Washington, Seattle, WA
| | | | - Emily A. Ogutu
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA
| | - Gabrielle O’Malley
- Department of Global Health, University of Washington, Seattle, WA
- International Training and Education Center for Health, University of Washington, Seattle, WA
| | | | | | - Yu Wang
- Department of Global Health, University of Washington, Seattle, WA
| | - Xinyi Zhai
- Department of Global Health, University of Washington, Seattle, WA
| | - David A. Katz
- Department of Global Health, University of Washington, Seattle, WA
| | - Laura Oyiengo
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Dalton C. Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Jennifer A. Slyker
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
| | - Grace C. John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Irene N. Njuguna
- Department of Global Health, University of Washington, Seattle, WA
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Anjuli D. Wagner
- Department of Global Health, University of Washington, Seattle, WA
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HIV Testing Uptake According to Opt-In, Opt-Out or Risk-Based Testing Approaches: a Systematic Review and Meta-Analysis. Curr HIV/AIDS Rep 2022; 19:375-383. [PMID: 35829949 PMCID: PMC9508204 DOI: 10.1007/s11904-022-00614-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 11/18/2022]
Abstract
Purpose of Review Improving HIV testing uptake is essential to ending the HIV pandemic. HIV testing approaches can be opt-in, opt-out or risk-based. This systematic review examines and compares the uptake of HIV testing in opt-in, opt-out and risk-based testing approaches. Recent Findings There remain missed opportunities for HIV testing in a variety of settings using different approaches: opt-in (a person actively accepts to be tested for HIV), opt-out (a person is informed that HIV testing is routine/standard of care, and they actively decline if they do not wish to be tested for HIV) or risk-based (using risk-based screening tools to focus testing on certain individuals or sub-populations at greater risk of HIV). It is not clear how the approach could impact HIV test uptake when adjusted for other factors (e.g. rapid testing, country-income level, test setting and population tested). Summary We searched four databases for studies reporting on HIV test uptake. In total, 18,238 records were screened, and 150 studies were included in the review. Most studies described an opt-in approach (87 estimates), followed by opt-out (76) and risk-based (19). Opt-out testing was associated with 64.3% test uptake (I2 = 99.9%), opt-in testing with 59.8% (I2 = 99.9%) and risk-based testing with 54.4% (I2 = 99.9%). When adjusted for settings that offered rapid testing, country income level, setting and population tested, opt-out testing had a significantly higher uptake (+ 12% (95% confidence intervals: 3–21), p = 0.007) than opt-in testing. We also found that emergency department patients and hospital outpatients had significantly lower HIV test uptake than other populations. Supplementary Information The online version contains supplementary material available at 10.1007/s11904-022-00614-0.
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Zhang Y, Wiseman V, Applegate TL, Lourenco RDA, Street DJ, Smith K, Jamil MS, Terris-Prestholt F, Fairley CK, McNulty A, Hynes A, Johnson K, Chow EPF, Bavinton BR, Grulich A, Stoove M, Holt M, Kaldor J, Guy R, Ong JJ. Preferences for HIV Testing Services and HIV Self-Testing Distribution Among Migrant Gay, Bisexual, and Other Men Who Have Sex With Men in Australia. Front Med (Lausanne) 2022; 9:839479. [PMID: 35514755 PMCID: PMC9063480 DOI: 10.3389/fmed.2022.839479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/16/2022] [Indexed: 01/13/2023] Open
Abstract
Background In Australia, undiagnosed HIV rates are much higher among migrant gay, bisexual, or other men who have sex with men (GBMSM) than Australian-born GBMSM. HIV self-testing is a promising tool to overcome barriers to HIV testing and improve HIV testing uptake among migrant GBMSM. We compared the preferences for HIV testing services, including HIV self-testing, among migrant and Australian-born GBMSM. Methods Preferences were assessed via two discrete choice experiments (DCEs). Participants were recruited between December 2017 and January 2018 using online and offline advertising and randomly assigned to complete one of two online DCE surveys. Migrant GBMSM were classified as being born in a country with a reciprocal healthcare agreement (RHCA) with Australia (providing free or subsided health care) or not. Latent class analysis and mixed logit models were used to explore heterogeneity in preferences. Findings We recruited 1,606 GBMSM, including 583 migrant men of whom 419 (72%) were born in non-RHCA countries. Most participants preferred a free or cheap oral test with higher accuracy and a shorter window period to facilitate early detection of infections. Cost was more important for men born in non-RHCA countries than for men from RHCA countries or Australia. All groups preferred accessing kits through online distributers or off the shelf purchasing from pharmacies. Men born in RHCA countries least preferred accessing HIV self-testing kits from a medical clinic, while more than half of men from non-RHCA countries most preferred sourcing kits from a clinic. Sex-on-premises venues were the least preferred location to access test kits among all groups. In addition, two latent class analyses explored heterogeneity in preferences among men from non-RHCA countries and we found four latent classes for HIV testing services and two latent classes for HIVST distribution. Interpretation Our findings emphasise the need for high-performing and low-cost HIV self-testing kits that are accessible from a variety of distribution points as a component of Australia's HIV response, especially for those who do not have access to free or subsidised health care in Australia.
