title: Latent class analysis of acceptability and willingness to pay for self-HIV testing in a United States urban neighbourhood with high rates of HIV infection.
abstract: Acceptability and willingness to both take and pay for HIV self-tests (HIVSTs) in US neighbourhoods with high rates of HIV infection are not well understood.
  
  
  
  We surveyed 1,535 individuals about acceptability and willingness to take and pay for an HIVST in a predominately African American neighbourhood with 3% HIV seroprevalence. We recruited individuals presenting for HIV screening services in a community-based programme. Latent class analysis (LCA) grouped individuals with similar patterns of HIV-risk behaviours and determined which groups would be most willing to use and buy HIVSTs.
  
  
  
  Nearly 90% of respondents were willing to use an HIVST; 55% were willing to buy HIVSTs, but only 23% were willing to pay the market price of US $40. Four distinct groups emerged and were characterized by risk behaviours: (1) low risk (N= 324); (2) concurrent partnerships (N= 346); (3) incarceration and substance use (N= 293); and (4) condomless sex/multiple partners (N= 538). Individuals in the low-risk class were less willing to self-test compared to concurrent sexual partners (OR = 0.39,p= .003) and incarceration and substance use (OR = 0.46,p= .011) classes. There were no significant differences across classes in the amount individuals were willing to pay for an HIVST.
  
  
  
  HIVSTs were overwhelmingly acceptable but cost prohibitive; most participants were unwilling to pay the market rate of US $40. Subsidizing and implementing HIVST programmes in communities with high rates of infection present a public health opportunity, particularly among individuals reporting condomless sex with multiple partners, concurrent sexual partnerships and those with incarceration and substance use histories.
authors.affiliation: Department of Behavioral and Social Sciences, Rhode Island Public Health Institute, Providence, RI, USA.|School of Public Health, Brown University, Providence, RI, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Nunn
authors.affiliation: Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA.|Center for Health Equity Research, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Brinkley-Rubinstein
authors.affiliation: Quantitative Statistical Center, Wesleyan University, Middletown, CT, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rose
authors.affiliation: Fenway Health, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mayer
authors.affiliation: School of Medicine, Tufts University, Boston, MA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Stopka
authors.affiliation: Department of Behavioral and Social Sciences, Rhode Island Public Health Institute, Providence, RI, USA.|School of Public Health, Brown University, Providence, RI, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Towey
authors.affiliation: Department of Behavioral and Social Sciences, Rhode Island Public Health Institute, Providence, RI, USA.|School of Public Health, Brown University, Providence, RI, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Harvey
authors.affiliation: School of Public Health, Brown University, Providence, RI, USA.
authors.forename: Karina
authors.initials: K
authors.lastname: Santamaria
authors.affiliation: School of Public Health, Brown University, Providence, RI, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Sabatino
authors.affiliation: College of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Stacey
authors.initials: S
authors.lastname: Trooskin
authors.affiliation: Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA.|Division of Infectious Diseases, The Miriam Hospital, Providence, RI, USA.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Chan
mesh_terms: D015492:AIDS Serodiagnosis / Q000191:economics / Q000379:methods*; D000293:Adolescent; D000328:Adult; D001741:Black or African American; D002947:Cities; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D012307:Risk Factors; D012648:Self Care / Q000191:economics / Q000379:methods*; D012698:Serologic Tests / Q000191:economics*; D014481:United States / Q000453:epidemiology
keywords: HIV self-test; geography; home-based testing; neighbourhood