{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:05:33Z","timestamp":1790100333625,"version":"4.0.1"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43 TW010037"],"award-info":[{"award-number":["D43 TW010037"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>HIV self-testing (HIVST) is a crucial innovation for improving testing coverage, particularly among adolescent girls and young women (AGYW) who are inadequately reached by standard provider-assisted HIV testing approaches. Understanding their preferences for HIVST services is essential for designing models that optimize uptake. We assessed the HIVST preferences among AGYW at a higher risk of acquiring HIV living in urban Uganda. We enrolled AGYW at a higher risk of HIV using a community-based convenience sampling in a discrete choice experiment (DCE). Each participant completed eight choice sets, each comprising of two hypothetical HIVST service alternatives and an opt-out option. The four attributes included level of assistance (assisted versus unassisted), distribution model (facility-based versus community-based), delivery channel (primary versus secondary) and sample type (oral swab versus blood). A mixed logit model was used to estimate the marginal utilities, relative importance (RI), HIVST profile utilities and predicted uptake (compared to opt-out). Between December 2024 and May 2025, 340 participants were enrolled with mean age 19.8 years (standard deviation (SD): 2.6), and 65.9% of them were not in school. In the main effects model, participants preferred; facility-based over community-based distribution model (\u03b2\u2009=\u20090.14 (95% confidence interval (CI): 0.06, 0.23)), primary over secondary delivery channel (\u03b2\u2009=\u20090.09 (95% CI: 0.00, 0.17)), and unassisted over assisted testing (\u03b2\u2009=\u20090.46 (95% CI: 0.37, 0.54). The sample type didn\u2019t significantly influence the preferences of participants to use HIVST (\u03b2\u2009=\u20090.05 (95%CI: -0.04, 0.13). The level of assistance emerged as the most important attribute (RI: 60%), followed by facility-based distribution model (RI: 18.9%) and primary delivery channel (RI: 12.2%). There was a significant interaction between delivery channel and level of assistance (\u03b2\u2009=\u20090.66 (95% CI: 0.07, 1.24)). Primary delivery was preferred over secondary delivery when testing was unassisted (\u03b2\u2009=\u20090.41 (95% CI: 0.11, 0.71), but not when testing was assisted (\u03b2\u2009=\u2009-0.25 (95% CI: -0.56, 0.06). AGYW preferred HIVST models combining primary delivery with unassisted testing while facility-based distribution also increased preference. This highlights the importance of considering both individual attributes and their interaction when designing HIV delivery models.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005431","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T17:32:31Z","timestamp":1790098351000},"page":"e0005431","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["HIV self-testing preferences among adolescent girls and young women (AGYW) in urban settings in Uganda: A discrete choice experiment"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5807-5799","authenticated-orcid":true,"given":"Laban","family":"Muteebwa","sequence":"first","affiliation":[{"name":"Makerere University","place":["Kampala, Uganda"],"department":["Department of Medicine, School of Medicine, College of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patience A.","family":"Muwanguzi","sequence":"additional","affiliation":[{"name":"Makerere University","place":["Kampala, Uganda"],"department":["Department of Nursing, School of Health Sciences, College of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivan","family":"Nuwasiima","sequence":"additional","affiliation":[{"name":"Makerere University","place":["Kampala, Uganda"],"department":["Clinical Epidemiology Unit, School of Medicine, College of health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8315-4891","authenticated-orcid":true,"given":"Ivan","family":"Ahimbisibwe","sequence":"additional","affiliation":[{"name":"Makerere University","place":["Kampala, Uganda"],"department":["Clinical Epidemiology Unit, School of Medicine, College of health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edson","family":"Atwine","sequence":"additional","affiliation":[{"name":"Makerere University Business School, Makerere University","place":["Kampala, Uganda"],"department":["Faculty of Graduate Studies"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0193-6252","authenticated-orcid":true,"given":"Dan","family":"Muramuzi","sequence":"additional","affiliation":[{"name":"Makerere University","place":["Kampala, Uganda"],"department":["Department of Pharmacy, School of Health Sciences, College of Health Sciences"]},{"name":"Makerere University","place":["Kampala, Uganda"],"department":["Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5289-673X","authenticated-orcid":true,"given":"Cathbert","family":"Tumusiime","sequence":"additional","affiliation":[{"name":"Directorate