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Designing HIV Testing and Self-Testing Services for Young People in Nigeria: A Discrete Choice Experiment

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Abstract

Background and Objective

A third of new human immunodeficiency virus (HIV) infections occur among young people and the majority of young people living with HIV are in sub-Saharan Africa. We examined the strength of Nigerian youth preferences related to HIV testing and HIV self-testing (HIVST).

Methods

Discrete choice experiments were conducted among Nigerian youth (age 14–24 years). Participants completed one of two discrete choice experiments: (1) preferred qualities of HIV testing (cost, location of test, type of test, person who conducts the test, and availability of HIV medicine at the testing site) and (2) preferred qualities of HIVST kits (cost, test quality, type of test, extra items, and support if tested positive). A random parameter logit model measured the strength of preferences.

Results

A total of 504 youth participated: mean age 21 years (standard deviation 2 years), 38% male, and 35% had a higher than secondary school education. There was a strong preference overall to test given the scenarios presented, although male individuals were less likely to test for HIV or use HIVST kits. Youth preferred HIV testing services (with attributes in order of importance) that are free, blood-based testing, available in private/public hospitals or home, for HIV medications to be available in the same location as testing, and a doctor conducts the test. Participants preferred HIVST kits (with attributes in order of importance) that are available from community health centers, free, approved by the World Health Organization, include other sexually transmitted infection testing, have the option of an online chat, and oral-based HIVST.

Conclusions

The HIV home testing was equally preferred to testing in a hospital, suggesting a viable market for HIVST if kits account for youth preferences. Male youth were less likely to choose to test for HIV or use HIVST kits, underscoring the need for further efforts to encourage HIV testing among young male individuals.

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References

  1. Avert. Young people, HIV and AIDS. 2021. https://www.avert.org/professionals/hiv-social-issues/key-affected-populations/young-people. Accessed 26 Apr 2021.

  2. Allen E, Gordon A, Krakower D, Hsu K. HIV preexposure prophylaxis for adolescents and young adults. Curr Opin Pediatr. 2017;29(4):399–406.

    Article  Google Scholar 

  3. UNAIDS. UNAIDS data 2020. 2021. https://www.unaids.org/en/resources/documents/2020/unaids-data. Accessed 26 Apr 2021.

  4. Oladele EA, Badejo OA, Obanubi C, Okechukwu EF, James E, Owhonda G, et al. Bridging the HIV treatment gap in Nigeria: examining community antiretroviral treatment models. J Int AIDS Soc. 2018;21(4):e25108.

    Article  Google Scholar 

  5. UNAIDS. Nigeria. 2021. https://www.unaids.org/en/regionscountries/countries/nigeria. Accessed 26 Apr 2021.

  6. Somefun OD, Wandera SO, Odimegwu C. Media exposure and HIV testing among youth in sub-Saharan Africa: evidence from demographic and health surveys (DHS). SAGE Open. 2019;9(2):2158244019851551.

    Article  Google Scholar 

  7. Demographic N. Health survey 2013. National Population Commission (NPC) [Nigeria] and ICF International. Abuja, Nigeria, and Rockville (MD): NPC and ICF International; 2019.

  8. World Health Organization. Guidelines on HIV self-testing and partner notification. 2021. https://www.who.int/hiv/pub/vct/hiv-self-testing-guidelines/en/. Accessed 26 Apr 2021.

  9. Global AIDS Monitoring (UNAIDS/WHO/UNICEF) and WHO Country Intelligence Tool, 2019. Status of HIV self-testing (HIVST) in national policies (situation as of July 2019). 2021. https://www.who.int/hiv/topics/self-testing/HIVST-policy_map-jul2019-a.png?ua=1. Accessed 26 Apr 2021.

  10. Ritchwood TD, Selin A, Pettifor A, Lippman SA, Gilmore H, Kimaru L, et al. HIV self-testing: South African young adults’ recommendations for ease of use, test kit contents, accessibility, and supportive resources. BMC Public Health. 2019;19(1):123.

    Article  Google Scholar 

  11. Hatzold K, Gudukeya S, Mutseta MN, Chilongosi R, Nalubamba M, Nkhoma C, et al. HIV self-testing: breaking the barriers to uptake of testing among men and adolescents in sub-Saharan Africa, experiences from STAR demonstration projects in Malawi, Zambia and Zimbabwe. J Int AIDS Soc. 2019;22(Suppl 1):e25244.

