HIV self‐testing: breaking the barriers to uptake of testing among men and adolescents in sub‐Saharan Africa, experiences from STAR demonstration projects in Malawi, Zambia and Zimbabwe

Abstract

Introduction Social, structural and systems barriers inhibit uptake of HIV testing. HIV self‐testing ( HIVST ) has shown promising uptake by otherwise underserved priority groups including men, young people and first‐time testers. Here, we use characteristics of HIVST kit recipients to investigate delivery to these priority groups during HIVST scale‐up in three African countries. Methods Kit distributors collected individual‐level age, sex and testing history from all clients. These data were aggregated and analysed by country (Malawi, Zambia and Zimbabwe) for five distribution models: local community‐based distributor ( CBD : door‐to‐door, street and local venues), workplace distribution ( WD ), integration into HIV testing services ( IHTS ), or public health facilities ( IPHF ) and during demand creation for voluntary male medical circumcision ( VMMC ). Used kits were collected and re‐read from CBD and IHTS recipients. Results Between May 2015 and July 2017, 628,705 HIVST kits were distributed in Malawi (172,830), Zambia (190,787) and Zimbabwe (265,091). Community‐based models, the first to be established, accounted for 519,658 (82.7%) of kits distributed, with 275,419 (53.0%) used kits returned. Subsequent model diversification delivered 54,453 (8.7%) test‐kits through IHTS , 23,561 (3.7%) through VMMC , 21,183 (3.4%) through IPHF and 9850 (1.7%) through WD . Men took 294,508 (48.2%) kits, and 263,073 (43.1%) went to young people (16 to 24 years). A higher proportion of male self‐testers (65,577; 22.3%) were first‐time testers than women (54,096; 17.1%) with this apparent in Zimbabwe (16.2% vs. 11.4%), Zambia (25.4% vs. 17.7%) and Malawi (27.9% vs. 25.9%). The highest proportions of first‐time testers were in young (16 to 24 years) and older (>50 years) men (country‐ranges: 18.7% to 35.9% and 13.8% to 26.8% respectively). Most IHTS clients opted for HIVST in preference to standard HTS in each of 12 delivery sites, with those selecting HIVST having lower HIV prevalence, potentially due to self‐selection. Conclusions HIVST delivered at scale using several different models reached a high proportion of men, young people and first‐time testers in Malawi, Zambia and Zimbabwe, some of whom may not have tested otherwise. As men and young people have limited uptake under s...

Exploring social harms during distribution of HIV self‐testing kits using mixed‐methods approaches in Malawi

“…Although we cannot define exact usage, participants receiving kits through community-based distributors were asked to return their used kits with a self-administered questionnaire. Use was confirmed by inspection of used kits for 75.7% of 27,789 distributed kits in HitTB (Study 1, Table 2) and 53.2% of 163,300 kits distributed under STAR-GP in Malawi [52] including 137,915 kits for which we report SHs (Studies 9 and 11, Table 2) [4,6,52]. Thus, while non-use of distributed kits will be contributing to underestimation of SHs, this has relatively little impact on our SH frequency-estimates reported here.…”

To thine own test be true: HIV self‐testing and the global reach for the undiagnosed

“…Also in this Supplement , Hatzold et al . reviewed STAR data from Malawi, Zambia and Zimbabwe that assessed the integration of HIVST tools into HIV programming . They found that by having clients perform HIVST in outpatient settings, they were able to decongest clinical testing facilities because healthcare workers could focus only on those that screened positive.…”

“…They found that by having clients perform HIVST in outpatient settings, they were able to decongest clinical testing facilities because healthcare workers could focus only on those that screened positive. They also demonstrated the ability to reach men through community distribution and in particular workplaces, and explored male attitudes to HIVST, noting that the briefer counselling messages, privacy and convenience appealed to them .…”

Adaptation of a Health Education Program for Improving the Uptake of HIV Self-Testing by Men in Rwanda: A Study Protocol

“…An HIVST scale-up study conducted in these three African countries revealed promising results. A higher proportion of male self-testers (22.3%), compared with women (17.1%), were first-time testers, which was apparent in Zimbabwe (16.2% vs. 11.4%), Zambia (25.4 vs. 17.7%), and Malawi (27.9 vs. 25.9%) [22]. Several other different scholars have shown HIVST as an acceptable strategy to improve men's uptake of HTSs [16,[24][25][26].…”

“…The World Health Organization (WHO) published the first global guidelines on HIV self-testing (HIVST) in 2016 [17]-an intervention that has shown global potential to increase uptake of HTSs [13,[18][19][20][21]. Studies have reported success, with HIVST being offered to men in health care facility-based settings [22,23] and community settings [22], in Malawi, Zambia, and Zimbabwe. An HIVST scale-up study conducted in these three African countries revealed promising results.…”