of Research, Baylor College of Medicine Children\u2019s Foundation-Uganda","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0624-7640","authenticated-orcid":true,"given":"Fred C.","family":"Semitala","sequence":"additional","affiliation":[{"name":"Makerere University","place":["Kampala, Uganda"],"department":["Department of Medicine, School of Medicine, College of Health Sciences"]},{"name":"Makerere University Joint AIDS Program","place":["Kampala, Uganda"],"department":["Department of Programs"]},{"name":"Research Department Infectious Disease Research Collaboration","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0458-2111","authenticated-orcid":true,"given":"Joanita","family":"Nangendo","sequence":"additional","affiliation":[{"name":"Makerere University","place":["Kampala, Uganda"],"department":["Department of Medicine, School of Medicine, College of Health Sciences"]},{"name":"Research Department Infectious Disease Research Collaboration","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"pgph.0005431.ref001","unstructured":"UNAIDS. Fact Sheet 2025. 2025 [cited 8 Aug 2025]. https:\/\/www.unaids.org\/sites\/default\/files\/2025-07\/2025_Global_HIV_Factsheet_en.pdf"},{"key":"pgph.0005431.ref002","unstructured":"Uganda AIDS Commission. Uganda HIV and AIDS FActsheet. 2024 [cited 8 Aug 2025]. https:\/\/uac.go.ug\/index.php\/easy-customization\/custom-404-page-and-offline-page"},{"key":"pgph.0005431.ref003","author":"P Mwine","year":"2022"},{"key":"pgph.0005431.ref004","unstructured":"UNAIDS. Understanding measures of progress towards the 95\u201395\u201395 HIV testing, treatment and viral suppression targets. 2023 [cited 8 Aug 2025]. Available: https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/progress-towards-95-95-95_en.pdf"},{"key":"pgph.0005431.ref005","unstructured":"Ministry of Health. Consolidated guidelines for the prevention and treatment of HIV and AIDS in Uganda. In: MoH-Uganda. Kampala; 2022."},{"key":"pgph.0005431.ref006","unstructured":"MoH. Addendum to the HIV testing services policy & implementation guidelines for HIV self-testing & Assisted Partner Notification services. In: Ministry of Health Uganda [Internet]. Kampala; 2018 [cited 13 May 2023]. https:\/\/www.health.go.ug\/download-attachment\/Sv3MJWLFryzTR69NvhNTzDuglek9ELnr5vfct1_pwYE"},{"key":"pgph.0005431.ref007","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.ijregi.2022.08.009","article-title":"HIV and adolescent girls and young women in sub-Saharan Africa: A call for expedited action to reduce new infections","volume":"5","author":"G Murewanhema","year":"2022","journal-title":"IJID Reg"},{"issue":"4","key":"pgph.0005431.ref008","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s11904-020-00504-3","article-title":"The evidence for HIV self-testing to increase HIV Testing rates and the implementation challenges that remain","volume":"17","author":"EA Kelvin","year":"2020","journal-title":"Curr HIV\/AIDS Rep"},{"key":"pgph.0005431.ref009","unstructured":"UNAIDS. HIV self-testing: what you need to know. 2024 [cited 8 Aug 2025]. https:\/\/www.unaids.org\/sites\/default\/files\/hiv-self-testing-what-you-need-to-know_en.pdf"},{"key":"pgph.0005431.ref010","doi-asserted-by":"crossref","first-page":"1121478","DOI":"10.3389\/frph.2023.1121478","article-title":"The evolution of HIV self-testing and the introduction of digital interventions to improve HIV self-testing","volume":"5","author":"AE Fischer","year":"2023","journal-title":"Front Reprod Health"},{"key":"pgph.0005431.ref011","unstructured":"World Health Organization. HIV Self-testing and Partner Notification. Supplement to Consolidated guidelines on HIV testing services. In: Geneva, Switzerland. 2016 [cited 18 May 2025]. https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/251655\/9789241549868-eng.pdf;jsessionid=A4502F66DB65552D95D583F71AC7468D?sequence=1"},{"key":"pgph.0005431.ref012","doi-asserted-by":"crossref","first-page":"100991","DOI":"10.1016\/j.eclinm.2021.100991","article-title":"Examining the effects of HIV self-testing compared to standard HIV testing services in the general population: A systematic review and meta-analysis","volume":"38","author":"MS Jamil","year":"2021","journal-title":"EClinicalMedicine"},{"issue":"1","key":"pgph.0005431.ref013","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1186\/s12916-020-01835-z","article-title":"Comparing the effects of HIV self-testing to standard HIV testing for key populations: A systematic review and meta-analysis","volume":"18","author":"TC Witzel","year":"2020","journal-title":"BMC Med"},{"issue":"2","key":"pgph.0005431.ref014","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0005857","article-title":"Acceptability of HIV self-testing among HIV high-risk Adolescent Girls and Young Women (AGYW) in urban settings in Uganda","volume":"6","author":"L Muteebwa","year":"2026","journal-title":"PLOS Glob Public Health"},{"key":"pgph.0005431.ref015","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1186\/s12879-023-08694-y","article-title":"Costs