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Cameron MP, Newman PA, Chakrapani V, Shunmugam M, Roungprakhon S, Rawat S, Baruah D, Nelson R, Tepjan S, Scarpa R. Stated preferences for new HIV prevention technologies among men who have sex with men in India: A discrete choice experiment. PLoS One 2024; 19:e0289396. [PMID: 39046999 PMCID: PMC11268640 DOI: 10.1371/journal.pone.0289396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 07/10/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION India has the second largest HIV epidemic in the world. Despite successes in epidemic control at the population level, a concentrated epidemic persists among gay and other men who have sex with men (MSM). However, India lags in implementation of biomedical prevention technologies, such as HIV pre-exposure prophylaxis (PrEP). In order to inform scale-up of new HIV prevention technologies, including those in the development pipeline, we assessed willingness to use oral PrEP, rectal microbicides, and HIV vaccines, and choices among product characteristics, among MSM in two major Indian cities. METHODS A cross-sectional survey was conducted with a discrete choice experiment (DCE), an established methodology for quantitively estimating end-user preferences in healthcare. Survey participants were randomly assigned to one of three questionnaire versions, each of which included a DCE for one prevention technology. Participants were recruited using chain-referral sampling by peer outreach workers, beginning with seeds in community-based organizations and public sex environments, in Chennai and Mumbai. DCE data were analyzed using random-parameters (mixed) logit (RPL) models. RESULTS Among participants (n = 600), median age was 25 years, with median monthly income of INR 9,000 (~US$125). Nearly one-third (32%) had completed a college degree and 82% were single/never married. A majority of participants (63%) reported condomless anal sex in the past month. The acceptability of all three products was universally high (≥90%). Across all three products, four attributes were significant predictors of acceptability-with efficacy consistently the most important attribute, and in decreasing order of preference, side-effects, dosing schedule, and venue. MSM varied in their preferences for product attributes in relation to their levels of education and income, and engagement in sex work and HIV risk behavior. CONCLUSION This study provides empirical evidence to facilitate the integration of end users' preferences throughout design, testing, and dissemination phases of HIV prevention technologies. The findings also suggest action points and targets for interventions for diverse subgroups to support the effectiveness of combination HIV prevention among MSM in India.
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Affiliation(s)
- Michael P. Cameron
- School of Accounting, Finance and Economics, University of Waikato, Hamilton, New Zealand
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
| | | | - Murali Shunmugam
- Centre for Sexuality and Health Research and Policy, Chennai, India
| | - Surachet Roungprakhon
- Faculty of Science and Technology, Rajamangala University of Technology, Phra Nakhon, Bangkok, Thailand
| | | | | | - Ruban Nelson
- Centre for Sexuality and Health Research and Policy, Chennai, India
| | | | - Riccardo Scarpa
- School of Accounting, Finance and Economics, University of Waikato, Hamilton, New Zealand
- Business School, Durham University, Durham, United Kingdom
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Richterman A, O'Brien C, Ghadimi F, Sumners E, Ford A, Houston N, Tate S, Aitcheson N, Nkwihoreze H, Jemmott JB, Momplaisir F. Acceptability, facilitators, and barriers to a hypothetical HIV vaccine in the pre-exposure prophylaxis era. AIDS Care 2024:1-7. [PMID: 38961850 DOI: 10.1080/09540121.2024.2372715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/21/2024] [Indexed: 07/05/2024]
Abstract
Little is known about the pre-implementation context for a preventive HIV vaccine. We conducted interviews of individuals in Philadelphia recruited at Penn clinics and community-based organizations serving LGBTQ-identifying persons of color who 1) were cisgender men who had sex with men, or were transgender-identified, 2) had a sexually transmitted infection in the last 12 months, or sex with multiple partners within the last two weeks. We assessed acceptability, facilitators, and barriers to a hypothetical HIV vaccine using an integrated analysis approach. We interviewed 30 individuals between 2/2023-9/2023. Participants were supportive of an HIV vaccine and reported that they would strongly consider receiving one if one became available. Participants contextualized a hypothetical vaccine with the current HIV prevention context, primarily pre-exposure prophylaxis (PrEP), indicating that they would evaluate any future vaccine in comparison to their experience within the PrEP landscape.Reported facilitators for a hypothetical HIV vaccine included vaccine access, knowledge, and understanding; their risk for HIV exposure; and perceived benefits of the vaccine. Barriers included lack of understanding of the purpose of a vaccine, stigma surrounding HIV and sexual practices that may surface towards people who seek vaccination, and potential issues with effectiveness, side effects, or lack of availability.
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Affiliation(s)
- Aaron Richterman
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Caroline O'Brien
- Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Fatemeh Ghadimi
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Andre Ford
- The COLOURS Organization, Philadelphia, PA, USA
| | | | - Sebrina Tate
- Bebashi-Transition to Hope, Philadelphia, PA, USA
| | - Nancy Aitcheson
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Hervette Nkwihoreze
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John B Jemmott
- Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Florence Momplaisir
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
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Choi J, May SB, Dang BN, Markham C, McGlone M, Cuccaro PM. Acceptability of a Future HIV Vaccine: A Rapid Scoping Review. J Acquir Immune Defic Syndr 2024; 96:197-207. [PMID: 38905472 DOI: 10.1097/qai.0000000000003416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/29/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND A HIV vaccine is not available yet, but perceptions of HIV vaccines will be important to explore before their roll-out for effective vaccine promotion. This article presents the findings of a rapid scoping review of the literature to identify individual, social, and vaccine-related factors associated with the acceptability of a future HIV vaccine. METHODS We searched 5 databases (Medline OVID, Embase, PsycINFO, Web of Science, and Cochrane) using relevant keywords and Medical Subject Headings. All articles, regardless of study design, publication year, and geographic location, were included if they examined HIV vaccine acceptability and its underlying factors. RESULTS We retrieved 2386 unique articles, of which 76 were included in the final review. Perceived benefits (34.2%) and perceived susceptibility (25.0%) were primary individual factors of HIV vaccine acceptability. Misinformation (17.1%) and distrust (22.4%) regarding future HIV vaccines, HIV stigma (30.3%), and social support (10.5%) were social factors of HIV vaccine acceptability. Vaccine efficacy (42.1%), cost (28.9%), and side effects (67.1%) were common vaccine characteristics influencing HIV vaccine acceptability. Altruism (10.5%) and risk compensation (26.3%) were also key factors. CONCLUSIONS Our analyses revealed that skeptical beliefs, negative perceptions, and misconceptions about HIV vaccines are real barriers to their acceptability. To alleviate HIV vaccine hesitancy and address trust concerns, strategic vaccine communication should be disseminated by trustworthy sources. Messages should impart accurate vaccine information and emphasize both individual and social benefits of HIV vaccination, as well as leverage social support in increasing willingness to get a future HIV vaccine.
