Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Preferences for linkage to HIV care services following a reactive self-test

discrete choice experiments in Malawi and Zambia

d’Elbée, Marca; Indravudh, Pitchaya P.b; Mwenge, Lawrencec; Kumwenda, Moses M.b; Simwinga, Musondac; Choko, Augustine T.b,d; Hensen, Bernadetted; Neuman, Melissad; Ong, Jason J.e; Sibanda, Euphemia L.f,g; Johnson, Cheryl C.h,i; Hatzold, Karinj; Cowan, Frances M.f,g; Ayles, Helenc,k; Corbett, Elizabeth L.b,h; Terris-Prestholt, Ferna

doi: 10.1097/QAD.0000000000001918
Epidemiology and Social

Objectives: The current research identifies key drivers of demand for linkage into care following a reactive HIV self-test result in Malawi and Zambia. Preferences are explored among the general population and key groups such as HIV-positive individuals and adolescents.

Design: We used discrete choice experiments (DCEs) embedded in representative household surveys to quantify the relative strength of preferences for various HIV services characteristics.

Methods: The DCE was designed on the basis of a literature review and qualitative studies. Data were collected within a survey (Malawi n = 553, Zambia n = 388), pooled across country and analysed using mixed logit models. Preference heterogeneity was explored by country, age, sex, wealth, HIV status and belief that HIV treatment is effective.

Results: DCE results were largely consistent across countries. Major barriers for linkage were fee-based testing and long wait for testing. Community-based confirmatory testing, that is at the participant's or counsellor's home, was preferred to facility-based confirmation. Providing separated waiting areas for HIV services at health facilities and mobile clinics was positively viewed in Malawi but not in Zambia. Active support for linkage was less important to respondents than other attributes. Preference heterogeneity was identified: overall, adolescents were more willing to seek care than adults, whereas HIV-positive participants were more likely to link at health facilities with separate HIV services.

Conclusion: Populations in Malawi and in Zambia were responsive to low-cost, HIV care services with short waiting time provided either at the community or privately at health facilities. Hard-to-reach groups could be encouraged to link to care with targeted support.

aDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK

bMalawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi

cZambart, Lusaka, Zambia

dDepartment of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health

eInternational Diagnostics Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

fCentre for Sexual Health HIV and AIDS Research, Harare, Zimbabwe

gDepartment of International Public Health, Liverpool School of Tropical Medicine, Liverpool

hDepartment of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

iDepartment of HIV/AIDS, World Health Organization, Geneva, Switzerland

jPopulation Services International, Harare, Zimbabwe

kLondon Centre for Neglected Tropical Disease Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.

Correspondence to Marc d’Elbée, Pharm.D., MSc, London School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, Kings Cross, London WC1H 9SH, UK. Tel: +44 (0)749 0405 594; e-mail:

Received 15 February, 2018

Revised 18 May, 2018

Accepted 24 May, 2018

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

Copyright © 2018 Wolters Kluwer Health, Inc.