Date Published: December 18, 2018
Publisher: Springer US
Author(s): Stephen W. Pan, Maya Durvasula, Jason J. Ong, Chuncheng Liu, Weiming Tang, Hongyun Fu, Chongyi Wei, Cheng Wang, Fern Terris-Prestholt, Joseph D. Tucker.
In China, some health departments and gay community-based organizations have begun to offer home-based HIV testing kits in order to augment test uptake among men who have sex with men (MSM). However, HIV test preferences and motivations for home-testing among MSM in China are not well understood. The HIV testing preferences of 803 MSM throughout China were evaluated using single-item assessment and a discrete choice experiment (DCE). In both the single-item assessment and DCE, participants expressed strong preference for free and anonymous testing by health professionals. Both approaches also indicated that naïve testers most prefer home testing. However, among previous testers, the single-item assessment indicated that “home” was the most preferred testing location (vs. hospital or clinic), while the DCE indicated that “home” was the least preferred testing location after controlling for anonymity. HIV home-testing may have limited appeal to previously tested Chinese MSM if anonymity is not maintained.
China has one of the world’s highest reported HIV incidence rates among men who have sex with men (MSM) . Moreover, rates of new infections among MSM in China are rising nationwide, having increased from 3.24 infections/100 person-years (PY) in 2005–2008 to 5.50 infections/100 PY in 2012–2014 . One critical factor contributing to ongoing HIV transmission among MSM is delayed diagnosis of infection .
In 23 days, the DCE survey link was clicked 3319 times. 2505 respondents failed to meet the study eligibility criteria or quit before eligibility could be established, and 11 respondents were removed after deduplication of identical phone numbers. The 803 eligible participants completed 4738 choice tasks. Alternative “A” (choice on the left side) and alternative “B” (choice on the right side) had comparable probabilities of being selected (47% vs. 45%, respectively); the “opt-out” alternative was selected in 8% of all choice tasks.
Today, MSM in China have increasingly diverse HIV testing options. Health professionals at hospitals and local health departments often provide free HIV screening tests for self-identified MSM , though such testing conditions may not be appealing to MSM reluctant to disclose their MSM status to heterosexual individuals for fear of stigmatization and/or discrimination . Larger cities often offer free and anonymous testing at gay community-based organizations staffed by MSM, but qualitative research suggests that some MSM may prefer testing at specialized hospitals staffed by formally trained health professionals . Most recently, online sales of HIV self-testing kits now enable individuals to conduct self-administered home-based testing, an approach which has received monetary and explicit policy support from the Chinese government and local health departments .
Supplementing conventional clinic-based testing with home-based HIV self-testing kits is a promising approach to increase HIV test uptake among MSM in China. However, findings from this study suggest that providing home-test kits to Chinese MSM may have limited impact on routine HIV test uptake unless testing is anonymous. Future studies should consider applying DCEs as a means of disentangling the motivations underpinning patient preferences at other stages of the HIV cascade of care.