Skip to main content

Youth Preferences for HIV Testing in South Africa: Findings from the Youth Action for Health (YA4H) Study Using a Discrete Choice Experiment

AIDS and Behavior volume 25, pages 182–190 (2021)Cite this article

Abstract

We conducted a discrete choice experiment (DCE) and quantified preferences for HIV testing among South African youth (Nov 2018 to Mar 2019). Six attributes and levels were identified through qualitative methods: source of HIV information; incentive amount and type; social support; testing method; and location. Each participant chose one of two options that comprised six attributes across 18 questions. Conditional logistic regression estimated the degree of preference [β]. Of 130 participants, median age was 21 years (interquartile range 19–23 years), majority female (58%), and 85% previously tested for HIV. Testing alone over accompanied by a friend (β = 0.22 vs. − 0.35; p < 0.01); SMS text over paper brochures (β = 0.13 vs. − 0.10; p < 0.01); higher incentive values (R50) over no incentive (β = 0.09 vs. − 0.07; p = 0.01); and food vouchers over cash (β = 0.06 vs. β =  − 0.08; p = 0.01) were preferred. Testing at a clinic or home and family encouragement were important. Tailoring HTS to youth preferences may increase HIV testing.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. HIV/AIDS JUNP on. GLOBAL AIDS UPDATE [Internet]. 2016. https://www.unaids.org

  2. Idele P, Gillespie A, Porth T, Suzuki C, Mahy M, Kasedde S, et al. Epidemiology of HIV and AIDS among adolescents. JAIDS J Acquir Immune Defic Syndr. 2014;66(2):S144–S153153.

    PubMed  Google Scholar 

  3. UNAIDS. The gap report-Beginning of the end of the AIDS epidemic [Internet]. Unaids. 2014. https://files.unaids.org/.../unaidspublication/2014/UNAIDS_Gap_report_com/doi/full/1

  4. Pettifor AE, Rees HV, Kleinschmidt I, Annie E, Macphail C, Hlongwa-madikizela L, et al. Young people’s sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey. AIDS. 2005;19:1525–34.

    PubMed  Google Scholar 

  5. Shisana O, Rehle T, Simbayi L, Zuma K, Jooste S, Zungu N, et al. South African National HIV prevalence, incidence and behaviour survey, 2012. 2014.

  6. Rehle TM, Zuma K, Zungu N, Simbayi LC, Labadarios D, Abdullah F, et al. New insights into HIV epidemic in South Africa: key findings from the National HIV prevalence, incidence and behaviour survey, 2012. Afr J AIDS Res. 2016;15(1):67–75.

    PubMed  Google Scholar 

  7. Gouws E, Stanecki KA, Lyerla R, Ghys PD. The epidemiology of HIV infection among young people aged 15–24 years in southern Africa. AIDS. 2008;22(4):S5–16.

    PubMed  Google Scholar 

  8. Simbayi L, Zuma K, Zungu N, Moyo S, Marinda E, Jooste S, et al. South African National HIV prevalence, incidence, behaviour and communication survey, 2017. 2019

  9. Harrison A, Colvin CJ, Kuo C, Swartz A, Lurie M. Sustained high HIV incidence in young women in Southern Africa: social, behavioral and structural factors and emerging intervention approaches. Curr HIV/AIDS Rep. 2016;12(2):207–15.

    Google Scholar 

  10. DOH. South Africa Demographic and Health Survey 2003. 2007.

  11. Ramirez-Avila L, Nixon K, Noubary F, Giddy J, Losina E, Walensky RP, et al. Routine HIV testing in adolescents and young adults presenting to an outpatient clinic in Durban South Africa. PLoS ONE. 2012;7(9):5–9.

    Google Scholar 

  12. Sam-Agudu NA, Folayan MO, Ezeanolue EE. Seeking wider access to HIV testing for adolescents in sub-Saharan Africa. Pediatr Res. 2016;79(6):838–45.

    PubMed  Google Scholar 

  13. Zanoni BC, Elliott RJ, Neilan AM, Haberer JE. Screening for HIV and linkage to care in adolescents: insights from a systematic review of recent interventions in high- versus low- and middle-income settings. Adolesc Health Med Ther. 2018;9:211–35.

    PubMed  PubMed Central  Google Scholar 

  14. HSRC. HIV impact assessment summary July 2018 the fifth South African National HIV prevalence, incidence, behaviour and communication survey, 2017. 2018;2017(July):5–8.