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Affiliation(s)
- Jihye Choi
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX
| | - Sarah B May
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX
| | - Bich N Dang
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX
- VA Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; and
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX
| | - Matthew McGlone
- Department of Communication Studies, Moody College of Communication, The University of Texas at Austin, Austin, TX
| | - Paula M Cuccaro
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX
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Torres-Rueda S, Terris-Prestholt F, Gafos M, Indravudh PP, Giddings R, Bozzani F, Quaife M, Ghazaryan L, Mann C, Osborne C, Kavanagh M, Godfrey-Faussett P, Medley G, Malhotra S. Health Economics Research on Non-surgical Biomedical HIV Prevention: Identifying Gaps and Proposing a Way Forward. PHARMACOECONOMICS 2023; 41:787-802. [PMID: 36905570 PMCID: PMC10007656 DOI: 10.1007/s40273-022-01231-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/18/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Although HIV prevention science has advanced over the last four decades, evidence suggests that prevention technologies do not always reach their full potential. Critical health economics evidence at appropriate decision-making junctures, particularly early in the development process, could help identify and address potential barriers to the eventual uptake of future HIV prevention products. This paper aims to identify key evidence gaps and propose health economics research priorities for the field of HIV non-surgical biomedical prevention. METHODS We used a mixed-methods approach with three distinct components: (i) three systematic literature reviews (costs and cost effectiveness, HIV transmission modelling and quantitative preference elicitation) to understand health economics evidence and gaps in the peer-reviewed literature; (ii) an online survey with researchers working in this field to capture gaps in yet-to-be published research (recently completed, ongoing and future); and (iii) a stakeholder meeting with key global and national players in HIV prevention, including experts in product development, health economics research and policy uptake, to uncover further gaps, as well as to elicit views on priorities and recommendations based on (i) and (ii). RESULTS Gaps in the scope of available health economics evidence were identified. Little research has been carried out on certain key populations (e.g. transgender people and people who inject drugs) and other vulnerable groups (e.g. pregnant people and people who breastfeed). Research is also lacking on preferences of community actors who often influence or enable access to health services among priority populations. Oral pre-exposure prophylaxis, which has been rolled out in many settings, has been studied in depth. However, research on newer promising technologies, such as long-acting pre-exposure prophylaxis formulations, broadly neutralising antibodies and multipurpose prevention technologies, is lacking. Interventions focussing on reducing intravenous and vertical transmission are also understudied. A disproportionate amount of evidence on low- and middle-income countries comes from two countries (South Africa and Kenya); evidence from other countries in sub-Saharan Africa as well as other low- and middle-income countries is needed. Further, data are needed on non-facility-based service delivery modalities, integrated service delivery and ancillary services. Key methodological gaps were also identified. An emphasis on equity and representation of heterogeneous populations was lacking. Research rarely acknowledged the complex and dynamic use of prevention technologies over time. Greater efforts are needed to collect primary data, quantify uncertainty, systematically compare the full range of prevention options available, and validate pilot and modelling data once interventions are scaled up. Clarity on appropriate cost-effectiveness outcome measures and thresholds is also lacking. Lastly, research often fails to reflect policy-relevant questions and approaches. CONCLUSIONS Despite a large body of health economics evidence on non-surgical biomedical HIV prevention technologies, important gaps in the scope of evidence and methodology remain. To ensure that high-quality research influences key decision-making junctures and facilitates the delivery of prevention products in a way that maximises impact, we make five broad recommendations related to: improved study design, an increased focus on service delivery, greater community and stakeholder engagement, the fostering of an active network of partners across sectors and an enhanced application of research.
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Affiliation(s)
| | | | - Mitzy Gafos
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Matthew Quaife
- London School of Hygiene & Tropical Medicine, London, UK
| | - Lusine Ghazaryan
- United States Agency for International Development (USAID), Washington, DC, USA
| | - Carlyn Mann
- United States Agency for International Development (USAID), Washington, DC, USA
| | | | - Matthew Kavanagh
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | | | - Graham Medley
- London School of Hygiene & Tropical Medicine, London, UK
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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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Capitine IPU, Macicame IB, Uanela AM, Bhatt NB, Yates A, Milazzo M, Nwoga C, Crowell TA, Michael NL, Robb ML, Jani IV, Kroidl A, Polyak CS, De Schacht C. Young at risk-people in Maputo City, Mozambique, present a high willingness to participate in HIV trials: Results from an HIV vaccine preparedness cohort study. PLoS One 2021; 16:e0260126. [PMID: 34855790 PMCID: PMC8638929 DOI: 10.1371/journal.pone.0260126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Vaccine efficacy testing requires engagement of willing volunteers with high disease incidence. We evaluated factors associated with willingness to participate in potential future HIV vaccine trials in Maputo, Mozambique. METHODS Adults aged 18-35 years without HIV and who reported at least two sexual partners in the 3 months prior to screening were enrolled into a 24-month observational study. They were asked at screening and exit if they would be willing to participate in a theoretical HIV vaccine study. Bivariate and multivariate logistic regression analyses were done between willingness to participate, demographic, sexual behavior, and motivational factors for screening visit data. Logistic regression with generalized estimating equations (GEE) was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors potentially associated with willingness to participate for data from both visits. RESULTS A total of 577 participants without HIV were eligible, including 275 (48%) women. The mean age was 22.2 (SD ± 3.9) years. At screening 529 (92%) expressed willingness to participate and the proportion remained stable at 378 (88%) of the 430 participants retained through the exit visit (p = 0.209). Helping the country (n = 556) and fear of needles (n = 26) were the top motive and barrier for willingness to participate, respectively. Results from the GEE binary logistic regression (screening visit and exit visit) showed that wanting to learn how to avoid risk behaviors (aOR 3.33, 95% CI: 1.61-6.86) and feeling protected against HIV infection (aOR 2.24, 95% CI: 1.07-4.7) were associated with willingness to participate in HIV vaccine studies. CONCLUSION The majority of our study population in Mozambique expressed willingness to participate in a theoretical HIV vaccine trial. Participation in a HIV vaccine trial was seen as a way to contribute to the fight against HIV but was associated with some unrealistic expectations such as protection against HIV. This reinforces the need for continuous mobilization and awareness of potential participants to HIV vaccine trial.
