A Discrete Choice Experiment To Assess Preferences for a Future Preventative HIV Vaccine Among Key Populations in Uganda

Abstract

Human immunodeficiency virus (HIV) affects over 39 million people worldwide, with Uganda being among the top ten countries most affected. Key populations are at heightened risk and require effective prevention measures. Discrete choice experiments (DCEs), derived from economics, identify factors influencing behavioral decisions. This study combined a systematic literature review, key informant interviews (KIIs), and a cross-sectional DCE survey to explore preferences for HIV prevention strategies in Uganda.We reviewed 71 stated preference studies from 2,970 screened (34,558 participants) published between 2018 and 2022. Most were DCEs (82%), conducted in Africa, with location (55%) and cost (39%) as the most common attributes. In the 20 KIIs conducted in March 2024, participants highlighted barriers such as duration, accessibility, and stigma. In June 2024, we surveyed 406 participants (85 young women, 159 female sex workers, 132 participants self-identifying as belonging to the LGBTQ+ community) using purposive and community-based sampling. Preferences were influenced most by severe side effects (β: -0.69, 95% CI: -0.78, -0.60), effectiveness (30% increase, β: 0.39, 95% CI: 0.34, 0.44), and cost (50,000 UGX/~14 USD increase, β: -0.22, 95% CI: -0.27, -0.17). Side effects had the greatest influence, followed by effectiveness and cost. Participants stressed the importance of accessible information and tailored messaging to address diverse preferences. Affordable or free prevention options with minimal side effects were essential attributes to increase uptake of HIV prevention strategies. Policymakers should prioritize reducing financial barriers and transparently communicate safety and efficacy to enhance uptake and improve public health outcomes.