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Affiliation(s)
- Ye Zhang
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia,*Correspondence: Ye Zhang
| | - Virginia Wiseman
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tanya L. Applegate
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Deborah J. Street
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Kirsty Smith
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Muhammad S. Jamil
- Global Human immunodeficiency virus (HIV), Hepatitis and Sexually transmitted infections (STIs) Programmes, World Health Organization, Geneva, Switzerland
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher K. Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia,School of Population Health, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Adam Hynes
- Thorne Harbour Health, Melbourne, VIC, Australia
| | | | - Eric P. F. Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Benjamin R. Bavinton
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Andrew Grulich
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | | | - Martin Holt
- Centre for Social Research in Health, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - John Kaldor
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Rebecca Guy
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Jason J. Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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11
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Johnson CA, Tran DN, Mwangi A, Sosa-Rubí SG, Chivardi C, Romero-Martínez M, Pastakia S, Robinson E, Jennings Mayo-Wilson L, Galárraga O. Incorporating respondent-driven sampling into web-based discrete choice experiments: preferences for COVID-19 mitigation measures. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2022; 22:297-316. [PMID: 35035272 PMCID: PMC8747856 DOI: 10.1007/s10742-021-00266-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/22/2021] [Accepted: 11/25/2021] [Indexed: 11/28/2022]
Abstract
To slow the spread of COVID-19, most countries implemented stay-at-home orders, social distancing, and other nonpharmaceutical mitigation strategies. To understand individual preferences for mitigation strategies, we piloted a web-based Respondent Driven Sampling (RDS) approach to recruit participants from four universities in three countries to complete a computer-based Discrete Choice Experiment (DCE). Use of these methods, in combination, can serve to increase the external validity of a study by enabling recruitment of populations underrepresented in sampling frames, thus allowing preference results to be more generalizable to targeted subpopulations. A total of 99 students or staff members were invited to complete the survey, of which 72% started the survey (n = 71). Sixty-three participants (89% of starters) completed all tasks in the DCE. A rank-ordered mixed logit model was used to estimate preferences for COVID-19 nonpharmaceutical mitigation strategies. The model estimates indicated that participants preferred mitigation strategies that resulted in lower COVID-19 risk (i.e. sheltering-in-place more days a week), financial compensation from the government, fewer health (mental and physical) problems, and fewer financial problems. The high response rate and survey engagement provide proof of concept that RDS and DCE can be implemented as web-based applications, with the potential for scale up to produce nationally-representative preference estimates.
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Affiliation(s)
- Courtney A Johnson
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-2, Providence, RI 02912 USA
| | - Dan N Tran
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA USA
| | - Ann Mwangi
- Department of Behavioural Science, School of Medicine, Moi University, Eldoret, Kenya
| | | | - Carlos Chivardi
- National Institute of Public Health (INSP), Cuernavaca, Morelos Mexico
| | | | - Sonak Pastakia
- Center for Health Equity and Innovation, Purdue University College of Pharmacy, Indianapolis, IN USA
| | | | | | - Omar Galárraga
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-2, Providence, RI 02912 USA
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12
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Chiwire P, Mühlbacher AC, Evers SM, Mahomed H, Ostermann J, Hiligsmann M. A discrete choice experiment investigating HIV testing preferences in South Africa. J Med Econ 2022; 25:481-490. [PMID: 35315750 DOI: 10.1080/13696998.2022.2055937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND South Africa (SA) has the world's highest burden of HIV infection, with an estimated 13.7% of the population living with HIV (PLWH/Persons Living With HIV). The early identification of PLWH and rapid engagement of them in HIV treatment are indispensable tools in the fight against HIV transmission. Understanding client preferences for HIV testing may help improve uptake. This study aimed to elicit client preferences for key characteristics of HIV testing options. METHODS A discrete-choice experiment (DCE) was conducted among individuals presenting for HIV testing at two public primary healthcare facilities in Cape Town, South Africa. Participants were asked to make nine choices between two unlabeled alternatives that differed in five attributes, in line with previous DCEs conducted in Tanzania and Colombia: testing availability, distance from the testing center, method for obtaining the sample, medication availability at testing centers, and confidentiality. Data were analyzed using a random parameter logit model. RESULTS A total of 206 participants agreed to participate in the study, of whom 199 fully completed the choice tasks. The mean age of the participants was 33.6 years, and most participants were female (83%). Confidentiality was the most important attribute, followed by distance from the testing center and the method of obtaining a sample. Patients preferred finger prick to venipuncture as a method for obtaining the sample. Medication availability at the testing site was also preferred over a referral to an HIV treatment center for a positive HIV test. There were significant variations in preferences among respondents. CONCLUSION In addition to accentuating the importance of confidentiality, the method for obtaining the sample and the location of sites for collection of medication should be considered in the testing strategy. The variations in preferences within target populations should be considered in identifying optimal testing strategies.
