A discrete choice experiment investigating HIV testing preferences in South Africa

P Chiwire*, A C Mühlbacher, S M Evers, H Mahomed, J Ostermann, M Hiligsmann

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: South Africa (SA) has the world's highest burden of HIV infection, with an estimated 13.7% of the population living with HIV (PLWH/Persons Living With HIV). The early identification of PLWH and rapid engagement of them in HIV treatment are indispensable tools in the fight against HIV transmission. Understanding client preferences for HIV testing may help improve uptake. This study aimed to elicit client preferences for key characteristics of HIV testing options.

METHODS: A discrete-choice experiment (DCE) was conducted among individuals presenting for HIV testing at two public primary healthcare facilities in Cape Town, South Africa. Participants were asked to make nine choices between two unlabeled alternatives that differed in five attributes, in line with previous DCEs conducted in Tanzania and Colombia: testing availability, distance from the testing center, method for obtaining the sample, medication availability at testing centers, and confidentiality. Data were analyzed using a random parameter logit model.

RESULTS: A total of 206 participants agreed to participate in the study, of whom 199 fully completed the choice tasks. The mean age of the participants was 33.6 years, and most participants were female (83%). Confidentiality was the most important attribute, followed by distance from the testing center and the method of obtaining a sample. Patients preferred finger prick to venipuncture as a method for obtaining the sample. Medication availability at the testing site was also preferred over a referral to an HIV treatment center for a positive HIV test. There were significant variations in preferences among respondents.

CONCLUSION: In addition to accentuating the importance of confidentiality, the method for obtaining the sample and the location of sites for collection of medication should be considered in the testing strategy. The variations in preferences within target populations should be considered in identifying optimal testing strategies.

Original languageEnglish
Pages (from-to)481-490
Number of pages10
JournalJournal of Medical Economics
Issue number1
Publication statusPublished - 23 Mar 2022


  • Adult
  • Choice Behavior
  • Female
  • HIV Infections/diagnosis
  • HIV Testing
  • Humans
  • Patient Preference
  • South Africa
  • SEX
  • AIDs
  • preferences for HIV testing
  • MEN
  • HIV testing
  • stated preferences
  • people living with HIV
  • Discrete choice experiment

Cite this