Work

Preferences for tuberculosis diagnostic test features among people tested for tuberculosis: a multicountry discrete choice experiment

Year: 2025

Type: article

Abstract: Background New and improved diagnostics are essential for reducing the global burden of tuberculosis. WHO target product profiles (TPPs) guide the development of tuberculosis diagnostics; however, TPPs do not account for the preferences of people undergoing testing. We aimed to establish the preferences of these individuals for key diagnostic test features to inform future WHO TPP updates and the development of tuberculosis diagnostics. Methods Between Dec 13, 2022, and Sept 3, 2024, we conducted a cross-sectional, survey-based discrete choice experiment (DCE) at eight outpatient public health centres across five diverse countries with a high burden of tuberculosis within the Rapid Research in Diagnostics Development network: the Philippines, Viet Nam, South Africa, Uganda, and India. Adults (aged ≥18 years) attending public health facilities with presumptive or microbiologically confirmed tuberculosis, or who had undergone tuberculosis testing in the previous 3 months, were invited to participate. The DCE evaluated participant preferences for five diagnostic test features (ie, sample type, accuracy, cost, location, and time to result), with three to four options each. We estimated mean preference weights (MPWs) for feature options using Hierarchical Bayesian models and conducted willingness-to-trade simulations to quantify the amount of one feature (eg, accuracy or cost) that participants were willing to compromise for a more preferred test feature. Findings Of 1142 participants enrolled across all sites, 1044 (91·4%) were included in the final analysis, of whom 537 (51·4%) were female and 507 (48·6%) were male, and the median age was 41 years (IQR 30–55). The most strongly valued test features were free cost (MPW 60·0 [95% CI 56·9–63·2]), high (90%) diagnostic accuracy (MPW 56·7 [53·6–59·8]), and rapid (15 min) result availability (MPW 37·8 [35·8–39·8]). Among less valued features, facility-based testing (MPW 22·7 [95% CI 19·7–25·6]) for location, and sputum (MPW 3·5 [95% CI 1·4–5·6]) for sample type were most preferred. The relative importance of features and their options differed by country. In willingness-to-trade simulations, participants in each country were willing to trade 14·5% (range across countries 10·4–19·5) lower test accuracy for rapid tests, but were unwilling to trade accuracy for alternative sample types (eg, tongue swab, urine, or blood) or alternative locations where tests could be performed (eg, at home or community-based). In willingness-to-pay analyses, participants were willing to pay US$2·80 (range across countries $2·00–4·00) out of pocket for rapid test results (15 min). Interpretation Individuals accessing tuberculosis services across high-burden settings universally value low to no cost tests, high diagnostic accuracy, and rapid result availability. These findings underscore the need to prioritise affordability and rapid results in the WHO TPP updates and the development of tuberculosis diagnostics. Funding National Institute of Allergy and Infectious Diseases of the US National Institutes of Health.

Source: The Lancet Primary Care

DOI: 10.1016/j.lanprc.2025.100012