  15. Tuysuzoglu S, Corliss HL, Fitzgerald SM, Abascal BR, Samples CL. Acceptability and feasibility of rapid HIV testing in an adolescent clinic setting: youth testing attitudes, knowledge, and behaviors. J Adolesc Health. 2011;49(6):609–14. https://doi.org/10.1016/j.jadohealth.2011.03.007.

    Article  PubMed  Google Scholar 

  16. Strauss M, Rhodes B, George G. A qualitative analysis of the barriers and facilitators of HIV counselling and testing perceived by adolescents in South Africa. BMC Health Serv Res. 2015;15(250):1–12. https://doi.org/10.1186/s12913-015-0922-0.

    Article  Google Scholar 

  17. 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;22:64–766.

    PubMed  Google Scholar 

  18. Chikwari CD, Dringus S, Ferrand RA. Barriers to, and emerging strategies for, HIV testing among adolescents in sub-Saharan Africa. Curr Opin HIV AIDS. 2018;31:257–64.

    Google Scholar 

  19. Kurth AE, Lally MA, Choko AT, Inwani IW, Fortenberry JD. HIV testing and linkage to services for youth. J Int AIDS Soc. 2015;18(Suppl 1):19433.

    PubMed  PubMed Central  Google Scholar 

  20. Thokoane C. Ethical challenges for piloting sexual health programs for youth in Hammanskraal, South Africa: bridging the gap between rights and services. Ethics Behav. 2015;25(2):169–79.

    PubMed  Google Scholar 

  21. Phelps BR, Vermund SH, Wong VJ, McCarraher DR, Murray KR. Adolescents, young people, and the 90–90–90 goals. AIDS. 2017;31:S191–S194194.

    PubMed  PubMed Central  Google Scholar 

  22. Ashton J, Dickson K, Pleaner M. Evolution of the national adolescent-friendly clinic initiative in South Africa [Internet]. 2009. http://apps.who.int/iris/bitstream/10665/44154/1/9789241598361_eng.pdf%0A. https://extranet.who.int/iris/restricted/handle/10665/44154

  23. Harvey B, Tony JS. Evaluation of a drama-in-education programme to increase AIDS awareness in South African high schools: a randomized community intervention trial. Int J STD AIDS. 2000;11:105–11.

    CAS  PubMed  Google Scholar 

  24. Thokoane C. Ethical challenges for piloting sexual health programs for youth in Hammanskraal, South Africa: bridging the gap between rights. Ethics Behav. 2015;25(2):169–79.

    PubMed  Google Scholar 

  25. Kranzer K, Govindasamy D, van Schaik N, Thebus E, Davies N, Zimmermann M, et al. incentivized recruitment of a population sample to a mobile HIV testing. HIV Med. 2013;13(2):132–7.

    Google Scholar 

  26. Mukund Bahadur KC, Murrayb PJ. Cell phone short messaging service (SMS) for HIV/AIDS in South Africa: a literature review. Stud Health Technol Inform. 2010;160(PART 1):530–4.

    PubMed  Google Scholar 

  27. Uhrig JD, Lewis MA, Harris JL, Coomes CM, Bann CM, Furberg RD. Beyond reminders: a conceptual framework for using short message service to promote prevention and improve healthcare quality and clinical outcomes for people living with HIV. AIDS Care. 2011;24(3):348–57.

    PubMed  Google Scholar 

  28. Amon KL, Campbell AJ, Hawke C, Steinbeck K. Facebook as a recruitment tool for adolescent health research: a systematic review. Acad Pediatr. 2014;14(5):439–47.

    PubMed  Google Scholar 

  29. Hall E, Sanchez T, Stephenson R, Stein AD, Sineath RC, Zlotorzynska M, et al. Randomised controlled trial of incentives to improve online survey completion among internet-using men who have sex with men. J Epidemiol Community Health. 2019;73:156–61.

    PubMed  Google Scholar 

  30. Nglazi MD, Van Schaik N, Kranzer K, Lawn SD, Wood R, Bekker LG. An incentivized HIV counseling and testing program targeting hard-to-reach unemployed men in Cape Town South Africa. J Acquir Immune Defic Syndr. 2012;59(3):e28–e34.

    PubMed  PubMed Central  Google Scholar 

  31. Pettifor A, MacPhail C, Nguyen N, Rosenberg M. Can money prevent the spread of HIV? A review of cash payments for HIV prevention. AIDS Behav. 2012;16(7):1729–38.

