Does Preference-based HIV Testing Increase Uptake in High Risk Populations?

NCT02714140 | Completed

• 1 other identifier: R01MH106388
• Study Type: interventional
• Target: 1,194
• Locations: 2 countries
• Sites: 3

Brief Summary

Despite worldwide efforts to promote HIV Counseling and Testing (HCT), rates of testing remain low. Understanding how high risk groups decide to test and adapting available testing options to their preferences has the potential to broadly improve HCT uptake and cost-effectiveness. This study proposes to use a Discrete Choice Experiment, a survey method increasingly used by health economists for the design of patient-centered health care options, to rigorously quantify HIV testing preferences among two high-risk populations, identify their preferred testing options, and evaluate, in a pragmatic randomized controlled trial (RCT), the effect of a preference-based HIV counseling and testing (PB-HCT) intervention on testing uptake. At a time of heightened focus on health preferences research and patient-centered care, this study evaluates the critical link between preference-based intervention design and efficacy. If the RCT indicates that PB-HCT increases testing rates, the testing options evaluated in this R01 can be offered to high-risk populations in the study area, and the preference elicitation method and tools can be used to inform the design of testing options that better match the preferences of other high-risk populations and in other settings.

Conditions

HIV Testing

Outcome Measures

Primary Outcomes (1)

• Uptake of HIV testing - 3 months

  Percent of participants who test for HIV

  3 months

Secondary Outcomes (1)

• Uptake of HIV testing - 15 months

  15 months

Study Arms (3)

Group A: More preferred Existing + Common

EXPERIMENTAL

Group A participants will be offered the common option and 3 currently available testing options that are targeted at the distribution of preferences among participants.

Behavioral: PB-HCT +; Behavioral: Economic incentive; Behavioral: SMS Reminder

Group B: More preferred Enhanced + Common

EXPERIMENTAL

Group B participants will be offered the common option and 3 preference-informed "enhanced" testing options, which include combinations of features that may not yet be available in the study area.

Behavioral: Economic incentive; Behavioral: PB-HCT ++; Behavioral: SMS Reminder

Group C: Less preferred + Common

ACTIVE COMPARATOR

Group C participants will be offered the common option and 3 predicted less-preferred options. With the common option being the best option in Group C, this group is effectively a non-PB-HCT comparison group.

Behavioral: PB-HCT -; Behavioral: Economic incentive; Behavioral: SMS Reminder

Interventions

PB-HCT ++ BEHAVIORAL

Participants will be offered 3 HIV testing options. The investigators will rank the predicted utility of all feasible ENHANCED HIV testing options for each participant and select those 3 PB-HCT options that jointly maximize the share of participants predicted to prefer at least one of the three options over the common option.

Group B: More preferred Enhanced + Common

Economic incentive BEHAVIORAL

Participants will be re-contacted three months after being offered PB-HCT options. Participants will be reminded of the options, and offered an incentive to present for testing using any of the PB-HCT options or the common option.

Group A: More preferred Existing + Common; Group B: More preferred Enhanced + Common; Group C: Less preferred + Common

SMS Reminder BEHAVIORAL

Participants will receive an SMS reminder to test.

Group A: More preferred Existing + Common; Group B: More preferred Enhanced + Common; Group C: Less preferred + Common

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Males who work as Kilimanjaro mountain porters, Females who regularly work at a bar, hotel or restaurant establishment and serve alcohol to patrons.
• Eligible participants will be ages 18+, reside in Moshi, Tanzania and have no plans to leave the study area.

You may not qualify if:

• Participants who are not able to see will be excluded owing to the visual nature of the survey presented to elicit preferences.

Sponsors & Collaborators

• University of South Carolina: lead
• Duke University: collaborator
• Kilimanjaro Christian Medical Centre, Tanzania: collaborator

Study Sites (3)

Duke University

Durham, North Carolina, 27708, United States

Location

University of South Carolina

Columbia, South Carolina, 29208, United States

Location

Kilimanjaro Clinical Research Institute

Moshi, Kilimanjaro, Tanzania

Location

Related Publications (7)

• Ostermann J, Njau B, Brown DS, Muhlbacher A, Thielman N. Heterogeneous HIV testing preferences in an urban setting in Tanzania: results from a discrete choice experiment. PLoS One. 2014 Mar 18;9(3):e92100. doi: 10.1371/journal.pone.0092100. eCollection 2014.

  PMID: 24643047 BACKGROUND

• Njau B, Ostermann J, Brown D, Muhlbacher A, Reddy E, Thielman N. HIV testing preferences in Tanzania: a qualitative exploration of the importance of confidentiality, accessibility, and quality of service. BMC Public Health. 2014 Aug 12;14:838. doi: 10.1186/1471-2458-14-838.

  PMID: 25124140 BACKGROUND

• Ostermann J, Njau B, Mtuy T, Brown DS, Muhlbacher A, Thielman N. One size does not fit all: HIV testing preferences differ among high-risk groups in Northern Tanzania. AIDS Care. 2015;27(5):595-603. doi: 10.1080/09540121.2014.998612. Epub 2015 Jan 23.

  PMID: 25616562 BACKGROUND

• Ostermann J, Brown DS, Muhlbacher A, Njau B, Thielman N. Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania. Health Econ Rev. 2015 Dec;5(1):60. doi: 10.1186/s13561-015-0060-8. Epub 2015 Aug 19.

  PMID: 26285777 BACKGROUND

• Ostermann J, Njau B, Hobbie A, Mtuy T, Masaki ML, Shayo A, van Zwetselaar M, Masnick M, Flaherty B, Brown DS, Muhlbacher AC, Thielman NM. Using discrete choice experiments to design interventions for heterogeneous preferences: protocol for a pragmatic randomised controlled trial of a preference-informed, heterogeneity-focused, HIV testing offer for high-risk populations. BMJ Open. 2020 Nov 6;10(11):e039313. doi: 10.1136/bmjopen-2020-039313.

  PMID: 33158826 BACKGROUND

• Ostermann J, Njau B, Hobbie AM, Mtuy TB, Masnick M, Brown DS, Muhlbacher AC, Thielman NM. Divergent preferences for enhanced HIV testing options among high-risk populations in northern Tanzania: a short report. AIDS Care. 2023 Sep;35(9):1270-1278. doi: 10.1080/09540121.2022.2119471. Epub 2022 Sep 5.

  PMID: 36063533 DERIVED

• Ostermann J, Njau B, Masaki M, Mtuy T, Itemba D, Hobbie A, Yelverton V, Moore S, Yamanis T, Thielman NM. Feasibility, Acceptability, and Potential Cost-Effectiveness of a Novel Mobile Phone Intervention to Promote Human Immunodeficiency Virus Testing Within Social Networks in Tanzania. Sex Transm Dis. 2022 Nov 1;49(11):778-781. doi: 10.1097/OLQ.0000000000001611. Epub 2022 Jan 29.

  PMID: 35093981 DERIVED

Study Officials

• Jan Ostermann, PhD

  University of South Carolina

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: DIAGNOSTIC
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: March 16, 2016
• First Posted: March 21, 2016
• Study Start: January 3, 2018
• Primary Completion: October 31, 2020
• Study Completion: October 31, 2020
• Last Updated: August 18, 2021

Record last verified: 2021-08

Data Sharing

• IPD Sharing: Will not share

Locations

US (2); TA (1)