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Affiliation(s)
- Igor P. U. Capitine
- Instituto Nacional de Saúde (INS), Maputo Province, Mozambique
- Centre for International Health (CIH), University of Munich (LMU), Munich, Germany
| | | | - Artur M. Uanela
- Instituto Nacional de Saúde (INS), Maputo Province, Mozambique
| | - Nilesh B. Bhatt
- Instituto Nacional de Saúde (INS), Maputo Province, Mozambique
| | - Adam Yates
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Mark Milazzo
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Chiaka Nwoga
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Nelson L. Michael
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Merlin L. Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Ilesh V. Jani
- Instituto Nacional de Saúde (INS), Maputo Province, Mozambique
| | - Arne Kroidl
- Centre for International Health (CIH), University of Munich (LMU), Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), Munich, Germany
| | - Christina S. Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
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Eliciting Preferences for HIV Prevention Technologies: A Systematic Review. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:151-174. [PMID: 33319339 PMCID: PMC7884379 DOI: 10.1007/s40271-020-00486-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 01/10/2023]
Abstract
Background Many human immunodeficiency virus (HIV) prevention technologies (pre-exposure prophylaxis, microbicides, vaccines) are available or in development. Preference elicitation methods provide insight into client preferences that may be used to optimize products and services. Given increased utilization of such methods in HIV prevention, this article identifies and reviews these methods and synthesizes their application to HIV prevention technologies. Methods In May 2020, we systematically searched peer-reviewed literature in PubMed, CINAHL, and Web of Science for studies employing quantitative preference elicitation methods to measure preferences for HIV prevention technologies among populations of any age, sex, or location. Quality assessment used an existing checklist (PREFS) and a novel adaptation of the Newcastle–Ottawa Scale (PROSPERO #CRD42018087027). Results We screened 5022 titles and abstracts, reviewed 318 full texts, and included 84 studies. Common methods employed were discrete-choice experiment (33%), conjoint analysis (25%), and willingness-to-participate/try/accept (21%). Studies were conducted in 25 countries and had a mean of 768 participants (range = 26–7176), two-thirds of them male. Common HIV prevention technologies included pre-exposure prophylaxis (23%), voluntary testing and counseling (19%), HIV self-testing (17%), vaccines (15%), and topical microbicides (9%). Most attributes focused on product design (side effects, frequency), service design (provider type, location), acceptability or willingness to accept/pay; results are summarized in these categories, by prevention type. Mean quality-adapted Newcastle–Ottawa Scale score was 4.5/8 (standard deviation = 2.1) and mean PREFS scores was 3.47/5 (standard deviation = 0.81). Conclusions This review synthesizes extant literature on quantitative measurement of preferences for HIV prevention technologies. This can enable practitioners to improve prevention products and interventions, and ultimately reduce HIV incidence.
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Cheung YK, Wood D, Zhang K, Ridenour TA, Derby L, St Onge T, Duan N, Duer-Hefele J, Davidson KW, Kronish I, Moise N. Personal preferences for Personalised Trials among patients with chronic diseases: an empirical Bayesian analysis of a conjoint survey. BMJ Open 2020; 10:e036056. [PMID: 32513886 PMCID: PMC7282396 DOI: 10.1136/bmjopen-2019-036056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe individual patient preferences for Personalised Trials and to identify factors and conditions associated with patient preferences. DESIGN Each participant was presented with 18 conjoint questions via an online survey. Each question provided two choices of Personalised Trials that were defined by up to eight attributes, including treatment types, clinician involvement, study logistics and trial burden on a patient. SETTING Online survey of adults with at least two common chronic conditions in the USA. PARTICIPANTS A nationally representative sample of 501 individuals were recruited from the Chronic Illness Panel by Harris Poll Online. Participants were recruited from several sources, including emails, social media and telephone recruitment of the target population. MAIN OUTCOME MEASURES The choice of Personalised Trial design that the participant preferred with each conjoint question. RESULTS There was large variability in participants' preferences for the design of Personalised Trials. On average, they preferred certain attributes, such as a short time commitment and no cost. Notably, a population-level analysis correctly predicted 62% of the conjoint responses. An empirical Bayesian analysis of the conjoint data, which supported the estimation of individual-level preferences, improved the accuracy to 86%. Based on estimates of individual-level preferences, patients with chronic pain preferred a long study duration (p≤0.001). Asthma patients were less averse to participation burden in terms of data-collection frequency than patients with other conditions (p=0.002). Patients with hypertension were more cost-sensitive (p<0.001). CONCLUSION These analyses provide a framework for elucidating individual-level preferences when implementing novel patient-centred interventions. The data showed that patient preference in Personalised Trials is highly variable, suggesting that individual differences must be accounted for when marketing Personalised Trials. These results have implications for advancing precise interventions in Personalised Trials by indicating when rigorous scientific principles, such as frequent monitoring, is feasible in a substantial subset of patients.