of distributing HIV self-testing kits in Eswatini through community and workplace models","volume":"22","author":"K McGee","year":"2024","journal-title":"BMC Infect Dis"},{"key":"pgph.0005431.ref016","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2021-005019","article-title":"The cost and intermediary cost-effectiveness of oral HIV self-test kit distribution across 11 distribution models in South Africa","volume":"6","author":"K Matsimela","year":"2021","journal-title":"BMJ Glob Health"},{"key":"pgph.0005431.ref017","doi-asserted-by":"crossref","first-page":"100653","DOI":"10.1016\/j.eclinm.2020.100653","article-title":"Heterogeneity in individual preferences for HIV testing: A systematic literature review of discrete choice experiments","author":"M Sharma","year":"2020","journal-title":"EClinicalMedicine"},{"issue":"1","key":"pgph.0005431.ref018","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1007\/s10461-020-02960-9","article-title":"Youth Preferences for HIV Testing in South Africa: Findings from the Youth Action for Health (YA4H) study using a discrete choice experiment","volume":"25","author":"CM Chetty-Makkan","year":"2021","journal-title":"AIDS Behav"},{"issue":"6","key":"pgph.0005431.ref019","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1007\/s40271-021-00522-2","article-title":"Designing HIV testing and self-testing services for young people in Nigeria: A discrete choice experiment","volume":"14","author":"JJ Ong","year":"2021","journal-title":"Patient"},{"issue":"1","key":"pgph.0005431.ref020","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s12981-022-00484-x","article-title":"Factors associated with HIV self-testing among female university students in Uganda: A cross-sectional study","volume":"19","author":"I Segawa","year":"2022","journal-title":"AIDS Res Ther"},{"key":"pgph.0005431.ref021","unstructured":"UNCST. National Guidelines for Research involving Humans as Research Participants. Uganda: Uganda National Council of Science and Technology; 2014 [cited 22 Nov 2023]. https:\/\/www.uncst.go.ug\/manage\/files\/downloads\/HumanSubjectsProtectionGuidelinesJuly2014(1).pdf"},{"issue":"2","key":"pgph.0005431.ref022","doi-asserted-by":"crossref","DOI":"10.1086\/259131","article-title":"A New Approach to Consumer Theory","volume":"74","author":"KJ Lancaster","year":"1966","journal-title":"Journal of Political Economy"},{"key":"pgph.0005431.ref023","unstructured":"McFadden D. Conditional logit analysis of qualitative choice behavior. 1972."},{"key":"pgph.0005431.ref024","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1186\/1472-6963-14-235","article-title":"Developing attributes and attribute-levels for a discrete choice experiment on micro health insurance in rural Malawi","volume":"14","author":"GA Abiiro","year":"2014","journal-title":"BMC Health Serv Res"},{"issue":"10","key":"pgph.0005431.ref025","doi-asserted-by":"crossref","DOI":"10.2196\/32365","article-title":"Understanding uptake of digital health products: Methodology tutorial for a discrete choice experiment using the bayesian efficient design","volume":"23","author":"D Szinay","year":"2021","journal-title":"J Med Internet Res"},{"key":"pgph.0005431.ref026","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1186\/s12978-021-01118-7","article-title":"HIV trends and disparities by gender and urban-rural residence among adolescents in sub-Saharan Africa","volume":"18","author":"R Maulide Cane","year":"2021","journal-title":"Reprod Health"},{"key":"pgph.0005431.ref027","unstructured":"UBOS. National Population and Housing Census 2024, Final Report. Kampala; 2024. https:\/\/www.ubos.org\/wp-content\/uploads\/2024\/12\/National-Population-and-Housing-Census-2024-Final-Report-Volume-1-Main.pdf"},{"key":"pgph.0005431.ref028","author":"PI Mukwaya","year":"2025"},{"issue":"5","key":"pgph.0005431.ref029","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25909","article-title":"Oral pre-exposure prophylaxis preference, uptake, adherence and continuation among adolescent girls and young women in Kampala, Uganda: A prospective cohort study","volume":"25","author":"Y Mayanja","year":"2022","journal-title":"J Int AIDS Soc"},{"key":"pgph.0005431.ref030","unstructured":"Orme B. Sample size issues for conjoint analysis studies. Sequim Sawtooth Softw Tech Pap. 1998."},{"key":"pgph.0005431.ref031","volume-title":"Sample size determination in health studies: a practical manual","author":"SK Lwanga","year":"1991"},{"key":"pgph.0005431.ref032","unstructured":"Uganda Breau of Statistics (UBOS). Gender statistics portal; one-stop center for gender statistics in Uganda. 