Syphilis, HIV, and co-infection risk is high in men who have sex with men (MSM) and transgender women in Peru. Enhanced control and prevention can be accomplished through increased testing. Conjoint analysis is an innovative method for systematically estimating consumer preferences across discrete attributes and has recently been utilized in academic research. We aimed to identify factors associated with testing preferences for HIV and syphilis infection among MSM and transgender women in Peru.
We created 8 hypothetical test profiles varying across six dichotomous attributes: cost (free vs. $4), accuracy (no false positive vs. false positive), time-to-result (20 minutes vs. 1 week), blood draw method (finger prick vs. venipuncture), number of draws (1 vs. 2), and test type (rapid vs. laboratory). After informed consent, participants were asked to rate each hypothetical test using Likert preference scales. Ratings were converted to 100-point preference scores; higher scores suggest increased preference. An impact score was generated for each attribute by taking the difference between the preference scores for the preferred and non-preferred level of each attribute.
We recruited 107 MSM and transgender women over 18 years of age from two STD clinics in Lima, Peru in 2013. Scores ranged from 49.07 (SD=33.63) to 82.48 (SD=23.09). Accuracy (no false positives) had the highest impact on testing preference (impact score=19.33, SD=26.51, p<.0001), followed by cost (free) (impact score=10.92, SD=19.50, p<.0001), and time-to-result (20 minutes), impact score=9.05, SD=17.83 SD=, p<.0001). Impacts of other testing attributes were not significant.
HIV and syphilis testing preferences for a high-risk group in Peru prioritized accuracy, cost and timeliness. Implementing an accurate and low cost rapid testing strategy for HIV and syphilis could improve screening uptake and accessibility of testing to accelerate time to treatment.