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Affiliation(s)
- Ying Kuen Cheung
- Biostatistics, Columbia University Irving Medical Center, New York, New York, USA
| | - Dallas Wood
- RTI International, Research Triangle Park, North Carolina, USA
| | - Kangkang Zhang
- Biostatistics, Columbia University Irving Medical Center, New York, New York, USA
| | - Ty A Ridenour
- RTI International, Research Triangle Park, North Carolina, USA
| | - Lilly Derby
- Center Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Tara St Onge
- Center Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Naihua Duan
- Biostatistics, Columbia University Irving Medical Center, New York, New York, USA
| | - Joan Duer-Hefele
- Research, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Karina W Davidson
- Research, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Ian Kronish
- Center Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Nathalie Moise
- Center Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, USA
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Humphrey JM, Naanyu V, MacDonald KR, Wools-Kaloustian K, Zimet GD. Stated-preference research in HIV: A scoping review. PLoS One 2019; 14:e0224566. [PMID: 31665153 PMCID: PMC6821403 DOI: 10.1371/journal.pone.0224566] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 10/16/2019] [Indexed: 12/21/2022] Open
Abstract
Discrete choice experiments (DCE), conjoint analysis (CA), and best-worst scaling (BWS) are quantitative techniques for estimating consumer preferences for products or services. These methods are increasingly used in healthcare research, but their applications within the field of HIV research have not yet been described. The objective of this scoping review was to systematically map the extent and nature of published DCE, CA, and BWS studies in the field of HIV and identify priority areas where these methods can be used in the future. Online databases were searched to identify published HIV-related DCE, CA and BWS studies in any country and year as the primary outcome. After screening 1,496 citations, 57 studies were identified that were conducted in 26 countries from 2000-2017. The frequency of published studies increased over time and covered HIV themes relating to prevention (n = 25), counselling and testing (n = 10), service delivery (n = 10), and antiretroviral therapy (n = 12). Most studies were DCEs (63%) followed by CA (37%) and BWS (4%). The median [IQR] sample size was 288 [138-496] participants, and 74% of studies used primary qualitative data to develop attributes. Only 30% of studies were conducted in sub-Saharan Africa where the burden of HIV is highest. Moreover, few studies surveyed key populations including men who have sex with men, transgender people, pregnant and postpartum women, adolescents, and people who inject drugs. These populations represent priorities for future stated-preference research. This scoping review can help researchers, policy makers, program implementers, and health economists to better understand the various applications of stated-preference research methods in the field of HIV.
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Affiliation(s)
- John M. Humphrey
- Department of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Violet Naanyu
- Department of Behavioral Sciences, Moi University, Eldoret, Uasin Gishu County, Kenya
- AMPATH Program, Eldoret, Uasin Gishu County, Kenya
| | - Katherine R. MacDonald
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, United States of America
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Gregory D. Zimet
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, United States of America
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Lin C, Li L, Lee SJ, Chen L, Pan Y, Guan J. Using Conjoint Analysis to Investigate Hospital Directors' Preference in Adoption of an Evidence-based Intervention. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019; 14:328-334. [PMID: 34239710 DOI: 10.1080/20479700.2019.1645925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study used conjoint analysis, a marketing research technique, to investigate hospital stakeholders' decision-making in adoption of evidence-based interventions (EBI). An efficacious hospital-based stigma-reduction intervention was used as a "product" to study adoption of EBI. Sixty hospital directors in Fujian, China evaluated the likelihood of adopting the EBI in their hospitals by rating across eight hypothetical scenarios with preferred and non-preferred levels of seven attributes, including 1) administrative support, 2) cost, 3) personnel involvement, 4) format, 5) duration, 6) technical support, and 7) priority alignment with the hospital. A hierarchical generalized linear model was fit to the likelihood of intervention adoption for the eight scenarios, with the seven attributes served as independent variables. Monetary cost of intervention implementation (impact score=2.12) had the greatest impact on the directors' reported likelihood of adopting the EBI, followed by duration of the intervention (impact score=0.88), availability of technical support (impact score=0.69), and flexibility of format (impact score=0.36). The impact scores of other attributes were not statistically significant. Conjoint analysis was feasible in modeling hospital directors' decision-making in adoption of EBI. The findings suggested the importance of considering cost, duration, technical support, and flexibility of format in development and dissemination of interventions in healthcare settings.
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Affiliation(s)
- Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
| | - Li Li
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
| | - Sung-Jae Lee
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
| | - Liang Chen
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Yunjiao Pan
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Jihui Guan
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
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11
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Bristow CC, Kojima N, Lee SJ, Leon SR, Ramos LB, Konda KA, Brown B, Caceres CF, Klausner JD. HIV and syphilis testing preferences among men who have sex with men and among transgender women in Lima, Peru. PLoS One 2018; 13:e0206204. [PMID: 30372465 PMCID: PMC6205634 DOI: 10.1371/journal.pone.0206204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 10/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) and transgender women in Peru are at high risk for acquiring syphilis and HIV infection. The World Health Organization highly recommends screening for HIV and syphilis to reduce morbidity and mortality associated with untreated infections. We aimed to identify factors associated with dual testing preferences for HIV and syphilis infection among MSM and transgender women in Lima, Peru. METHODS We used conjoint analysis, an innovative method for systematically estimating consumer preferences. We created eight hypothetical test profiles varying across six dichotomous attributes: cost (free vs. $4), potential for false positive syphilis result (no false positive vs. some risk of false positive), time-to-result (20 minutes vs. 1 week), blood draw method (finger prick vs. venipuncture), test type (rapid vs. laboratory), and number of draws (1 vs. 2). We fit a conjoint analysis model for each participant using a simple main effects ANOVA. Attribute importance values were calculated using percentages from relative ranges in the attribute's utility values. Results were summarized across participants and averages were reported. RESULTS We recruited 415 MSM/transgender women over 18 years of age from two STD clinics in Lima, Peru. No potential for syphilis false positive result (no false positive vs. some potential for false positive) had the largest average impact on willingness to use the test and on average accounted for 23.8% of test type preference, followed by cost (free vs. ~USD$4; 21.6%), time to results (20 minutes vs. 1 week; 17.4%), number of blood draws (1 draw vs. 2 draws; 13.8%), method of blood draw (fingerprick vs. venipuncture; 13.7%), and test type (rapid POC vs. laboratory; 9.7%). CONCLUSION MSM/transgender women in Peru prioritized accuracy, cost, timeliness and number of blood draws for HIV and syphilis testing. Implementing a low cost, accurate, rapid and dual testing strategy for HIV and syphilis could improve screening uptake and accessibility of testing to accelerate time to treatment.
