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

Abstract

ObjectivesDespite 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.MethodsIn 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.ResultsMore 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.ConclusionsThe 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.

Perceived Cost Advantages and Disadvantages of Purchasing HIV Self- Testing Kits among Urban Tanzanian Men: An Inductive Content Analysis

“…On the other hand, the perceived trade-offs of non-financial and emotional costs relating self-testing, such as the distress of having unreliable results or making a death-related purchase disfavored use of HIVST. These findings suggest that men’s individual cost structure (i.e., the process for determining the expected gains and losses) for deciding whether to self-test considers multiple trade-offs [ 46 , 75 ]. Men with the highest opportunity cost (i.e., those who face significant resource constraints or those who face high potential lost earnings in time) may prefer free or low-cost testing.…”

“…Economic theory suggests that rational individuals will obtain an HIV test if the anticipated benefits are greater than the anticipated costs [ 45 ]. This would mean that an individual’s decision to test for HIV reflects a valuation of testing that exceeds both the expected financial costs of testing, such as clinic or laboratory fees, as well as the expected non-financial costs of testing, such as the physical discomfort from the test procedure, the psychological expense (i.e., stress, fear, stigma, guilt) of having a positive diagnosis, or the opportunity costs of lost fare, time, or productivity [ 21 , 46 ]. Individuals, including men, with low monetary resources may also be more sensitive to the cumulative costs, relative to the expected benefit, of initial and repeat testing [ 10 , 47 , 48 ].…”

Patient perspectives and willingness to accept incentives for tuberculosis diagnostic evaluation in Uganda.

“…The use of hypothetical choice experiments such as willingness-to-accept experiments can be a useful tool in designing complex intervention that include patient incentives, such as social protection interventions for public health (32,62,63).…”

“…1), thus reaching the lowest value of an incentive that the participant deemed su cient to facilitate their return to the health center. The design of the willingness-to-accept experiment (Supplement) followed the structure of similar experiments that have been conducted for other public health conditions (31,32).…”

Perceived Cost Advantages and Disadvantages of Purchasing HIV Self-Testing Kits among Urban Tanzanian Men: An Inductive Content Analysis

“…This would mean that an individual's decision to test for HIV reflects a valuation of testing that exceeds both the expected financial costs of testing, such as clinic or laboratory fees, as well as the expected nonfinancial costs of testing, such as the physical discomfort from the test procedure, the psychological expense (i.e., stress, fear, stigma, guilt) of having a positive diagnosis, or the opportunity costs of lost fare, time, or productivity [21,46]. Individuals, including men, with low monetary resources may also be more sensitive to the cumulative costs, relative to the expected benefit, of initial and repeat testing [10,47,48].…”