Preferences for linkage to HIV care services following a reactive self-test: discrete choice experiments in Malawi and Zambia.

d'Elbée, Marc, Indravudh, Pitchaya P, Mwenge, Lawrence, Kumwenda, Moses, Simwinga, Musonda, Choko, Augustine, Hensen, Bernadette, Neuman, Melissa, Ong, Jason J, Sibanda, Euphemia ORCID: https://orcid.org/0000-0003-1754-1076, Johnson, Cheryl C, Hatzold, Karin, Cowan, Frances ORCID: https://orcid.org/0000-0003-3087-4422, Ayles, Helen, Corbett, Elizabeth and Terris-Prestholt, Fern (2018) 'Preferences for linkage to HIV care services following a reactive self-test: discrete choice experiments in Malawi and Zambia.'. AIDS, Vol 32, Issue 14, pp. 2043-2049.

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Abstract

OBJECTIVES
The current research identifies key drivers of demand for linkage into care following a reactive HIV self-test result in Malawi and Zambia. Preferences are explored among the general population and key groups such as HIV-positive individuals and adolescents.

DESIGN
We used discrete choice experiments (DCEs) embedded in representative household surveys to quantify the relative strength of preferences for various HIV services characteristics.

METHODS
The DCE was designed on the basis of a literature review and qualitative studies. Data were collected within a survey (Malawi n = 553, Zambia n = 388), pooled across country and analysed using mixed logit models. Preference heterogeneity was explored by country, age, sex, wealth, HIV status and belief that HIV treatment is effective.

RESULTS
DCE results were largely consistent across countries. Major barriers for linkage were fee-based testing and long wait for testing. Community-based confirmatory testing, that is at the participant's or counsellor's home, was preferred to facility-based confirmation. Providing separated waiting areas for HIV services at health facilities and mobile clinics was positively viewed in Malawi but not in Zambia. Active support for linkage was less important to respondents than other attributes. Preference heterogeneity was identified: overall, adolescents were more willing to seek care than adults, whereas HIV-positive participants were more likely to link at health facilities with separate HIV services.

CONCLUSION
Populations in Malawi and in Zambia were responsive to low-cost, HIV care services with short waiting time provided either at the community or privately at health facilities. Hard-to-reach groups could be encouraged to link to care with targeted support.

Item Type:	Article
Subjects:	WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.1 Diagnosis
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Digital Object Identifer (DOI):	https://doi.org/10.1097/QAD.0000000000001918
Depositing User:	Stacy Murtagh
Date Deposited:	18 Jun 2018 15:16
Last Modified:	07 Oct 2019 07:36
URI:	https://archive.lstmed.ac.uk/id/eprint/8775

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