Abstract
Designing strategies to introduce new HIV prevention technologies requires balancing equitable access with sustainable distribution, particularly in resource constrained settings with high HIV prevalence. This paper explores how knowledge of preference heterogeneity can guide the equitable targeting of HIV prevention products using differentiated advertising and product placement to balance increased access with sustainability.A discrete choice experiment elicited 1016 women's preferences for distribution of HIV prevention products in South Africa. Qualitative research guided the experimental design which considered distribution outlet, collection method, advertising message, and price. A range of choice models, including random parameters logit, latent class and latent class random parameters logit models, were compared for fit.A latent class model showed the best fit and distinguished two classes of women: Class 1 were significantly more likely to be cohabiting and unemployed, who preferred products advertised for HIV prevention distributed through clinics and were highly price sensitive. Class 2 significantly preferred distribution through pharmacies and advertising around women's empowerment, while price was not a key factor.This analysis suggests that equity in access to new products could be advanced through exploiting preference heterogeneity between groups. The identified groups can be then used to design social marketing differentiated distribution strategies. Distributing free products promoted for HIV prevention could discourage ‘leakage’ of highly subsidised products to women with some capacity to pay, while priced products marketed for women's empowerment through pharmacies could encourage cost recovery with minimal reductions in coverage among employed women.
Highlights
Achieving high levels of access and uptake of preventive health interventions is challenging
This paper demonstrates how discrete choice experiments (DCEs) can be used to identify market segments across those more and less able to pay, using a case study on HIV prevention products for women in South Africa
Using the case of over-the-counter public health products with positive externalities in South Africa, we extend both these analyses to show how discrete choice experiments can guide the design of a distribution strategy to balance equity and sus tainability objectives, how analysis of preference heterogeneity can inform product introduction strategies reaching populations with varying abilities to pay, while allowing for some cost recovery
Summary
Achieving high levels of access and uptake of preventive health interventions is challenging. Access to health involves demand and supply factors including: ‘approach ability, acceptability, availability and accommodation, affordability and appropriateness’ (Levesque et al 2013). Social marketing aims to use private sector marketing methods to stimulate positive behaviour change across a range of social issues, including public health. Social marketing aims to increase demand for public health goods, intervening on both sides of the market, summarised by a focus on the four P’s: product, price, placement, and promotion (Grier and Bryant 2005). Learning from private sector marketing, social marketing often uses market segmentation to understand how populations vary in order to develop tailored behaviour change strategies, i.e. it aims to identify homogenous groups of consumers with similar tastes (market segments) and willingness to pay within the full population (Kubacki et al 2017). In a vertical product differentiation approach, products would be priced, rather than provided free to reduce wastage, with price signalling differences in quality and lay the foundation for some degree of cost recovery in the longer term, and may generate space for cross-subsidisation, where higher price products subsidise the cost of distributing other very low priced public health products (Kubacki, Dietrich, and Rundle-Thiele)
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