Husband’s Willingness-to-Pay for HIV and Syphilis Screening at Antenatal Care Clinic under the Thai Universal Coverage Scheme
Abstract Background Screening for sexually transmitted infection (STI) especially HIV as early detection and treatment have been financially supported under the Thai Universal Coverage (UC) scheme since 2009 (THB140 for HIV). However, the implementation has not been evidence-based, strategic risk-based, nor economically evaluated whereas husbands who accompanied the pregnant women are likely to have a lower risk than those who did not come along. This study is aimed to explore the husband’s willingness-to-pay (WTP) for his HIV and syphilis screenings at the antenatal care (ANC) clinic of a tertiary hospital in Thailand. Methods A survey of 200 randomly selected husbands of pregnant women was conducted at King Chulalongkorn Memorial Hospital from April to June 2018. A pilot study using an open-ended question was conducted to estimate the WTP for HIV and syphilis screening tests. Then, two contingent valuation methods (bidding and payment scale) were performed for the final WTP assessments, using the mean WTP identified from the pilot study as a starting WTP with 1⁄4 SD step-up/down. Results During the study period, 597 pregnant women received their first ANC. Of 368 accompanying husbands, 200 were enrolled in the study. Their median age was 31 (IQR 27-36) years old and 67% had a first child. Eighty-eight percent of the participants were willing to test for the STIs. Based on the bidding method, WTP for HIV and syphilis screening tests were US$14.5 (IQR 12.4-14.5) and US$9.7 (IQR 10-12), respectively. The payment scale method suggested approximately three-quarters of the price. Conclusions The husbands who accompanied their pregnant wives to the ANC clinic showed positive behaviors according to the propitious selection theory. They tend to cooperate well with STI testing and are willing to pay at least two times the price of the STI screening tests. The financial support to promote STI screenings should be reconsidered to cover other groups with higher sexual behavior risks and less WTP.