Introduction
Methods
Study Design
Identification of HIV Testing Service Attributes and Levels
Development of the d-Efficient Design Matrix
Implementation of the DCE
Statistical Analyses
Ethical Review
Results
Participant Characteristics
Code | Total n (%) | Among those who ever received an HIV test (%) | Among those who never received an HIV test (%) | p value | |
---|---|---|---|---|---|
Age (years) | |||||
1st quantile < 21 | 1 | 187 (23) | (18) | (34) | < 0.0001 |
2nd quantile 21–23 | 2 | 191 (24) | (25) | (21) | |
3rd quantile 24–28 | 3 | 199 (25) | (25) | (24) | |
4th quantile > 28 | 4 | 226 (28) | (31) | (21) | |
Educational attainment | |||||
Elementary/middle | 1 | 137 (17) | (15) | (21) | 0.02 |
High school | 2 | 287 (36) | (36) | (36) | |
Vocational college | 3 | 129 (16) | (15) | (19) | |
Four-year college and above | 4 | 250 (31) | (34) | (25) | |
Urban residency status | |||||
Official urban resident | 1 | 421 (52) | (55) | (48) | 0.08 |
Rural resident | 0 | 382 (48) | (45) | (52) | |
Current marital status | |||||
Single | 1 | 689 (86) | (84) | (90) | < 0.01 |
Married | 2 | 77 (10) | (10) | (9) | |
Separated/divorced/widowed | 3 | 37 (5) | (6) | (1) | |
Sexual orientation | |||||
Gay | 1 | 623 (78) | (80) | (73) | 0.10 |
Heterosexual | 0 | 144 (18) | (16) | (23) | |
Bisexual | 0 | 8 (1) | (1) | (1) | |
Unsure | 0 | 28 (3) | (4) | (3) | |
Income, USD/month | |||||
< 217 | 1 | 177 (22) | (19) | (28) | < 0.01 |
217–433 | 2 | 246 (31) | (31) | (30) | |
434–724 | 3 | 235 (29) | (29) | (30) | |
725–1159 | 4 | 89 (11) | (13) | (8) | |
> 1159 | 4 | 56 (7) | (8) | (4) | |
n | 803 | 550 | 253 |
Single-Item Assessment of Testing Preferences
Total n (%) | Among those who ever received an HIV test (%) | Among those who never received an HIV test (%) | p value | |
---|---|---|---|---|
Test locationa | ||||
Home | 271 (34%) | (29) | (45) | < 0.0001 |
Gay community-based organization | 201 (25%) | (26) | (23) | |
Hospital | 75 (9%) | (10) | (8) | |
Local health department | 144 (18%) | (21) | (11) | |
Indifferent | 109 (14%) | (14) | (13) | |
Cost/incentive of testa | ||||
$7.50 USD incentive | 194 (24%) | (28) | (16) | < 0.001 |
Free | 438 (55%) | (53) | (58) | |
Pay $ 7.50 USD | 34 (4%) | (3) | (6) | |
Pay $15 USD | 44 (6%) | (6) | (4) | |
Indifferent | 90 (11%) | (9) | (15) | |
Appointment versus walk-in testinga | ||||
Walk-in | 532 (66%) | (67) | (64) | 0.12 |
Appointment necessary | 159 (20%) | (18) | (24) | |
Indifferent | 112 (14%) | (15) | (12) | |
Disclosure of same-sex sexual activities to test administratora | ||||
Not required to disclose | 483 (60%) | (60) | (60) | 0.27 |
Required to disclose | 189 (24%) | (22) | (26) | |
Indifferent | 129 (16%) | (17) | (13) | |
Test administratora | ||||
Trained health professional | 484 (60%) | (64) | (52) | < 0.001 |
Individual with on the job training to administer test | 89 (11%) | (12) | (9) | |
Self-test | 164 (20%) | (15) | (33) | |
Indifferent | 65 (8%) | (9) | (6) | |
Test typea | ||||
Finger prick | 387 (48%) | (46) | (54) | < 0.001 |
Venous | 217 (27%) | (31) | (18) | |
Indifferent | 198 (25%) | (23) | (28) | |
Anonymitya | ||||
Not required to show national ID card | 604 (75%) | (79) | (67) | < 0.01 |
Required to show national ID card | 132 (16%) | (14) | (22) | |
Indifferent | 66 (8%) | (7) | (11) | |
n | 803 | 550 | 253 |
Overall Design Attribute Effects
MNL Model
MXL Model
Design attributes and levels | Coefficient | SE | StdD | SE |
---|---|---|---|---|
Test location | ||||
Home | − 0.14* | 0.05 | 0.75*** | 0.11 |
Community-based organization | 0.04 | 0.05 | 0.59*** | 0.12 |
Hospital | − 0.05 | 0.05 | − 0.01 | 0.65 |
Health department | 0.15** | 0.05 | 0.01 | 0.90 |
Identifier collected at test time | ||||
Must show ID card | − 0.33*** | 0.04 | 0.58*** | 0.07 |
Do not need to show ID card | 0.33*** | 0.04 | 0.61*** | 0.07 |