    Article  Google Scholar 

  12. Lancaster K. A new approach to consumer theory. J Polit Econ. 1966;74(2):132–57.

    Article  Google Scholar 

  13. Sibanda EL, d’Elbee M, Maringwa G, Ruhode N, Tumushime M, Madanhire C, et al. Applying user preferences to optimize the contribution of HIV self-testing to reaching the “first 90” target of UNAIDS fast-track strategy: results from discrete choice experiments in Zimbabwe. J Int AIDS Soc. 2019;22(Suppl 1):e25245.

    Article  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. Michaels-Igbokwe C, Lagarde M, Cairns J, Integra I, Terris-Prestholt F. Designing a package of sexual and reproductive health and HIV outreach services to meet the heterogeneous preferences of young people in Malawi: results from a discrete choice experiment. Health Econ Rev. 2015;5:9.

    Article  Google Scholar 

  16. Bristow CC, Kojima N, Lee SJ, Leon SR, Ramos LB, Konda KA, et al. HIV and syphilis testing preferences among men who have sex with men and among transgender women in Lima, Peru. PLoS ONE. 2018;13(10):e0206204.

    Article  Google Scholar 

  17. Strauss M, George G, Lansdell E, Mantell JE, Govender K, Romo M, et al. HIV testing preferences among long distance truck drivers in Kenya: a discrete choice experiment. AIDS Care. 2018;30(1):72–80.

    Article  Google Scholar 

  18. Zanolini A, Chipungu J, Vinikoor MJ, Bosomprah S, Mafwenko M, Holmes CB, et al. HIV self-testing in Lusaka Province, Zambia: acceptability, comprehension of testing instructions, and individual preferences for self-test kit distribution in a population-based sample of adolescents and adults. AIDS Res Hum Retroviruses. 2018;34(3):254–60.

    Article  CAS  Google Scholar 

  19. Strauss M, George GL, Rhodes BD. Determining preferences related to HIV counselling and testing services among high school learners in KwaZulu-Natal: a discrete choice experiment. AIDS Behav. 2018;22(1):64–76.

    Article  Google Scholar 

  20. Strauss M, George G, Mantell JE, Romo ML, Mwai E, Nyaga EN, et al. Stated and revealed preferences for HIV testing: can oral self-testing help to increase uptake amongst truck drivers in Kenya? BMC Public Health. 2018;18(1):1231.

    Article  Google Scholar 

  21. 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;9(3):e92100.

    Article  Google Scholar 

  22. Indravudh PP, Sibanda EL, d’Elbee M, Kumwenda MK, Ringwald B, Maringwa G, et al. “I will choose when to test, where I want to test”: investigating young people’s preferences for HIV self-testing in Malawi and Zimbabwe. AIDS. 2017;31(Suppl 3):S203–12.

    Article  Google Scholar 

  23. Pan SW, Durvasula M, Ong JJ, Liu C, Tang W, Fu H, et al. No place like home? Disentangling preferences for HIV testing locations and services among men who have sex with men in China. AIDS Behav. 2019;23(4):847–59.

    Article  Google Scholar 

  24. Mangham LJ, Hanson K, McPake B. How to do (or not to do) … Designing a discrete choice experiment for application in a low-income country. Health Policy Plan. 2009;24(2):151–8.

    Article  Google Scholar 

  25. Obiezu-Umeh C, Gbajabiamila T, Ezechi O, Nwaozuru U, Ong JJ, Idigbe I, et al. Young people’s preferences for HIV self-testing services in Nigeria: a qualitative analysis. BMC Public Health. 2021;21(1):67.

    Article  Google Scholar 

  26. Bech M, Gyrd-Hansen D. Effects coding in discrete choice experiments. Health Econ. 2005;14(10):1079–83.

    Article  Google Scholar 

  27. Hensher DA, Rose JM, Greene WH. Applied choice analysis. 2nd ed. Cambridge: Cambridge University Press; 2015.

    Book  Google Scholar 

  28. Wong V, Jenkins E, Ford N, Ingold H. To thine own test be true: HIV self-testing and the global reach for the undiagnosed. J Int AIDS Soc. 2019;22(Suppl 1):e25256.

    Article  Google Scholar 

  29. Indravudh PP, Choko AT, Corbett EL. Scaling up HIV self-testing in sub-Saharan Africa: a review of technology, policy and evidence. Curr Opin Infect Dis. 2018;31(1):14–24.

    Article  Google Scholar 

  30. Stevens DR, Vrana CJ, Dlin RE, Korte JE. A global review of HIV self-testing: themes and implications. AIDS Behav. 2018;22(2):497–512.

    Article  Google Scholar 

  31. Zhong F, Tang W, Cheng W, Lin P, Wu Q, Cai Y, et al. Acceptability and feasibility of a social entrepreneurship testing model to promote HIV self-testing and linkage to care among men who have sex with men. HIV Med. 2017;18(5):376–82.

