HIV self-testing preferences among adolescent girls and young women (Agyw) in urban settings in Uganda
A discrete choice experiment
Bibliographic Data
HIV self-testing (HIVST) is a crucial innovation for improving testing coverage, particularly among adolescent girls and young women (AGYW) who are inadequately reached by standard provider-assisted HIV testing approaches. Understanding their preferences for HIVST services is essential for designing models that optimize uptake. We assessed the HIVST preferences among AGYW at a higher risk of acquiring HIV living in urban Uganda. We enrolled AGYW at a higher risk of HIV using a community-based convenience sampling in a discrete choice experiment (DCE). Each participant completed eight choice sets, each comprising of two hypothetical HIVST service alternatives and an opt-out option. The four attributes included level of assistance (assisted versus unassisted), distribution model (facility-based versus community-based), delivery channel (primary versus secondary) and sample type (oral swab versus blood). A mixed logit model was used to estimate the marginal utilities, relative importance (RI), HIVST profile utilities and predicted uptake (compared to opt-out). Between December 2024 and May 2025, 340 participants were enrolled with mean age 19.8 years (standard deviation (SD): 2.6), and 65.9% of them were not in school. In the main effects model, participants preferred; facility-based over community-based distribution model (β = 0.14 (95% confidence interval (CI): 0.06, 0.23)), primary over secondary delivery channel (β = 0.09 (95% CI: 0.00, 0.17)), and unassisted over assisted testing (β = 0.46 (95% CI: 0.37, 0.54). The sample type didn’t significantly influence the preferences of participants to use HIVST (β = 0.05 (95%CI: -0.04, 0.13). The level of assistance emerged as the most important attribute (RI: 60%), followed by facility-based distribution model (RI: 18.9%) and primary delivery channel (RI: 12.2%). There was a significant interaction between delivery channel and level of assistance (β = 0.66 (95% CI: 0.07, 1.24)). Primary delivery was preferred over secondary delivery when testing was unassisted (β = 0.41 (95% CI: 0.11, 0.71), but not when testing was assisted (β = -0.25 (95% CI: -0.56, 0.06). AGYW preferred HIVST models combining primary delivery with unassisted testing while facility-based distribution also increased preference. This highlights the importance of considering both individual attributes and their interaction when designing HIV delivery models.
Confidence interval · Discrete choice · Human immunodeficiency virus (HIV) · Logistic regression · Mixed logit · Sample (material) · Test (biology) · HIV Research and Treatment · HIV/AIDS drug development and treatment · HIV/AIDS Research and Interventions
Applied Choice Analysis
The cost and intermediary cost-effectiveness of oral HIV self-test kit distribution across 11 distribution models in South Africa
Acceptability of HIV self-testing among HIV high-risk Adolescent Girls and Young Women (Agyw) in urban settings in Uganda
Stigma in the health clinic and implications for PrEP access and use by adolescent girls and young women
Youth Preferences for HIV Testing in South Africa
A New Approach to Consumer Theory
| Citation velocity | historical |
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| Highly cited | No |