Background: We updated a 2017 systematic review and compared the effects of HIV self-testing (HIVST) to standard HIV testing services to understand effective service delivery models among the general population. Methods: We included randomized controlled trials (RCTs) comparing testing outcomes with HIVST to standard testing in the general population and published between January 1, 2006 and June 4, 2019. Random effects meta-analysis was conducted and pooled risk ratios (RRs) were reported. The certainty of evidence was determined using the GRADE methodology. Findings: We identified 14 eligible RCTs, 13 of which were conducted in sub-Saharan Africa. Support provided to self-testers ranged from no/basic support to one-on-one in-person support. HIVST increased testing uptake overall (RR:2.09; 95% confidence interval: 1.69À2.58; p < 0.0001;13 RCTs; moderate certainty evidence) and by service delivery model including facility-based distribution, HIVST use at facilities, secondary distribution to partners, and community-based distribution. The number of persons diagnosed HIV-positive among those tested (RR:0.81, 0.45À1.47; p = 0.50; 8 RCTs; moderate certainty evidence) and number linked to HIV care/ treatment among those diagnosed (RR:0.95, 0.79À1.13; p = 0.52; 6 RCTs; moderate certainty evidence) were similar between HIVST and standard testing. Reported harms/adverse events with HIVST were rare and appeared similar to standard testing (RR:2.52: 0.52À12.13; p = 0.25; 4 RCTs; very low certainty evidence). Interpretation: HIVST appears to be safe and effective among the general population in sub-Saharan Africa with a range of delivery models. It identified and linked additional people with HIV to care. These findings support the wider availability of HIVST to reach those who may not otherwise access testing.

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Background HIV self-testing (HIVST) is an innovative HIV testing approach that effectively reaches those who do not otherwise test, including key populations (KPs). Despite potential benefits, HIVST is not currently implemented in Pakistan. The high risk of HIV among transgender (TGs) persons is among the highest risk group for HIV in Pakistan, yet knowledge of HIV status remains low in this key population group. We conducted a pilot project to assess the acceptability and feasibility of distributing HIVST to TGs in Larkana. Methods Eligible participants were 18 years or above and self-identified as transgender (“hijra”). One oral fluid HIVST kit per person was distributed free of cost in the community by trained transgender peer outreach workers (ORW). Participants could request a demonstration of the HIVST procedure before performing self-testing which was provided by the trained ORW. Demographic characteristics of participants were collected. The ORW followed up with phone calls two days later to record if HIVST kits were used, the results, and whether assistance was required. Results Between November 2020 and February 2021, 150 HIVST kits were distributed to eligible TGs. The average age of participants was 25.5 years (standard deviation: 7.0). Over a third (52, 34.7%) had no formal education, while (16, 10.6%) had attended at least five years of schooling. Over one-third (58, 38.6%) of participants were first-time testers. One hundred and thirty-nine (92.7%) participants reported their results within two days. For the remaining 11 participants, ORWs had to contact them. All participants reported using HIVST kits within three days. A majority (141, 94%) used the kit in their homes, and the remaining nine (6%) used it at the community-based organization’s office. Overall, a small proportion (11, 7.3%) of participants requested a demonstration of the test procedure before performing HIVST. Four (2.7%) participants who had performed unsupervised self-tests reported reactive HIVST results; all were linked to treatment within five working days once their HIV result was confirmed. The majority (136, 90.6%) of participants felt that self-testing was easy to perform independently, and 143 (95%) reported that they would recommend HIVST to their peers. Conclusion HIVST is acceptable among TGs and identified by first-time testers as undiagnosed infections. Peer-led distribution appears to be a feasible approach for implementation in this setting. HIVST should be considered for routine implementation and scale up to reduce testing gaps among Pakistan’s key population, particularly TGs.

Objective: To use a peer-to-peer and social media approach to reach out to men who have sex with men and to distribute human immunodeficiency virus self-testing kits among them in an urban setting. Method: The cross-sectional, pilot study was conducted by a community-based organisation in Karachi from November 2020 to February 2021, and comprised men aged 18 years or above who have sex with men. The subjects were provided one human immunodeficiency virus self-testing kit per person by trained outreach workers. It was an oral fluid-based kit. Data related to demographics, behavioural patterns and human immunodeficiency virus testing detail was collected on a structured questionnaire with some open-ended questions. The analysis of qualitative data was done manually, using content analysis technique in which all common responses were grouped that led to the generation of themes. Results: There were 150 male subjects with mean age 31.5+/-8.7 years. Overall, 62(41.3%) subjects had received up to 15 years of formal education, 94(62.6%) were first-time testers; 139(92.7%) performed the test at home; 11(7.3%) used the kit at the community-based organisation’s office. In terms of results, 1(0.7%) participant had a reactive result which was later confirmed as positive for human immunodeficiency virus. Of the total, 145(96.6%) participants found the instructions and the kit easy to use on their own, 83(55.3%) preferred a social media-based approach, and 68(45.3%) preferred the peer-to-peer approach. Conclusion: The human immunodeficiency virus self-testing kit was found to be acceptable among men who have sex with men, while peer-led and social media approaches seemed to be an effective method of information dissemination. Key Words: HIV testing, HIV self-testing, Pilot study, HIV Pakistan, Men who have sex with men, Peer to peer, Social media.

MSMEs have a strategic role in strengthening the local and national economy. MSMEs have advantages because business actors move in various business fields and directly touch the interests of the community. Especially in the Manado city, MSMEs play a role in increasing economic growth so that the optimization of the role of MSMEs will provide synergy and positive acceleration towards regional development. The aim of this study (1) find out the profile and problems of MSMEs, (2) To analyze MSME business and development strategies. Management of the MSMEs business, still has to get serious and very strategic attention, so it must be considered the local government, and related parties, considering the average MSMEs in the Manado city the business management is still simple, locally oriented, and have not business development plan, the reason that they are still oriented to survive competition and limited business capital.