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Affiliation(s)
- Claire C. Bristow
- Department of Medicine, University of California San Diego, La Jolla, CA, United States of America
| | - Noah Kojima
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Sung-Jae Lee
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Segundo R. Leon
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Lourdes B. Ramos
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kelika A. Konda
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Brandon Brown
- Department of Medicine, University of California Riverside, Riverside, CA, United States of America
| | - Carlos F. Caceres
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D. Klausner
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
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12
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Moise N, Wood D, Cheung YKK, Duan N, Onge TS, Duer-Hefele J, Pu T, Davidson KW, Kronish IM. Patient preferences for personalized (N-of-1) trials: a conjoint analysis. J Clin Epidemiol 2018; 102:12-22. [PMID: 29859242 DOI: 10.1016/j.jclinepi.2018.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/18/2018] [Accepted: 05/24/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Despite their promise for increasing treatment precision, Personalized Trials (i.e., N-of-1 trials) have not been widely adopted. We aimed to ascertain patient preferences for Personalized Trials. STUDY DESIGN AND SETTING We recruited 501 adults with ≥2 common chronic conditions from Harris Poll Online. We used Sawtooth Software to generate 45 plausible Personalized Trial designs comprising combinations of eight key attributes (treatment selection, treatment type, clinician involvement, blinding, time commitment, self-monitoring frequency, duration, and cost) at different levels. Conditional logistic regression was used to assess relative importance of different attributes using a random utility maximization model. RESULTS Overall, participants preferred Personalized Trials with no costs vs. $100 cost (utility difference 1.52 [standard error 0.07], P < 0.001) and with less vs. more time commitment/day (0.16 [0.07], P < 0.015) but did not hold preferences for the other six attributes. In subgroup analyses, participants ≥65 years, white, and with income ≤$50,000 were more averse to costs than their counterparts (P all <0.05). CONCLUSION To optimize dissemination, Personalized Trial designers should seek to minimize out-of-pocket costs and time burden of self-monitoring. They should also consider adaptive designs that can accommodate subgroup differences in design preferences.
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Affiliation(s)
| | - Dallas Wood
- RTI International, Research Triangle Park, NC, USA
| | | | - Naihua Duan
- Columbia University Medical Center, New York, NY, USA
| | - Tara St Onge
- Columbia University Medical Center, New York, NY, USA
| | | | | | | | - Ian M Kronish
- Columbia University Medical Center, New York, NY, USA
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Shrestha R, Karki P, Altice FL, Dubov O, Fraenkel L, Huedo-Medina T, Copenhaver M. Measuring Acceptability and Preferences for Implementation of Pre-Exposure Prophylaxis (PrEP) Using Conjoint Analysis: An Application to Primary HIV Prevention Among High Risk Drug Users. AIDS Behav 2018; 22:1228-1238. [PMID: 28695388 PMCID: PMC5762432 DOI: 10.1007/s10461-017-1851-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although people who use drugs (PWUD) are one of the key risk populations who could benefit from the use of pre-exposure prophylaxis (PrEP), to date, little attention has been given to incorporating PrEP into HIV prevention approaches targeting this underserved group. This study investigated the acceptability of PrEP based on a number of known PrEP attributes among high-risk PWUD in a drug treatment setting. A total of 400 HIV-negative PWUD, who reported drug- and/or sex-related risk behaviors were recruited from a methadone clinic to complete a stated preference (full-profile conjoint) survey. Participants ranked the eight hypothetical PrEP program scenarios with varied combinations of six attributes related to PrEP (cost, dosing, efficacy, side-effects, treatment setting, and frequency of HIV testing). SPSS conjoint procedure was used to estimate the relative importance of each attribute and preferences across eight possible PrEP delivery programs. PrEP acceptability ranged from 30.6 to 86.3% with a mean acceptability of 56.2% across the eight hypothetical PrEP program scenarios. The PrEP program scenario with the highest acceptability had the following attribute levels: insurance covered, daily dosing, 95% effective, no side-effects, treatment at HIV clinic, and HIV testing needed every 6 months. The cost associated with PrEP was the most important attribute (relative importance score: RIS = 38.8), followed by efficacy (RIS = 20.5) and side effects (RIS = 11.9); other attributes had no significant effect. Our findings reported a high acceptability of PrEP in response to different PrEP program scenarios with different attribute profiles. As the result of having this information, researchers and policymakers will be better equipped for evidence informed targeting and dissemination efforts to optimize PrEP uptake among this underserved population.
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Affiliation(s)
- Roman Shrestha
- Department of Community Medicine & Health Care, University of Connecticut Health Center, 263 Farmington Avenue, MC 6325, Farmington, CT, 06030-6325, USA.
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.
| | - Pramila Karki
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Frederick L Altice
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
- Department of Internal Medicine, AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Oleksandr Dubov
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Liana Fraenkel
- Department of Internal Medicine, Section of Rheumatology, School of Medicine, Yale University, New Haven, CT, USA
| | - Tania Huedo-Medina
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Michael Copenhaver
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
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14
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Chimoyi L, Kamndaya M, Venables E, von Knorring N, Stadler J, MacPhail C, Chersich MF, Rees H, Delany-Moretlwe S. Using surrogate vaccines to assess feasibility and acceptability of future HIV vaccine trials in men: a randomised trial in inner-city Johannesburg, South Africa. BMC Public Health 2017; 17:524. [PMID: 28832280 PMCID: PMC5498868 DOI: 10.1186/s12889-017-4355-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Developing an effective HIV vaccine is the overriding priority for HIV prevention research. Enrolling and maintaining cohorts of men into HIV vaccine efficacy trials is a necessary prerequisite for the development and licensure of a safe and efficacious vaccine. METHODS One hundred-fifty consenting HIV-negative men were enrolled into a pilot 1:1 randomised controlled trial of immediate vaccination with a three-dose hepatitis B vaccine compared to deferred vaccination (at 12 months) to investigate feasibility and acceptability of a future HIV vaccine trial in this population. Adverse events, changes in risk behaviour, acceptability of trial procedures and motivations for participation in future trials were assessed. RESULTS Men were a median 25 years old (inter-quartile range = 23-29), 53% were employed, 90% secondary school educated and 67% uncircumcised. Of the 900 scheduled study visits, 90% were completed in the immediate vaccination arm (405/450) and 88% (396/450) in the delayed arm (P = 0.338). Acceptability of trial procedures and services was very high overall. However, only 65% of the deferred group strongly liked being randomised compared to 90% in the immediate group (P = 0.001). Informed consent processes were viewed favourably by 92% of the delayed and 82% of the immediate group (P = 0.080). Good quality health services, especially if provided by a male nurse, were rated highly. Even though almost all participants had some concern about the safety of a future HIV vaccine (98%), the majority were willing to participate in a future trial. Future trial participation would be motivated mainly by the potential for accessing an effective vaccine (81%) and altruism (75%), rather than by reimbursement incentives (2%). CONCLUSIONS Recruitment and retention of men into vaccine trials is feasible and acceptable in our setting. Findings from this surrogate vaccine trial show a high willingness to participate in future HIV vaccine trials. While access to potentially effective vaccines is important, quality health services are an equally compelling incentive for enrolment.