    Article  CAS  Google Scholar 

  32. Li KT, Tang W, Wu D, Huang W, Wu F, Lee A, et al. Pay-it-forward strategy to enhance uptake of dual gonorrhea and chlamydia testing among men who have sex with men in China: a pragmatic, quasi-experimental study. Lancet Infect Dis. 2019;19(1):76–82.

    Article  Google Scholar 

  33. Ajayi AI, Awopegba OE, Adeagbo OA, Ushie BA. Low coverage of HIV testing among adolescents and young adults in Nigeria: implication for achieving the UNAIDS first 95. PLoS ONE. 2020;15(5):e0233368.

    Article  CAS  Google Scholar 

  34. World Health Organization. Prequalification of in vitro diagnostics public report. Product: first response HIV1+2/syphilis Combo Card test. 2021. https://www.who.int/diagnostics_laboratory/evaluations/pq-list/190625_pqdx_0364_010_00_final_pqpr.pdf. Accessed 26 Apr 2021.

  35. World Health Organization. The point-of-care diagnostic landscape for STIs October 2019. 2021. https://www.who.int/reproductivehealth/topics/rtis/pocts/en/. Accessed 26 Apr 2021.

  36. Chesson HW, Mayaud P, Aral SO. Sexually transmitted infections: impact and cost-effectiveness of prevention. In: Holmes KK, Bertozzi S, Bloom BR, Jha P (eds) Major infectious diseases. Washington (DC): The International Bank for Reconstruction and Development/The World Bank; 2017.

    Google Scholar 

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Acknowledgements

We thank the Nigerian Institute of Medical Research for their support of the project and the young people who participated.

Author information

Authors and Affiliations

  1. Central Clinical School, Monash University, Melbourne, VIC, 3053, Australia

    Jason J. Ong

  2. London School of Hygiene and Tropical Medicine, London, UK

    Jason J. Ong, Fern Terris-Prestholt & Joseph D. Tucker

  3. Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia

    Jason J. Ong

  4. Saint Louis University College for Public Health and Social Justice, St Louis, MO, USA

    Ucheoma Nwaozuru, Chisom Obiezu-Umeh, Hong Xian & Juliet Iwelunmor

  5. Georgia State University, Atlanta, GA, USA

    Collins Airhihenbuwa

  6. The Nigerian Institute of Medical Research, Lagos, Nigeria

    Titilola Gbajabiamila, Adesola Z. Musa, David Oladele, Ifeoma Idigbe, Agatha David, Jane Okwuzu, Tajudeen Bamidele & Oliver Ezechi

  7. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Joseph D. Tucker

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  1. Jason J. Ong
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Corresponding author

Correspondence to Jason J. Ong.

Ethics declarations

Funding

Financial support for this study was provided entirely by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, grant number: UG3HD096929. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the report.

Conflict of interest

Jason J. Ong, Ucheoma Nwaozuru, Chisom Obiezu-Umeh, Collins Airhihenbuwa, Hong Xian, Fern Terris-Prestholt, Titi Gbajabiamila, Adesola Z. Musa, David Oladele, Ifeoma Idigbe, Agatha David, Jane Okwuzu, Tajudeen Bamidele, Juliet Iwelunmor, Joseph D. Tucker, and Oliver Ezechi have no conflicts of interest that are directly relevant to the content of this article.

Ethics approval

Ethical approvals for the study were granted by the Saint Louis University and the Nigerian Institute of Medical Research Institutional Review Boards.

Consent to participate

Written informed consents were obtained from all the study participants. This is in accordance with the Nigerian guidelines for sexual and reproductive health research, such that young people who are aged 13 years and over can provide informed consent for sexual and reproductive health research.

Consent for publication

All authors have reviewed the final manuscript and approved this for publication.

Availability of data and material

All relevant data are presented in the article. Further data may be accessed by writing to the corresponding author.

Code availability

Not applicable.

Author's contributions

JJO, JI, JDT, and OE designed the research study. JJO, UN, COU, CA, HX, TG, AZM, DO, II, AD, JO, and TB performed the research. JJO and FTP analyzed the data. JJO wrote the paper and all authors have read and approved the final manuscript.

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Ong, J.J., Nwaozuru, U., Obiezu-Umeh, C. et al. Designing HIV Testing and Self-Testing Services for Young People in Nigeria: A Discrete Choice Experiment. Patient 14, 815–826 (2021). https://doi.org/10.1007/s40271-021-00522-2

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