Test administrator | ||||
Self-test | − 0.18 | 0.19 | 0.98*** | 0.12 |
Person with on-the job training | − 0.24* | 0.10 | − 0.25* | 0.12 |
Health professional | 0.41*** | 0.11 | 0.10 | 0.31 |
MSM identity disclosure | ||||
Required to disclose MSM activity | − 0.13*** | 0.03 | 0.46*** | 0.07 |
NOT required to disclose MSM activity | 0.13*** | 0.03 | 0.43*** | 0.07 |
Type of test | ||||
Venipuncture | 0.06 | 0.03 | 0.38*** | 0.08 |
Finger prick | − 0.06 | 0.03 | 0.31*** | 0.09 |
Cost/incentive | ||||
7.50 USD incentive | 0.31*** | 0.05 | 0.40** | 0.14 |
Free | 0.49*** | 0.06 | 0.66*** | 0.12 |
7.50 USD cost | − 0.22*** | 0.06 | − 0.04 | 0.47 |
15 USD cost | − 0.59*** | 0.06 | 0.01 | 0.52 |
Scheduling | ||||
Walk-in | 0.06 | 0.03 | 0.14 | 0.17 |
Appointment necessary | − 0.06 | 0.03 | 0.22* | 0.11 |
Nonrandom parameter | ||||
Opt-out ASC | − 0.89*** | 0.05 | ||
Model fit statistics | ||||
Number of individuals | 803 | |||
Number of completed choice sets | 4738 | |||
Log-likelihood function | − 4075.5 |
MXL-I Model
Scaled HIV Testing Preferences
Design attributes and levels | Coefficient | SE | StdD | SE |
---|---|---|---|---|
Test location | ||||
Home | 0.25** | 0.10 | 0.72*** | 0.11 |
Gay community-based organization (CBO) | 0.07 | 0.10 | 0.58*** | 0.12 |
Hospital | − 0.13 | 0.09 | 0.02 | 0.77 |
Health department | − 0.19* | 0.09 | ||
Identifier collected at test time | ||||
Must show ID card | − 0.28*** | 0.06 | 0.57*** | 0.07 |
Do not need to show ID card | 0.28*** | 0.06 | ||
Test administrator | ||||
Self-test | − 0.21 | 0.33 | 0.97*** | 0.12 |
Person with on the job training | − 0.25 | 0.17 | − 0.24* | 0.12 |
Health professional | 0.46* | 0.18 | ||
MSM identity disclosure | ||||
Required to disclose MSM activity | − 0.13* | 0.05 | 0.47*** | 0.07 |
NOT required to disclose MSM activity | 0.13* | 0.05 | ||
Type of test | ||||
Venipuncture | 0.04 | 0.06 | 0.37*** | 0.08 |
Finger prick | − 0.04 | 0.06 | ||
Cost/incentive | ||||
7.50 USD incentive | 0.22* | 0.09 | 0.39** | 0.15 |
Free test | 0.47*** | 0.11 | 0.66*** | 0.12 |
7.50 USD cost | − 0.16 | 0.09 | − 0.02 | 0.50 |
15 USD cost | − 0.53*** | 0.09 | ||
Scheduling | ||||
Appointment necessary | − 0.02 | 0.06 | 0.12 | 0.19 |
Walk-in | 0.02 | 0.06 | ||
Nonrandom parameter | ||||
Opt-out ASC | − 0.74*** | 0.09 | ||
Interaction terms | ||||
Ever had HIV test * Home | − 0.58*** | 0.12 | ||
Ever had HIV test * Gay CBO | − 0.03 | 0.12 | ||
Ever had HIV test * Hospital | 0.12 | 0.11 | ||
Ever had HIV test * Must show ID card | − 0.07 | 0.08 | ||
Ever had HIV test * Self-test | 0.07 | 0.40 | ||
Ever had HIV test * Person with on the job training | 0.00 | 0.21 | ||
Ever had HIV test * Required to disclose MSM activity | 0.00 | 0.07 | ||
Ever had HIV test * Venipuncture | 0.02 | 0.07 | ||
Ever had HIV test * 7.50 USD incentive | 0.14 | 0.11 | ||
Ever had HIV test * Free test | 0.04 | 0.13 | ||
Ever had HIV test * 7.50 USD cost | − 0.08 | 0.12 | ||
Ever had HIV test * Appointment necessary | 0.11 | 0.07 | ||
Ever had HIV test * optout | − 0.23* | 0.11 | ||
Model fit statistics | ||||
Number of individuals | 803 | |||
Number of observations | 4738 | |||
Log-likelihood function | − 4054.4 |
Relative Importance
Location | Anonymity | Test administrator | Disclosure of MSM activity | Test type | Cost/incentive | Appointment/walk-in | |
---|---|---|---|---|---|---|---|
Overall | 9.2% (5.7–12.4%) | 20.8% (18.1–23.3%) | 20.4% (7.0–30.4%) | 7.9% (5.3–10.4%) | 3.9% (1.0–6.7%) | 34.0% (31.2–36.7%) | 3.7% (1.0–6.2%) |
Ever tested | 17.8% (14.3–21.0%) | 19.3% (16.3–22.0%) | 17.0% (3.1–27.5%) | 6.7% (3.9–9.3%) | 3.6% (0.4–6.5%) | 30.8% (27.3–33.8%) | 5.0% (2.2–7.7%) |
Never tested | 13.9% (8.0–19.2%) | 18.5% (14.2–22.4%) | 22.1% (15.3–27.9%) | 7.7% (3.5–11.5%) | 2.6% (2.2–6.9%) | 33.5% (28.0–38.3%) | 1.6% (0.0–5.7%) |