HIV Self-Test Program Preferences Among Non-Hispanic Black and Hispanic Men Who Have Sex with Men in the Southern United States: A Discrete Choice Experiment

Non-Hispanic Black and Hispanic men who have sex with men (BHMSM) in the Southern United States (US) have the highest rates of new HIV diagnoses in the country. Self-testing can increase detection and contribute to decreasing diagnoses, but it is unclear which self-test program characteristics encourage the highest engagement. To inform the design of self-test programs, we conducted an online discrete choice experiment with BHMSM in this region who did not have an HIV diagnosis (n = 290) to understand their preferences for the following self-test program attributes: delivery strategy (home delivery, friend delivery, clinic pickup), support (instructions only, during the test, 1 week after delivery), delivery speed (same day, next day, 3 days, 5 days), and price ($0, $20, $40, $50, $60). We analyzed choice data using random parameters to estimate preferences and marginal willingness to pay. BHMSM preferred free (b = 2.67) self-tests, home delivery (b = 0.60), and same-day (b = 0.24) or next-day (b = 0.35) delivery and had a preference against support 1 week after delivery (b=-0.19). Marginal willingness to pay estimates showed that BHMSM would pay $6.71 more for home delivery compared to clinic pickup and $9.10 more for same-day delivery and $10.96 more for next-day delivery compared to 5-day delivery. Based on these results, a self-test program with free rapid home delivery and support via instructions only or during the test would best address the preferences of BHMSM in the Southern US. Patients may also be willing to pay for rapid home delivery, highlighting the possibility of cost-sharing models for self-test programs.