Dr. Matthew Romo, a doctoral student at the CUNY Graduate School of Public Health and Health Policy (CUNY SPH), and Dr. Elizabeth Kelvin, a professor at CUNY SPH, along with colleagues examined the HIV testing preferences among long distance truck drivers in Kenya. The findings were published in the journal AIDS Care.
Providing HIV testing services to truck drivers in Africa is crucial but has proven challenging. The introduction of HIV self-testing may provide expanded service delivery options for clients, potentially increasing demand for services and expanding coverage – especially important for high-risk and difficult-to-reach populations. This study examined the preferences regarding HIV testing service delivery models, among long distance truck drivers to identify testing services that would appeal to this population.
The study used a discrete choice experiment. The team recruited 305 truck drivers from two roadside wellness clinics along major trucking routes in Kenya. This study examines the drivers of choice regarding HIV counselling and testing. Participants made trade-offs between characteristics of HIV testing service delivery models by making hypothetical choices in a series of paired HIV testing scenarios.
“Discrete choice experiments are a quantitative technique that allow for eliciting preferences and have applications in multiple fields, such as market research, but are especially useful in public health when thinking about how to implement an intervention that has to do with individual level behavior such as HIV testing,” explains Dr. Romo.
Participants preferred free, provider-administered HIV testing at a roadside clinic, using a finger-prick test, with in-person counselling, undertaken in the shortest possible time. The strongest driver of choice was the cost of the test. Those who had never tested previously preferred oral testing and telephonic counselling, while those who were not regular testers favored clinic based – over self-testing.
The results of this study indicate that for the majority of participants – most of whom had tested before – the existing services offered at roadside clinics were the preferred service delivery model. The introduction of oral self-testing increases the options available to truck drivers and may even improve testing uptake for some, especially among those who have never tested before. These findings suggest the impact on HIV testing uptake of introducing oral self-testing may be limited in this population of long-distance truck drivers.
Summarizing the findings, Dr. Romo explains, “An important finding of this study was that cost was the strongest driver of choice of HIV testing among a sample of long-distance truck drivers in Kenya (who are considered high risk for HIV transmission). Therefore, if new testing modalities, such as HIV self-testing, are introduced, considering cost will be essential to ensure uptake in this population. Recently, HIV self-testing has been introduced in Kenya at select pharmacies and test kits have a cost of 7-8 USD, which is substantial. The results of the discrete choice experiment suggest that among the truck driver population, uptake of self-testing will probably be poor until self-testing is integrating into the public health system at low cost or for free.”
Strauss, M., George, G., Lansdell, E., Mantell, J., Govender, K., Romo, M., Odhiambo, J., Mwai, E., Nyaga, E. and Kelvin, E. (2017). HIV testing preferences among long distance truck drivers in Kenya: a discrete choice experiment. AIDS Care, pp.1-9.