Understand HIVST Preferences Among Key Populations in Thailand Using a Discrete Choice Experiment

HIV testing is vital for disease prevention and accessing lifesaving treatments, yet testing rates remain suboptimal, especially among high-risk populations such as cisgender men who have sex with men (cisgender MSM) and transgender women (TGW). HIV self-testing (HIVST) has emerged as a potential solution for reaching individuals who may face barriers or prefer not to use facility-based testing services. Although HIVST has been found feasible and acceptable for cisgender MSM and TGW, the current evidence lacks sufficient detail to guide decision-making for HIVST program development tailored to these groups, particularly in Thailand, where self-testing has only recently become legally available. This dissertation study aimed to fill these knowledge gaps by gaining a comprehensive understanding of the HIVST preferences and decision-making processes of Thai cisgender MSM and TGW. Employing a discrete choice experiment (DCE) with an online cross-sectional design, data were collected from 417 Thai cisgender MSM and TGW recruited both online and offline. The analytical findings are conveyed in two manuscripts. The first presents DCE findings, describing participants’ preferences across eight HIVST attributes (cost, specimen type, acquisition and testing locations, mode of administration, need for assistance, and mode and timing of post-test counseling) and how these preferences varied based on individual characteristics. The second manuscript focuses on participants’ awareness, knowledge, attitudes, and perceptions of HIVST, examining how these elements are linked to HIVST usage. Among key findings, cost was the primary factor influencing HIVST service selection. Lower-cost options provided by LGBTQ community-based organizations or clinics were preferred, along with online counseling methods. The study also revealed that individuals who had greater knowledge about HIVST, perceived more benefits, and saw fewer barriers were more likely to use HIVST. Interestingly, those with lower HIVST self-efficacy and higher perceived risk of HIV infection were also more inclined to use HIVST. The study findings offer a comprehensive understanding of what drives HIVST uptake among Thai cisgender MSM and TGW. These insights are crucial for tailoring HIVST programs to the specific needs of this population, not only in Thailand but also in other countries facing similar challenges.