HIV self-testing preferences among adolescent girls and young women (AGYW) in urban settings in Uganda: A discrete choice experiment
9 affiliations
- 1Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- 2Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- 3Clinical Epidemiology Unit, School of Medicine, College of health Sciences, Makerere University, Kampala, Uganda
- 4Faculty of Graduate Studies, Makerere University Business School, Makerere University, Kampala, Uganda
- 5Department of Pharmacy, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- 6Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- 7Directorate of Research, Baylor College of Medicine Children’s Foundation-Uganda, Kampala, Uganda
- 8Department of Programs, Makerere University Joint AIDS Program, Kampala, Uganda
- 9Research Department Infectious Disease Research Collaboration, Kampala, Uganda
Abstract
HIV self-testing (HIVST) is a crucial innovation for improving testing coverage, particularly among adolescent girls and young women (AGYW) who are inadequately reached by standard provider-assisted HIV testing approaches. Understanding their preferences for HIVST services is essential for designing models that optimize uptake. We assessed the HIVST preferences among AGYW at a higher risk of acquiring HIV living in urban Uganda. We enrolled AGYW at a higher risk of HIV using a community-based convenience sampling in a discrete choice experiment (DCE). Each participant completed eight choice sets, each comprising of two hypothetical HIVST service alternatives and an opt-out option. The four attributes included level of assistance (assisted versus unassisted), distribution model (facility-based versus community-based), delivery channel (primary versus secondary) and sample type (oral swab versus blood). A mixed logit model was used to estimate the marginal utilities, relative importance (RI), HIVST profile utilities and predicted uptake (compared to opt-out). Between December 2024 and May 2025, 340 participants were enrolled with mean age 19.8 years (standard deviation (SD): 2.6), and 65.9% of them were not in school. In the main effects model, participants preferred; facility-based over community-based distribution model (β = 0.14 (95% confidence interval (CI): 0.06, 0.23)), primary over secondary delivery channel (β = 0.09 (95% CI: 0.00, 0.17)), and unassisted over assisted testing (β = 0.46 (95% CI: 0.37, 0.54). The sample type didn’t significantly influence the preferences of participants to use HIVST (β = 0.05 (95%CI: -0.04, 0.13). The level of assistance emerged as the most important attribute (RI: 60%), followed by facility-based distribution model (RI: 18.9%) and primary delivery channel (RI: 12.2%). There was a significant interaction between delivery channel and level of assistance (β = 0.66 (95% CI: 0.07, 1.24)). Primary delivery was preferred over secondary delivery when testing was unassisted (β = 0.41 (95% CI: 0.11, 0.71), but not when testing was assisted (β = -0.25 (95% CI: -0.56, 0.06). AGYW preferred HIVST models combining primary delivery with unassisted testing while facility-based distribution also increased preference. This highlights the importance of considering both individual attributes and their interaction when designing HIV delivery models.
Related
- Dairy farmers’ preferences for reducing pesticide use: does workload matter? Evidence from a discrete choice experiment among dairy farmers in Brittany, France
- Preferences for olive oil between taste and healthiness: an incentivised experiment in Morocco and Tunisia
- Smallholder farmers' preferences for public expenditure priorities to support maize productivity: evidence from a best–worst scaling experiment in western Kenya
- Current Data to Inform Point-of-Care Testing for Sexually Transmitted Infections in United States Healthcare Settings: A Narrative Review
- Predicted choice and acceptability of regimens for tuberculosis preventive treatment among people living with HIV in Uganda – A discrete choice experiment
BibTeX
@article{muteebwa2026selftesting,
title = {{HIV self-testing preferences among adolescent girls and young women (AGYW) in urban settings in Uganda: A discrete choice experiment}},
author = {Laban Muteebwa and Patience A. Muwanguzi and Shivan Nuwasiima and Ivan Ahimbisibwe and Edson Atwine and Dan Muramuzi and Cathbert Tumusiime and Fred C. Semitala and Joanita Nangendo},
journal = {PLOS Global Public Health},
year = {2026},
month = sep,
doi = {10.1371/journal.pgph.0005431},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005431},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - HIV self-testing preferences among adolescent girls and young women (AGYW) in urban settings in Uganda: A discrete choice experiment
AU - Laban Muteebwa
AU - Patience A. Muwanguzi
AU - Shivan Nuwasiima
AU - Ivan Ahimbisibwe
AU - Edson Atwine
AU - Dan Muramuzi
AU - Cathbert Tumusiime
AU - Fred C. Semitala
AU - Joanita Nangendo
PY - 2026
DA - 2026/09/22
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0005431
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005431
AB - HIV self-testing (HIVST) is a crucial innovation for improving testing coverage, particularly among adolescent girls and young women (AGYW) who are inadequately reached by standard provider-assisted HIV testing approaches. Understanding their preferences for HIVST services is essential for designing models that optimize uptake. We assessed the HIVST preferences among AGYW at a higher risk of acquiring HIV living in urban Uganda. We enrolled AGYW at a higher risk of HIV using a community-based convenience sampling in a discrete choice experiment (DCE). Each participant completed eight choice sets, each comprising of two hypothetical HIVST service alternatives and an opt-out option. The four attributes included level of assistance (assisted versus unassisted), distribution model (facility-based versus community-based), delivery channel (primary versus secondary) and sample type (oral swab versus blood). A mixed logit model was used to estimate the marginal utilities, relative importance (RI), HIVST profile utilities and predicted uptake (compared to opt-out). Between December 2024 and May 2025, 340 participants were enrolled with mean age 19.8 years (standard deviation (SD): 2.6), and 65.9% of them were not in school. In the main effects model, participants preferred; facility-based over community-based distribution model (β = 0.14 (95% confidence interval (CI): 0.06, 0.23)), primary over secondary delivery channel (β = 0.09 (95% CI: 0.00, 0.17)), and unassisted over assisted testing (β = 0.46 (95% CI: 0.37, 0.54). The sample type didn’t significantly influence the preferences of participants to use HIVST (β = 0.05 (95%CI: -0.04, 0.13). The level of assistance emerged as the most important attribute (RI: 60%), followed by facility-based distribution model (RI: 18.9%) and primary delivery channel (RI: 12.2%). There was a significant interaction between delivery channel and level of assistance (β = 0.66 (95% CI: 0.07, 1.24)). Primary delivery was preferred over secondary delivery when testing was unassisted (β = 0.41 (95% CI: 0.11, 0.71), but not when testing was assisted (β = -0.25 (95% CI: -0.56, 0.06). AGYW preferred HIVST models combining primary delivery with unassisted testing while facility-based distribution also increased preference. This highlights the importance of considering both individual attributes and their interaction when designing HIV delivery models.
SN - 2767-3375
ER -