HIV self-testing preferences among adolescent girls and young women (AGYW) in urban settings in Uganda: A discrete choice experiment

Résumé

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.

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