2023 [cited 24 Nov 2023]. http:\/\/gender.ubos.org:8080\/"},{"issue":"10","key":"pgph.0005431.ref033","article-title":"A protocol for a discrete choice experiment: Understanding preferences of patients with cancer towards their cancer care across metropolitan and rural regions in Australia","volume":"4","author":"SF Wong","year":"2014","journal-title":"BMJ Open"},{"issue":"1","key":"pgph.0005431.ref034","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1186\/s12913-021-07365-5","article-title":"Developing a patient-centered community-based model for management of multi-drug resistant tuberculosis in Uganda: A discrete choice experiment","volume":"22","author":"R Makabayi-Mugabe","year":"2022","journal-title":"BMC Health Serv Res"},{"issue":"4","key":"pgph.0005431.ref035","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1002\/hec.729","article-title":"Design techniques for stated preference methods in health economics","volume":"12","author":"F Carlsson","year":"2003","journal-title":"Health Econ"},{"issue":"3","key":"pgph.0005431.ref036","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1080\/00401706.1980.10486162","article-title":"A Comparison of Algorithms for Constructing Exact D-Optimal Designs","volume":"22","author":"RD Cook","year":"1980","journal-title":"Technometrics"},{"key":"pgph.0005431.ref037","unstructured":"Zwerina K, Huber J, Kuhfeld WF. A general method for constructing efficient choice designs. Durham, NC Fuqua Sch Business, Duke Univ. 1996;7."},{"key":"pgph.0005431.ref038","unstructured":"Noun project. Photos for everything. 2022 [cited 3 Sep 2023]. https:\/\/thenounproject.com\/"},{"key":"pgph.0005431.ref039","article-title":"Getting started with conjoint analysis: strategies for product design and pricing research second edition","author":"B Orme","year":"2010","journal-title":"Madison Res Publ LLC"},{"key":"pgph.0005431.ref040","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9781316136232","volume-title":"Applied choice analysis","author":"DA Hensher","year":"2015"},{"issue":"1","key":"pgph.0005431.ref041","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1186\/s12889-019-7685-1","article-title":"A systematic review of qualitative evidence on factors enabling and deterring uptake of HIV self-testing in Africa","volume":"19","author":"B Njau","year":"2019","journal-title":"BMC Public Health"},{"issue":"1","key":"pgph.0005431.ref042","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1186\/s12913-022-07622-1","article-title":"Implementation of a campus-based and peer-delivered HIV self-testing intervention to improve the uptake of HIV testing services among university students in Zimbabwe: The SAYS initiative","volume":"22","author":"F Mukora-Mutseyekwa","year":"2022","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pgph.0005431.ref043","doi-asserted-by":"crossref","first-page":"1916","DOI":"10.1186\/s12889-022-14236-z","article-title":"Stigma in the health clinic and implications for PrEP access and use by adolescent girls and young women: Conflicting perspectives in South Africa","volume":"22","author":"L Nyblade","year":"2022","journal-title":"BMC Public Health"},{"issue":"2","key":"pgph.0005431.ref044","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0246717","article-title":"Relationship dynamics and anticipated stigma: Key considerations for PrEP use among Tanzanian adolescent girls and young women and male partners","volume":"16","author":"N Jani","year":"2021","journal-title":"PLoS One"},{"key":"pgph.0005431.ref045","article-title":"Applying user preferences to optimize the contribution of HIV self-testing to reaching the \u201cfirst 90\u201d target of UNAIDS Fast-track strategy: Results from discrete choice experiments in Zimbabwe","author":"EL Sibanda","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"pgph.0005431.ref046","doi-asserted-by":"crossref","first-page":"17455057221092268","DOI":"10.1177\/17455057221092268","article-title":"Willingness to use and distribute HIV self-test kits to clients and partners: A qualitative analysis of female sex workers\u2019 collective opinion and attitude in C\u00f4te d\u2019Ivoire, Mali, and Senegal","volume":"18","author":"O Ky-Zerbo","year":"2022","journal-title":"Womens Health (Lond)"},{"issue":"5","key":"pgph.0005431.ref047","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1177\/09564624221076955","article-title":"Preference and ability to perform blood-versus oral-fluid-based HIV self-testing in adolescents and young adults in Bangkok","volume":"33","author":"P Trabwongwitaya","year":"2022","journal-title":"Int J STD AIDS"},{"key":"pgph.0005431.ref048","unstructured":"Reuning K, Plutzer E. Valid vs. invalid straightlining: The complex relationship between straightlining and data quality. Survey Research Methods. 2020. pp. 439\u201359."}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005431","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T17:32:41Z","timestamp":1790098361000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005431"}},"subtitle":[],"editor":[{"given":"Hannah Hogan","family":"Leslie","sequence":"first","affiliation":[{"name":"University of California San Francisco","place":["UNITED STATES OF AMERICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,22]]},"references-count":48,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0005431","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,22]]}}}