Using discrete choice experiments to design interventions for heterogeneous preferences: protocol for a pragmatic randomised controlled trial of a preference-informed, heterogeneity-focused, HIV testing offer for high-risk populations

• Published in: BMJ open 2020-11, Vol.10 (11), p.e039313-e039313
• Main Authors: Ostermann, Jan, Njau, Bernard, Hobbie, Amy, Mtuy, Tara, Masaki, Martha L, Shayo, Aisa, van Zwetselaar, Marco, Masnick, Max, Flaherty, Brian, Brown, Derek S, Mühlbacher, Axel C, Thielman, Nathan M
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Counseling; Disease prevention; Female; Females; Health Services Research; HIV; HIV Infections - diagnosis; HIV Testing; Human immunodeficiency virus; Humans; Infections; Intervention; Male; Medical tests; Preferences; Public health; Tanzania
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-039313

IntroductionApproximately one million undiagnosed persons living with HIV in Southern and Eastern Africa need to test for HIV. Novel approaches are necessary to identify HIV testing options that match the heterogeneous testing preferences of high-risk populations. This pragmatic randomised controlled trial (PRCT) will evaluate the efficacy of a preference-informed, heterogeneity-focused HIV counselling and testing (HCT) offer, for improving rates of HIV testing in two high-risk populations.Methods and analysisThe study will be conducted in Moshi, Tanzania. The PRCT will randomise 600 female barworkers and 600 male Kilimanjaro mountain porters across three study arms. All participants will receive an HIV testing offer comprised of four preference-informed testing options, including one ‘common’ option—comprising features that are commonly available in the area and, on average, most preferred among study participants—and three options that are specific to the study arm. Options will be identified using mixed logit and latent class analyses of data from a discrete choice experiment (DCE). Participants in Arm 1 will be offered the common option and three ‘targeted’ options that are predicted to be more preferred than the common option and combine features widely available in the study area. Participants in Arm 2 will be offered the common option and three ‘enhanced’ options, which also include HCT features that are not yet widely available in the study area. Participants in Arm 3, an active control arm, will be offered the common option and three predicted ‘less preferred’ options. The primary outcome will be uptake of HIV testing.Ethics and disseminationEthical approval was obtained from the Duke University Health System IRB, the University of South Carolina IRB, the Ethics Review Committee at Kilimanjaro Christian Medical University College, Tanzania’s National Institute for Medical Research, and the Tanzania Food & Drugs Authority (now Tanzania Medicines & Medical Devices Authority). Findings will be published in peer-reviewed journals. The use of rigorous DCE methods for the preference-based design and tailoring of interventions could lead to novel policy options and implementation science approaches.Trial registration numberNCT02714140.