Willingness to Pay for HIV Self-Testing Kits Among Adolescent Girls and Young Women in Rural Northern Uganda: A Cross-Sectional Study
Author(s)
Ronald Olum, MD, MPH1, Morrish Obol Okello, MD2, Freddy Kitutu, PhD, MSc.3, Musoke Philippa, MBChB, FAAP, PhD,4, Elvin Geng, MD, MPH5.
1Makerere Univeristy School of Public Health, Kampala, Uganda, 2Faculty of Medicine, Gulu University, Gulu, Uganda, 3Department of Pharmacy, Makerere Univeristy College of Health Sciences, Kampala, Uganda, 4MU-JHU Care Limited, Kampala, Uganda, 5Division of Infectious Diseases, Washington University in St Louis, St. Louis, MO, USA.
1Makerere Univeristy School of Public Health, Kampala, Uganda, 2Faculty of Medicine, Gulu University, Gulu, Uganda, 3Department of Pharmacy, Makerere Univeristy College of Health Sciences, Kampala, Uganda, 4MU-JHU Care Limited, Kampala, Uganda, 5Division of Infectious Diseases, Washington University in St Louis, St. Louis, MO, USA.
OBJECTIVES: To assess willingness to pay (WTP) for HIV self-testing (HIVST) and identify associated factors among adolescent girls and young women (AGYW) in rural Northern Uganda, a region with high HIV prevalence (9.7%), to inform scalable HIV testing strategies.
METHODS: This cross-sectional study, part of a quasi-experimental HIVST trial baseline, enrolled 415 AGYW aged 15-24 years from five sub-counties in Omoro District in Northern Uganda using systematic random sampling. Trained research assistants administered structured questionnaires face-to-face, capturing socio-demographics, sexual history, HIV testing practices, and WTP. Data were collected in 2024 after ethical approval from Makerere University School of Health Sciences Research Ethics Committee. Simple and multivariable logistic regression in Stata 18.0 analyzed factors associated with WTP. Level of significance was set at P-value<0.05 in the final model.
RESULTS: Of 415 AGYW (median age 19, IQR 17-22; 51.8% aged 15-19; 68.4% with primary education or less; 73.5% unmarried). While 93% (n=385) of the AGYW were willing to use the HIVST, 78.1% (n=324) were willing to pay for HIVST (median 3,000 UGX, IQR 2,000-5,000). WTP was associated with employment (aOR 3.17, 95% CI 1.54-6.50, p=0.002), proximity to health facilities (<5 km; aOR 0.53, 95% CI 0.30-0.92, p=0.025), and exposure to health campaigns (aOR 1.97, 95% CI 1.00-3.89, p=0.050). Preferred access points were government health facilities (64.8%) and community hotspots (57.8%). Key barriers included high kit costs (43.9%) and concerns about result interpretation (57.1%).
CONCLUSIONS: While 93% of AGYW were willing to use HIVST, only 78.1% were willing to pay, highlighting economic barriers to uptake. Cost-sharing models are feasible, but subsidies and community-based distribution through health facilities, paired with sensitization campaigns, are needed. Future research on cost-effectiveness and qualitative barriers will optimize HIVST, enhancing early HIV diagnosis in this vulnerable population.
METHODS: This cross-sectional study, part of a quasi-experimental HIVST trial baseline, enrolled 415 AGYW aged 15-24 years from five sub-counties in Omoro District in Northern Uganda using systematic random sampling. Trained research assistants administered structured questionnaires face-to-face, capturing socio-demographics, sexual history, HIV testing practices, and WTP. Data were collected in 2024 after ethical approval from Makerere University School of Health Sciences Research Ethics Committee. Simple and multivariable logistic regression in Stata 18.0 analyzed factors associated with WTP. Level of significance was set at P-value<0.05 in the final model.
RESULTS: Of 415 AGYW (median age 19, IQR 17-22; 51.8% aged 15-19; 68.4% with primary education or less; 73.5% unmarried). While 93% (n=385) of the AGYW were willing to use the HIVST, 78.1% (n=324) were willing to pay for HIVST (median 3,000 UGX, IQR 2,000-5,000). WTP was associated with employment (aOR 3.17, 95% CI 1.54-6.50, p=0.002), proximity to health facilities (<5 km; aOR 0.53, 95% CI 0.30-0.92, p=0.025), and exposure to health campaigns (aOR 1.97, 95% CI 1.00-3.89, p=0.050). Preferred access points were government health facilities (64.8%) and community hotspots (57.8%). Key barriers included high kit costs (43.9%) and concerns about result interpretation (57.1%).
CONCLUSIONS: While 93% of AGYW were willing to use HIVST, only 78.1% were willing to pay, highlighting economic barriers to uptake. Cost-sharing models are feasible, but subsidies and community-based distribution through health facilities, paired with sensitization campaigns, are needed. Future research on cost-effectiveness and qualitative barriers will optimize HIVST, enhancing early HIV diagnosis in this vulnerable population.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE757
Topic
Economic Evaluation
Disease
Infectious Disease (non-vaccine), No Additional Disease & Conditions/Specialized Treatment Areas