    PubMed  PubMed Central  Google Scholar 

  32. Lee R, Cui RR, Muessig KE, Thirumurthy H, Tucker JD. Incentivizing HIV/STI testing: a systematic review of the literature. AIDS Behav. 2014;18(5):905–12.

    PubMed  PubMed Central  Google Scholar 

  33. Luciana M, Collins PF. Incentive motivation, cognitive control, and the adolescent brain: is it time for a paradigm shift? Child Dev Perspect. 2012;6(4):392–9.

    PubMed  PubMed Central  Google Scholar 

  34. Giles EL, Becker F, Ternent L, Sniehotta FF, McColl E, Adams J. Acceptability of financial incentives for health behaviours: a discrete choice experiment. PLoS ONE. 2016;11(6):1–19.

    Google Scholar 

  35. Kim HY, Dowdy DW, Martinson NA, Kerrigan D, Tudor C, Golub J, et al. Maternal motivation to take preventive therapy in antepartum and postpartum among HIV-positive pregnant women in South Africa: a choice experiment. AIDS Behav. 2018. https://doi.org/10.1007/s10461-018-2324-x.

    Article  PubMed  Google Scholar 

  36. Quaife M, Eakle R, Cabrera Escobar MA, Vickerman P, Kilbourne-Brook M, Mvundura M, et al. Divergent preferences for HIV prevention: a discrete choice experiment for multipurpose HIV prevention products in South Africa. Med Decis Making. 2018;38(1):120–33.

    PubMed  Google Scholar 

  37. Terris-prestholt F, Neke N, Grund JM, Plotkin M, Kuringe E, Osaki H, et al. Using discrete choice experiments to inform the design of complex interventions. BMC Trials. 2019;20(157):1–11.

    Google Scholar 

  38. Brunie A, Chen M, Akol A. Qualitative assessment of the application of a discrete choice experiment with community health workers in Uganda: aligning incentives with preferences. Glob Health Sci Pract. 2016;4(4):684–93.

    PubMed  PubMed Central  Google Scholar 

  39. 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.

    PubMed  Google Scholar 

  40. Eshun-wilson I, Mukumbwa-mwenechanya M, Kim H, Zannolini A, Mwamba CP, Dowdy D, et al. Differentiated care preferences of stable patients on antiretroviral therapy in Zambia : a discrete choice experiment. JAIDS J Acquir Immune Defic Syndr. 2019;81(5):540–6.

    CAS  PubMed  Google Scholar 

  41. US Embassy. Dream South Africa gauteng fact sheet 2016 [Internet]. 2016. https://za.usembassy.gov/wp-content/uploads/sites/19/2016/12/DREAMS-SA_FactSheet_October_-2016.pdf

  42. Hall KS. The health belief model can guide modern contraceptive behavior research and practice. J Midwifery Women’s Heal. 2012;57(1):74–81.

    Google Scholar 

  43. Tarkang EE, Zotor FB. Application of the health belief model (HBM) in HIV prevention: a literature review. Sci Publ Gr. 2015;1(1):1–8. https://www.sciencepublishinggroup.com/journal/paperinfo.aspx?journalid=326&doi=10.11648/j.cajph.20150101.11

  44. Janssen EM, Segal JB, Bridges JFP. A framework for instrument development of a choice experiment: an application to type 2 diabetes. Patient. 2016;9(5):465–79.

    PubMed  Google Scholar 

  45. Janssen EM, Hauber AB, Bridges JFP. Conducting a discrete-choice experiment study following recommendations for good research practices: an application for eliciting patient preferences for diabetes treatments. Value Heal. 2018;21(1):59–68. https://doi.org/10.1016/j.jval.2017.07.001.

    Article  Google Scholar 

  46. Hollin IL, Peay HL, Bridges JFP. Caregiver preferences for emerging duchenne muscular dystrophy treatments: a comparison of best-worst scaling and conjoint analysis. Patient. 2014;8(1):19–27.

    Google Scholar 

  47. Kuhfeld WF. Marketing research methods in SAS. Marketing research methods in SAS: experimental design, choice, conjoint, and graphical techniques. USA: SAS Institute Inc; 2010.

  48. Johnson FR, Lancsar E, Marshall D, Kilambi V, Mühlbacher A, Regier DA, et al. Constructing experimental designs for discrete-choice experiments: report of the ISPOR conjoint analysis experimental design good research practices task force. Value Heal. 2013;16(1):3–13.