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Affiliation(s)
- Lucy Chimoyi
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mphatso Kamndaya
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Emilie Venables
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nina von Knorring
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan Stadler
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine MacPhail
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Matthew F Chersich
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Rees
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sinead Delany-Moretlwe
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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15
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Bristow CC, Lee SJ, Severe L, William Pape J, Javanbakht M, Scott Comulada W, Klausner JD. Attributes of diagnostic tests to increase uptake of dual testing for syphilis and HIV in Port-au-Prince, Haiti. Int J STD AIDS 2016; 28:259-264. [PMID: 27037111 DOI: 10.1177/0956462416642340] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Syphilis and HIV screening is highly recommended for pregnant women and those at risk for infection. We used conjoint analysis to identify factors associated with testing preferences for HIV and syphilis infection. Methods We recruited 298 men and women 18 years and over seeking testing or care at GHESKIO (Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections) clinics. We created eight hypothetical dual HIV-syphilis test profiles varying across six dichotomous attributes. Participants were asked to rate each profile using Likert preference scales. An impact score was generated for each attribute by taking the difference between the preference scores for the preferred and non-preferred level of each attribute. Two-sided one-sample t-test was used to generate p values. Results Of 298 study participants, 61 (20.5%) were male. Of 237 females, 49 (20.7%) were pregnant. Cost (free vs. US$4; p < .0001) had the highest impact on willingness to test, followed by number of blood draws (1 vs. 2; p < .0001), blood draw method (fingerprick vs. venipuncture; p < .0001), test type (rapid vs. laboratory; p = .0005), and time-to-result (20 minutes vs. 1 week; p = .0139). Conclusion HIV and syphilis testing preferences for this study sample in Port-au-Prince prioritized cost, single fingerprick, laboratory-based testing and timeliness.
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Affiliation(s)
- Claire C Bristow
- 1 Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Sung-Jae Lee
- 2 Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,3 Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Jean William Pape
- 4 Les Centres GHESKIO, Port-au-Prince, Haiti.,5 Center for Global Health, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Marjan Javanbakht
- 2 Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Warren Scott Comulada
- 3 Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeffrey D Klausner
- 2 Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,6 Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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16
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Primrose RJ, Zaveri T, Bakke AJ, Ziegler GR, Moskowitz HR, Hayes JE. Drivers of Vaginal Drug Delivery System Acceptability from Internet-Based Conjoint Analysis. PLoS One 2016; 11:e0150896. [PMID: 26999009 PMCID: PMC4801188 DOI: 10.1371/journal.pone.0150896] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/19/2016] [Indexed: 01/14/2023] Open
Abstract
Vaginal microbicides potentially empower women to protect themselves from HIV and other sexually transmitted infections (STIs), especially when culture, religion, or social status may prevent them from negotiating condom use. The open literature contains minimal information on factors that drive user acceptability of women's health products or vaginal drug delivery systems. By understanding what women find to be most important with regard to sensory properties and product functionality, developers can iteratively formulate a more desirable product. Conjoint analysis is a technique widely used in market research to determine what combination of elements influence a consumer's willingness to try or use a product. We applied conjoint analysis here to better understand what sexually-active woman want in a microbicide, toward our goal of formulating a product that is highly acceptable to women. Both sensory and non-sensory attributes were tested, including shape, color, wait time, partner awareness, messiness/leakage, duration of protection, and functionality. Heterosexually active women between 18 and 35 years of age in the United States (n = 302) completed an anonymous online conjoint survey using IdeaMap software. Attributes (product elements) were systematically presented in various combinations; women rated these combinations of a 9-point willingness-to-try scale. By coupling systematic combinations and regression modeling, we can estimate the unique appeal of each element. In this population, a multifunctional product (i.e., broad spectrum STI protection, coupled with conception) is far more desirable than a microbicide targeted solely for HIV protection; we also found partner awareness and leakage are potentially strong barriers to use.
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Affiliation(s)
- Rachel J. Primrose
- Sensory Evaluation Center, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Toral Zaveri
- Sensory Evaluation Center, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Alyssa J. Bakke
- Sensory Evaluation Center, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Gregory R. Ziegler
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Howard R. Moskowitz
- Mind Genomics Associates Inc., White Plains, New York, United States of America
| | - John E. Hayes
- Sensory Evaluation Center, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- * E-mail:
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17
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Weil-Olivier C, Millier A, Toumi M, Trichard M. Population access to rotavirus vaccination in industrialized countries: lessons learnt from current experience. Expert Rev Vaccines 2014; 13:1405-17. [PMID: 25142637 DOI: 10.1586/14760584.2014.943194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Four steps are usually necessary before population access to vaccination programmes. Marketing authorization, appropriation by national agencies of the data, recommendation and policy-decision steps on funding and implementation. Using rotavirus vaccination as an illustrative case, this study aims at better understanding picture of population access, and identifying lessons learnt from current experience. METHODS Systematic review of national vaccination policies in 20 countries. RESULTS 12 countries have included rotavirus vaccination in their childhood national vaccination programme, two decided not to include it, decision is pending in three countries, while it has not started in the three remaining countries. Published evaluations and/or advice were available in 16 countries. Many differences in content and outcomes were identified. CONCLUSION Rotavirus vaccination implementation across industrialized countries was disparate, leading to unequal population access over time. Comparative analyses of the decision-making process suggest different interpretations of available evidence, raising the need for a similar decision integrated framework, using a structured and systematic approach.