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Affiliation(s)
- P Chiwire
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - A C Mühlbacher
- Institut Gesundheitsökonomie und Medizinmanagement, Neubrandenburg, Germany
| | - S M Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - H Mahomed
- Metro Health Services, Western Cape Government: Health and Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J Ostermann
- Centre for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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13
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Pereira CCDA, Torres TS, Luz PM, Hoagland B, Farias A, Brito JDU, Guimarães Lacerda MV, da Silva DAR, Benedetti M, Pimenta MC, Grinsztejn B, Veloso VG. Preferences for pre-exposure prophylaxis (PrEP) among men who have sex with men and transgender women at risk of HIV infection: a multicentre protocol for a discrete choice experiment in Brazil. BMJ Open 2021; 11:e049011. [PMID: 34580095 PMCID: PMC8477321 DOI: 10.1136/bmjopen-2021-049011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is an important and well-established prevention strategy for sexual acquisition of HIV. In Brazil, transgender women (TGW) and men who have sex with men (MSM) bear the largest burden among key populations. Little is known about preferences for PrEP characteristics in these vulnerable populations in Latin America. The goal of this study is to investigate preferences of TGW and MSM with respect to PrEP characteristics, whether current user or not, and to assess any attributes and levels that may improve the decision to start using PrEP (uptake) and optimal continuity of use (adherence), which are important dimensions for PrEP success. METHODS AND ANALYSIS We hereby outline the protocol of a discrete choice experiment (DCE) to be conducted among TGW and MSM in Brazil. The study will be carried out in two phases. The first phase involves literature review and qualitative approaches including in-depth interviews to inform the development of the DCE (attributes and levels). The second phase entails the DCE survey and supporting questions pertaining to sociodemographic and risk behaviour information. The survey is aimed at current PrEP users and non-users, consisting of two modes of administration: face to face in five Brazilian capitals (Rio de Janeiro, Brasília, Manaus, Porto Alegre and Salvador) and online targeting the entire country. A D-efficient zero-prior blocked experimental design will be used to select 60 paired-profile DCE choice tasks, in which participants will be randomly assigned to one of four groups and presented with a set of 15 choice tasks. The planned sample size is 1000 volunteers. ETHICS, TIMELINE AND DISSEMINATION The study was approved by Comitê de Ética em Pesquisa-Instituto Nacional de Infectologia Evandro Chagas-INI/FIOCRUZ, CEP/INI, CAAE 28416220.2.1001.5262, approval number 3.979.759 in accordance with the Comissão Nacional de Ética em Pesquisa (CONEP-Brazilian National Board of Research Ethics). The study will be conducted between 2020 and 2021. The results will be disseminated to the scientific community and to the public in general through publications in published in peer-reviewed journals and in scientific conferences.
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Affiliation(s)
| | - Thiago Silva Torres
- Instituto Nacional de Infectologia Evandro Chagas - INI/FIOCRUZ, FIOCRUZ, Rio de Janeiro, Brazil
| | - Paula Mendes Luz
- Instituto Nacional de Infectologia Evandro Chagas - INI/FIOCRUZ, FIOCRUZ, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas - INI/FIOCRUZ, FIOCRUZ, Rio de Janeiro, Brazil
| | - Alessandro Farias
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Governo do Estado da Bahia, Salvador, Brazil
| | | | | | - Daila Alena Raenck da Silva
- Centro de Testagem Aconselhamento (CTA) Santa Marta, Porto Alegre Secretaria Municipal de Saude, Porto Alegre, Brazil
| | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas - INI/FIOCRUZ, FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria Cristina Pimenta
- Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis, Ministério da Saúde, Brasilia, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas - INI/FIOCRUZ, FIOCRUZ, Rio de Janeiro, Brazil
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