    Google Scholar 

  49. Train KE. Discrete choice methods with simulation. 2nd ed. Cambridge: Cambridge University Press; 2009.

    Google Scholar 

  50. Hole AR. Fitting mixed logit models by using maximum simulated likelihood. Stata J. 2007;7:388–401.

    Google Scholar 

  51. Saul J, Bachman G, Allen S, Toiv NF, Cooney C, Beamon T. The DREAMS core package of interventions: a comprehensive approach to preventing HIV among adolescent girls and young women. PLoS ONE. 2018;13(12):1–18.

    Google Scholar 

  52. George G, Cawood C, Puren A, Khanyile D, Gerritsen A, Govender K, et al. Evaluating DREAMS HIV prevention interventions targeting adolescent girls and young women in high HIV prevalence districts in South Africa: protocol for a cross-sectional study. BMC Womens Health. 2020;20(1):7.

    PubMed  PubMed Central  Google Scholar 

  53. Lawrence E, Struthers P, Van Hove G. HIV counselling and testing in secondary schools: what students want. South Afr J HIV Med. 2015;16(1):1–6.

    CAS  Google Scholar 

  54. Perry C, Chhatralia K, Damesick D, Hobden S, Volpe L. Behavioural insights in health care Nudging to reduce inefficiency and waste. London: Health Foundation; 2015.

    Google Scholar 

  55. Beger G, Sinha A, Pawelczyk K. South African mobile generation Study on South African young people on mobiles [Internet]. UNICEF. 2012. https://www.unicef.org/southafrica/SAF_resources_mobilegeneration.pdf

  56. Ronen K, Unger JA, Drake AL, Perrier T, Akinyi P, Osborn L, et al. SMS messaging to improve ART adherence: perspectives of pregnant HIV-infected women in Kenya on HIV-related message content. AIDS Care Psychol Socio-Medical Asp AIDS/HIV. 2018;30(4):500–5.

    Google Scholar 

  57. Peter J, Barron P, Pillay Y. Using mobile technology to improve maternal, child and youth health and treatment of HIV patients. S Afr Med J. 2016;106(1):3–4.

    Google Scholar 

Download references

Acknowledgements

We would like to acknowledge our funder SANTHE for the financial support, the research team for their dedication and participants for their willingness to engage with us.

Funding

This work was supported through the Sub-Saharan African Network for TB/HIV Research Excellence (SANTHE), a DELTAS Africa Initiative [Grant # DEL-15-006]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [Grant # 107752/Z/15/Z] and the UK government. The views expressed in this publication are those of the author(s) and not necessarily those of AAS, NEPAD Agency, Wellcome Trust or the UK government.

Author information

Authors and Affiliations

  1. The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa

    Candice M. Chetty-Makkan, Christopher J. Hoffmann, Salome Charalambous, Claire Botha, Simphiwe Ntshuntshe & Nolwazi Nkosi

  2. John Hopkins University, Baltimore, USA

    Christopher J. Hoffmann

  3. School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Candice M. Chetty-Makkan & Salome Charalambous

  4. Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa

    Hae-Young Kim

  5. Department of Population Health, New York University School of Public Health, New York, USA

    Hae-Young Kim

Authors
  1. Candice M. Chetty-Makkan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher J. Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Salome Charalambous
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Claire Botha
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Simphiwe Ntshuntshe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nolwazi Nkosi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hae-Young Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CMK, Designed the study, conducted the analysis and wrote the first draft of the manuscript; HC, Designed the study, reviewed the analysis and the draft manuscripts; B, Managed recruitment for study, reviewed the analysis and the draft manuscripts; NN, Involved with recruitment, data collection and review of the draft manuscripts.

Corresponding author

Correspondence to Candice M. Chetty-Makkan.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Electronic supplementary material 1 (DOCX 59 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chetty-Makkan, C.M., Hoffmann, C.J., Charalambous, S. et al. Youth Preferences for HIV Testing in South Africa: Findings from the Youth Action for Health (YA4H) Study Using a Discrete Choice Experiment. AIDS Behav 25, 182–190 (2021). https://doi.org/10.1007/s10461-020-02960-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-020-02960-9

Keywords

  • Discrete choice experiment
  • Youth
  • HIV testing uptake
  • Cellphone technology
  • Incentives N = 149