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Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania

OBJECTIVES: Despite substantial public health efforts to increase HIV testing, testing rates have plateaued in many countries and rates of repeat testing for those with ongoing risk are low. To inform policies aimed at increasing uptake of HIV testing, we identified characteristics associated with i...

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Autores principales: Ostermann, Jan, Brown, Derek S., Mühlbacher, Axel, Njau, Bernard, Thielman, Nathan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540717/
https://www.ncbi.nlm.nih.gov/pubmed/26285777
http://dx.doi.org/10.1186/s13561-015-0060-8
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author Ostermann, Jan
Brown, Derek S.
Mühlbacher, Axel
Njau, Bernard
Thielman, Nathan
author_facet Ostermann, Jan
Brown, Derek S.
Mühlbacher, Axel
Njau, Bernard
Thielman, Nathan
author_sort Ostermann, Jan
collection PubMed
description OBJECTIVES: Despite substantial public health efforts to increase HIV testing, testing rates have plateaued in many countries and rates of repeat testing for those with ongoing risk are low. To inform policies aimed at increasing uptake of HIV testing, we identified characteristics associated with individuals’ willingness-to-accept (WTA) an HIV test in a general population sample and among two high-risk populations in Moshi, Tanzania. METHODS: In total, 721 individuals, including randomly selected community members (N = 402), female barworkers (N = 135), and male Kilimanjaro mountain porters (N = 184), were asked in a double-bounded contingent valuation format if they would test for HIV in exchange for 2000, 5000 or 10,000 Shillings (approximately $1.30, $3.20, and $6.40, respectively). The study was conducted between September 2012 and February 2013. RESULTS: More than one quarter of participants (196; 27 %) stated they would be willing to test for Tanzania Shilling (TSH) 2000, whereas one in seven (98; 13.6 %) required more than TSH 10,000. The average WTA estimate was TSH 4564 (95 % Confidence Interval: TSH 4201 to 4927). Significant variation in WTA estimates by gender, HIV risk factors and other characteristics plausibly reflects variation in individuals’ valuations of benefits of and barriers to testing. WTA estimates were higher among males than females. Among males, WTA was nearly one-third lower for those who reported symptoms of HIV than those who did not. Among females, WTA estimates varied with respondents’ education, own and partners’ HIV testing history, and lifetime reports of transactional sex. For both genders, the most significant association was observed with respondents’ perception of the accuracy of the HIV test; those believing HIV tests to be completely accurate were willing to test for approximately one third less than their counterparts. The mean WTA estimates identified in this study suggest that within the study population, incentivized universal HIV testing could potentially identify undiagnosed HIV infections at an incentive cost of $150 per prevalent infection and $1400 per incident infection, with corresponding costs per quality adjusted life year (QALY) gained of $70 for prevalent and $620 for incident HIV infections. CONCLUSIONS: The results support the value of information about the accuracy of HIV testing, and suggest that relatively modest amounts of money may be sufficient to incentivize at-risk populations to test.
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spelling pubmed-45407172015-08-24 Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania Ostermann, Jan Brown, Derek S. Mühlbacher, Axel Njau, Bernard Thielman, Nathan Health Econ Rev Research OBJECTIVES: Despite substantial public health efforts to increase HIV testing, testing rates have plateaued in many countries and rates of repeat testing for those with ongoing risk are low. To inform policies aimed at increasing uptake of HIV testing, we identified characteristics associated with individuals’ willingness-to-accept (WTA) an HIV test in a general population sample and among two high-risk populations in Moshi, Tanzania. METHODS: In total, 721 individuals, including randomly selected community members (N = 402), female barworkers (N = 135), and male Kilimanjaro mountain porters (N = 184), were asked in a double-bounded contingent valuation format if they would test for HIV in exchange for 2000, 5000 or 10,000 Shillings (approximately $1.30, $3.20, and $6.40, respectively). The study was conducted between September 2012 and February 2013. RESULTS: More than one quarter of participants (196; 27 %) stated they would be willing to test for Tanzania Shilling (TSH) 2000, whereas one in seven (98; 13.6 %) required more than TSH 10,000. The average WTA estimate was TSH 4564 (95 % Confidence Interval: TSH 4201 to 4927). Significant variation in WTA estimates by gender, HIV risk factors and other characteristics plausibly reflects variation in individuals’ valuations of benefits of and barriers to testing. WTA estimates were higher among males than females. Among males, WTA was nearly one-third lower for those who reported symptoms of HIV than those who did not. Among females, WTA estimates varied with respondents’ education, own and partners’ HIV testing history, and lifetime reports of transactional sex. For both genders, the most significant association was observed with respondents’ perception of the accuracy of the HIV test; those believing HIV tests to be completely accurate were willing to test for approximately one third less than their counterparts. The mean WTA estimates identified in this study suggest that within the study population, incentivized universal HIV testing could potentially identify undiagnosed HIV infections at an incentive cost of $150 per prevalent infection and $1400 per incident infection, with corresponding costs per quality adjusted life year (QALY) gained of $70 for prevalent and $620 for incident HIV infections. CONCLUSIONS: The results support the value of information about the accuracy of HIV testing, and suggest that relatively modest amounts of money may be sufficient to incentivize at-risk populations to test. Springer Berlin Heidelberg 2015-08-19 /pmc/articles/PMC4540717/ /pubmed/26285777 http://dx.doi.org/10.1186/s13561-015-0060-8 Text en © Ostermann et al. 2015 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Research
Ostermann, Jan
Brown, Derek S.
Mühlbacher, Axel
Njau, Bernard
Thielman, Nathan
Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania
title Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania
title_full Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania
title_fullStr Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania
title_full_unstemmed Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania
title_short Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania
title_sort would you test for 5000 shillings? hiv risk and willingness to accept hiv testing in tanzania
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540717/
https://www.ncbi.nlm.nih.gov/pubmed/26285777
http://dx.doi.org/10.1186/s13561-015-0060-8
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