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18
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Lee SJ, Newman PA, Duan N, Cunningham WE. Development of an HIV vaccine attitudes scale to predict HIV vaccine acceptability among vulnerable populations: L.A. VOICES. Vaccine 2014; 32:5013-8. [PMID: 25045817 DOI: 10.1016/j.vaccine.2014.07.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/30/2014] [Accepted: 07/08/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Decade-long delays in successful implementation of Hepatitis B vaccines and ongoing obstacles in HPV vaccine roll-out suggest the importance of an implementation science approach to prepare for the effective translation of future HIV vaccines from clinical trials into routine practice. The objective of this study was to test HIV vaccine attitude items to develop reliable scales and to examine their association with HIV vaccine acceptability. METHODS HIV vaccine attitude items were assessed as part of the L.A. VOICES survey, a large-scale study conducted among underserved residents of Los Angeles, to identify factors that may influence HIV vaccine acceptability. Participants (n=1225) were randomly selected from public STD clinics, needle exchange sites and Latino community clinics using three-stage, venue-based time space sampling. RESULTS Exploratory factor analysis across 20 items revealed four distinct factors - mistrust, HIV vaccine social concerns, risk compensation, and altruistic vaccination - with acceptable reliability coefficients for each subscale (Cronbach's α range 0.61-0.84). We found no significant differences in reliability by gender or by vaccine acceptability. Risk compensation (odds ratio (OR)=1.49; 95% CI=[1.18, 1.89]; p=0.001) and altruistic vaccination (OR=1.40; 95% CI=[1.14, 1.71]; p=0.001) were significantly and positively associated with HIV vaccine acceptability. CONCLUSIONS We identified four HIV vaccine attitude scales with sound internal reliability parameters. In the aftermath of the first candidate vaccine to demonstrate efficacy against HIV infection, these scales may be helpful in bridging expectable research-to-practice gaps in future HIV vaccine dissemination among populations at risk. As HIV vaccine trials progress in the United States and globally, these measures also may be useful as a tool to assess and facilitate effective responses to community concerns about HIV vaccine trials and to target interventions to support recruitment and mitigate risk compensation.
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Affiliation(s)
- Sung-Jae Lee
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute, Center for Community Health, University of California, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA 90024-6521, USA.
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, Canada M5S 1V4.
| | - Naihua Duan
- Department of Psychiatry, Columbia University Medical Center, Room Old PI R209, Unit/Box: Biostatistics Division, 1051 Riverside Drive, New York, NY 10032, USA.
| | - William E Cunningham
- Department of Health Policy and Management, UCLA Fielding School of Public Health; Division of General Internal Medicine & Health Services Research, UCLA David Geffen School of Medicine, University of California, 640 Charles E Young Dr S, Los Angeles, CA 90024, USA.
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HIV vaccine acceptability among high-risk drug users in Appalachia: a cross-sectional study. BMC Public Health 2014; 14:537. [PMID: 24885970 PMCID: PMC4065595 DOI: 10.1186/1471-2458-14-537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/23/2014] [Indexed: 12/22/2022] Open
Abstract
Background A vaccine could substantially impact the HIV epidemic, but inadequate uptake is a serious concern. Unfortunately, people who use drugs, particularly those residing in rural communities, have been underrepresented in previous research on HIV vaccine acceptability. This study examined HIV vaccine acceptability among high-risk drug users in a rural community in the United States. Methods Interviewer-administered questionnaires included questions about risk behavior and attitudes toward HIV vaccination from 433 HIV-negative drug users (76% with history of injection) enrolled in a cohort study in Central Appalachia. HIV vaccine acceptability was measured on a 4-point Likert scale. Generalized linear mixed models were used to determine correlates to self-report of being “very likely” to receive a 90% effective HIV vaccine (i.e. “maximum vaccine acceptability”, or MVA). Adjusted odds ratios (AORs) and corresponding 95% confidence intervals (CIs) are reported. Results Most (91%) reported that they would accept a preventive HIV vaccine, but concerns about cost, dosing, transportation constraints, vaccine-induced seropositivity, and confidentiality were expressed. Cash incentives, oral-administration, and peer/partner encouragement were anticipated facilitators of uptake. In multivariate analysis, men were significantly less likely to report MVA (AOR: 0.33, CI: 0.21 – 0.52). MVA was more common among participants who believed that they were susceptible to HIV (AOR: 2.31, CI: 1.28 – 4.07), that an HIV vaccine would benefit them (AOR: 2.80, CI: 1.70 – 4.64), and who had positive experiential attitudes toward HIV vaccination (AOR: 1.85, CI: 1.08 – 3.17). MVA was also more common among participants who believed that others would encourage them to get vaccinated and anticipated that their behavior would be influenced by others' encouragement (AOR: 1.81, 95% 1.09 – 3.01). Conclusions To our knowledge, this study was among the first to explore and provide evidence for feasibility of HIV vaccination in a rural, high-risk population in the United States. This study provides preliminary evidence that gender-specific targeting in vaccine promotion may be necessary to promoting vaccine uptake in this setting, particularly among men. The data also underscore the importance of addressing perceived risks and benefits, social norms, and logistical constraints in efforts to achieve widespread vaccine coverage in this high-risk population.
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20
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DiSantis KI, Grier SA, Oakes JM, Kumanyika SK. Food prices and food shopping decisions of black women. Appetite 2014; 77:104-12. [PMID: 24583415 DOI: 10.1016/j.appet.2014.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 02/02/2014] [Accepted: 02/24/2014] [Indexed: 11/29/2022]
Abstract
Identifying food pricing strategies to encourage purchases of lower-calorie food products may be particularly important for black Americans. Black children and adults have higher than average obesity prevalence and disproportionate exposure to food marketing environments in which high calorie foods are readily available and heavily promoted. The main objective of this study was to characterize effects of price on food purchases of black female household shoppers in conjunction with other key decision attributes (calorie content/healthfulness, package size, and convenience). Factorial discrete choice experiments were conducted with 65 low- and middle-/higher-income black women. The within-subject study design assessed responses to hypothetical scenarios for purchasing frozen vegetables, bread, chips, soda, fruit drinks, chicken, and cheese. Linear models were used to estimate the effects of price, calorie level (or healthfulness for bread), package size, and convenience on the propensity to purchase items. Moderating effects of demographic and personal characteristics were assessed. Compared with a price that was 35% lower, the regular price was associated with a lesser propensity to purchase foods in all categories (β = -0.33 to -0.82 points on a 1 to 5 scale). Other attributes, primarily calorie content/healthfulness, were more influential than price for four of seven foods. The moderating variable most often associated with propensity to pay the regular versus lower price was the reported use of nutrition labels. Price reductions alone may increase purchases of certain lower-calorie or more healthful foods by black female shoppers. In other cases, effects may depend on combining price changes with nutrition education or improvements in other valued attributes.
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Affiliation(s)
- Katherine I DiSantis
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 8th Floor Blockley Hall, Philadelphia, PA 19104, USA
| | - Sonya A Grier
- Department of Marketing, Kogod School of Business, American University, 4400 Massachusetts Avenue, NW, Washington, DC, WA 20016-8044, USA
| | - J Michael Oakes
- Division of Epidemiology, University of Minnesota School of Public Health, West Bank Office Building, 1300 S. Second Street, Suite 300, Minneapolis, MN 55454-1015, USA
| | - Shiriki K Kumanyika
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 8th Floor Blockley Hall, Philadelphia, PA 19104, USA.
