The University of Southampton
University of Southampton Institutional Repository

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

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

Background: in the UK, approximately 4,200 men who have sex with men (MSM) are living with HIV but remain undiagnosed. Maximising the number of high-risk people testing for HIV is key to ensuring prompt treatment and preventing onward infection. This study assessed how different HIV test characteristics affect the choice of testing option, including remote testing (HIV self-testing or HIV self-sampling), in the UK, a country with universal access to healthcare. 

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

Conclusions: our results suggest that preferences in the context we examined are broadly dichotomous. One group, containing the majority of MSM, appears comfortable testing for HIV but prefers face-to-face testing by HCPs rather than remote testing. The other group is much smaller, but contains MSM who are more likely to be at high infection risk. For these people, the availability of remote testing has the potential to significantly increase net testing rates, particularly if provided for free.

1549-1277
e1002779
Miners, Alec
00f4a0ec-6a07-44c7-b1a4-f44c5b3fb400
Nadarzynski, Tom
218d69a1-d1be-46f4-bead-23071bd4f270
Witzel, Charles
4dc9d6ae-76e2-4fff-8a24-a6c9356a9750
Phillips, Andrew N.
0297382c-e4fc-4ed3-946a-cf2028ccefc1
Cambiano, Valentina
0646e2d8-0415-4012-b800-612c8c8b4a96
Rodger, Alison J.
dbbaae95-9431-48c8-b57f-5d0e287a05ad
Llewellyn, Carrie D.
1db5dffa-4401-42b0-a54f-ed428ac14839
Miners, Alec
00f4a0ec-6a07-44c7-b1a4-f44c5b3fb400
Nadarzynski, Tom
218d69a1-d1be-46f4-bead-23071bd4f270
Witzel, Charles
4dc9d6ae-76e2-4fff-8a24-a6c9356a9750
Phillips, Andrew N.
0297382c-e4fc-4ed3-946a-cf2028ccefc1
Cambiano, Valentina
0646e2d8-0415-4012-b800-612c8c8b4a96
Rodger, Alison J.
dbbaae95-9431-48c8-b57f-5d0e287a05ad
Llewellyn, Carrie D.
1db5dffa-4401-42b0-a54f-ed428ac14839

Miners, Alec, Nadarzynski, Tom, Witzel, Charles, Phillips, Andrew N., Cambiano, Valentina, Rodger, Alison J. and Llewellyn, Carrie D. (2019) Preferences for HIV testing services among men who have sex with men in the UK: a discrete choice experiment. PLoS Medicine, 16 (4), e1002779. (doi:10.1371/journal.pmed.1002779).

Record type: Article

Abstract

Background: in the UK, approximately 4,200 men who have sex with men (MSM) are living with HIV but remain undiagnosed. Maximising the number of high-risk people testing for HIV is key to ensuring prompt treatment and preventing onward infection. This study assessed how different HIV test characteristics affect the choice of testing option, including remote testing (HIV self-testing or HIV self-sampling), in the UK, a country with universal access to healthcare. 

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

Conclusions: our results suggest that preferences in the context we examined are broadly dichotomous. One group, containing the majority of MSM, appears comfortable testing for HIV but prefers face-to-face testing by HCPs rather than remote testing. The other group is much smaller, but contains MSM who are more likely to be at high infection risk. For these people, the availability of remote testing has the potential to significantly increase net testing rates, particularly if provided for free.

Text
Preferences for HIV testing services among - Version of Record
Available under License Creative Commons Attribution.
Download (656kB)

More information

Accepted/In Press date: 12 March 2019
Published date: 11 April 2019

Identifiers

Local EPrints ID: 430789
URI: http://eprints.soton.ac.uk/id/eprint/430789
ISSN: 1549-1277
PURE UUID: bc8d740d-5711-4095-94cc-c1fcd8ffe587

Catalogue record

Date deposited: 13 May 2019 16:30
Last modified: 07 Oct 2020 00:03

Export record

Altmetrics

Contributors

Author: Alec Miners
Author: Tom Nadarzynski
Author: Charles Witzel
Author: Valentina Cambiano
Author: Alison J. Rodger
Author: Carrie D. Llewellyn

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×