More evidence is needed to improve molecular HIV surveillance for cluster detection and response

Molecular HIV surveillance (MHS) is used in the U.S. to inform public health prevention and intervention activities aimed at helping end the HIV epidemic. Its application in this context is currently challenged by ethical, legal, and social concerns, with gaps in understanding how end users weigh these issues. We sought to identify the preferences of MHS end users for improving MHS.

End users completed 12 choice experiment tasks evaluating five attributes of MHS for cluster detection and response. We generated a choice model using conditional logit and report results as relative attribute importance scores, comparing them to attitudinal data from close-ended questions. Responses to open-ended questions provide additional context on areas for MHS improvement.

We report findings from 55 of 90 potential end-users who felt capable and agreed to participate. End users include researchers (n = 28) and public health practitioners (n = 27); their preferences do not differ significantly (p = 0.174) so their responses are combined. The highest weight is placed on certainty of MHS benefit (38%), followed by depth of HIV sequence sampling (26%). Lower weight is given to reducing stigma (20%) and personalized inferences (10%) and communication (6%). End users highlight improving MHS through implementation support, community engagement, transparent communication, intervention assistance, risk minimization, and impact assessment; researchers stress the need for better data access.

End users place the highest value on having more evidence of MHS benefits. Improving MHS requires attention to implementation support, community engagement, transparent communication, intervention assistance, risk mitigation, impact assessment, and data access.