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Harrison M, Rigby D, Vass C, Flynn T, Louviere J, Payne K. Risk as an Attribute in Discrete Choice Experiments: A Systematic Review of the Literature. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 7:151-70. [DOI: 10.1007/s40271-014-0048-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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How much demand for New HIV prevention technologies can we really expect? Results from a discrete choice experiment in South Africa. PLoS One 2013; 8:e83193. [PMID: 24386160 PMCID: PMC3875434 DOI: 10.1371/journal.pone.0083193] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 11/11/2013] [Indexed: 01/08/2023] Open
Abstract
Background For the first time in the history of HIV, new bio-medical interventions have been shown to be effective in preventing HIV transmission. For these new HIV prevention technologies (NPTs) to have an impact on the epidemic, they must be widely used. This study uses a discrete choice experiment (DCE) to: understand the relative strength of women’s preferences for product characteristics, understand the implications for substitution away from male condoms, and inform realistic modelling of their potential impact and cost-effectiveness. Methods A DCE was conducted among 1017 women in urban South Africa. Women were presented with choices between potential women’s NPTs (microbicides, diaphragm, female condom) and ‘what I did last time’ (use or not use a condom) with different HIV and pregnancy prevention effectiveness’ and prices. Choice probabilities are estimated using the nested logit model and used to predict uptake. Results In this high HIV prevalence setting, HIV prevention effectiveness is the main driver of uptake followed by pregnancy prevention effectiveness. For example a microbicide with poor effectiveness would have niche appeal at just 11% predicted uptake, while a highly effective microbicide (95% effective against HIV and pregnancy) would have far wider appeal (56% predicted uptake). Though women who reported not using condoms were more likely to choose the NPTs, at current very high rates of male condom use in South Africa (60%), about half of microbicide uptake is projected to be among those currently not using condoms. Conclusions Women are very interested in NPTs, especially if highly effective in preventing HIV and pregnancy. Women in greatest need were also most likely to switch to the new products. Where products are not yet available for distribution, proxy data, such as that generated by DCEs, can bring realism to overly optimistic uptake scenarios found in many current impact models.
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Weaver J, Newman PA, Williams CC, Massaquoi N, Brown M. "Sisters, Mothers, Daughters and Aunties": HIV vaccine acceptability among African, Caribbean and other Black women in Toronto. Canadian Journal of Public Health 2013; 104:e413-7. [PMID: 24183184 DOI: 10.17269/cjph.104.3915] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 08/23/2013] [Accepted: 08/11/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Black women in Canada are at disproportionately high risk for HIV. We assessed HIV vaccine acceptability and correlates of acceptability among Black women from African and Caribbean communities in Toronto. METHODS "Sisters, Daughters, Mothers, and Aunties" was a community-based research project. Black women of African and Caribbean descent were recruited using venue-based sampling across diverse community organizations in Toronto. We used a structured questionnaire to collect data on socio-demographic characteristics and acceptability of 8 future HIV vaccines, each defined by a set of 7 dichotomous attributes. Conjoint analysis was used to quantify the relative impact of vaccine attributes on acceptability, with multiple regression to adjust for socio-demographic characteristics associated with overall acceptability. RESULTS Mean vaccine acceptability was 58.8 (SD=17.2) on the 100-point scale. Efficacy had the greatest impact on acceptability, followed by side effects, cost, duration of protection, and number of doses. Acceptability of a high (99%) efficacy vaccine (70.1/100) was significantly greater than for a 50% efficacy vaccine (47.6/100). Vaccine acceptability was significantly higher among women of Caribbean versus African descent, ever married versus single women, and women with full-time versus part-time employment. CONCLUSIONS Black women in Toronto indicated a modest level of acceptability for future HIV vaccines. Educational interventions that address the benefits of partially efficacious vaccines and clearly explain potential side effects, as well as vaccine cost subsidies may promote HIV vaccine uptake. Differences in acceptability within Black communities suggest that tailored multi-level interventions may mitigate barriers to uptake.
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Lee SJ, Brooks R, Bolan RK, Flynn R. Assessing willingness to test for HIV among men who have sex with men using conjoint analysis, evidence for uptake of the FDA-approved at-home HIV test. AIDS Care 2013; 25:1592-8. [PMID: 23651439 DOI: 10.1080/09540121.2013.793272] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Men who have sex with men (MSM) in the USA, represent a vulnerable population with lower rates of HIV testing. There are various specific attributes of HIV testing that may impact willingness to test (WTT) for HIV. Identifying specific attributes influencing patients' decisions around WTT for HIV is critical to ensure improved HIV testing uptake. This study examined WTT for HIV by using conjoint analysis, an innovative method for systematically estimating consumer preferences across discrete attributes. WTT for HIV was assessed across eight hypothetical HIV testing scenarios varying across seven dichotomous attributes: location (home vs. clinic), price (free vs. $50), sample collection (finger prick vs. blood), timeliness of results (immediate vs. 1-2 weeks), privacy (anonymous vs. confidential), results given (by phone vs. in-person), and type of counseling (brochure vs. in-person). Seventy-five MSM were recruited from a community-based organization providing HIV testing services in Los Angeles to participate in conjoint analysis. WTT for HIV score was based on a 100-point scale. Scores ranged from 32.2 to 80.3 for eight hypothetical HIV testing scenarios. Price of HIV testing (free vs. $50) had the highest impact on WTT (impact score = 31.4, SD = 29.2, p<0.0001), followed by timeliness of results (immediate vs. 1-2 weeks) (impact score = 13.9, SD = 19.9, p≤0.0001) and testing location (home vs. clinic) (impact score = 10.3, SD = 22.8, p=0.0002). Impacts of other HIV testing attributes were not significant. Conjoint analysis method enabled direct assessment of HIV testing preferences and identified specific attributes that significantly impact WTT for HIV among MSM. This method provided empirical evidence to support the potential uptake of the newly FDA-approved over-the-counter HIV home test kit with immediate results, with cautionary note on the cost of the kit.
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Affiliation(s)
- Sung-Jae Lee
- a Department of Psychiatry and Biobehavioral Sciences , UCLA Semel Institute - Center for Community Health , Los Angeles , CA , USA
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