HIV self-testing preferences among HIV high-risk Adolescent Girls and Young Women (AGYW) in urban settings in Uganda: A Discrete Choice Experiment

HIV self-testing (HIVST) represents a crucial innovation for improving testing coverage, particularly among high-risk adolescent girls and young women (AGYW) inadequately reached through standard provider-assisted HIV testing approaches. Understanding user preferences for HIVST services is essential for designing models that optimize uptake. We assessed the HIVST preferences among high-risk AGYW living in urban Uganda. We enrolled high-risk AGYW consecutively 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 utility, relative importance (RI) and trade-offs. Between December 2024 and May 2025, a total of 340 participants were enrolled with mean age 19.8 years (SD: 2.6), and 65.9% of them were not in school. The distribution model, delivery channel and level of assistance significantly influenced participants choices to use HIVST services with coefficients of 0.14 (95%CI: 0.06, 0.23), 0.09 (95%CI: 0.00, 0.17) and 0.46 (95%CI: 0.37, 0.54) respectively. The sample type didnt significantly influence the choice of participants to use HIVST (coefficient, 0.05 (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%). AGYW were willing to sacrifice 9.2 units of utility of the test kit type to get unassisted HIVST. AGYW living in urban settings preferred unassisted HIVST delivered through the health facility. Regardless of the type of kit, the level of autonomy and convenience attained during unassisted testing greatly influenced the users choice of the HIVST service.