Sue Napierala Mavedzenge Liz Corbett London School of Hygiene & Tropical Medicine A systematic review of HIV self-testing: research, policy and a new era in HIV prevention

Policy *Summarized in UNAIDS 2000 Technical Update  Global policy is increasingly public-health orientated: emphasis on convenience, integration into routine health services, wide coverage  Current UNAIDS/WHO policy does not include self-testing, however summarising a 2000 UNAIDS policy statement: “Home testing and self-testing are likely to be more commonly used. This will provide greater access to VCT for people who are reluctant to attend formal VCT services.” *  2009 Kenyan National Guidelines for HIV Testing and Counselling include oral fluid test kits for HIV self-testing

Research and current practice  Evidence that informal self-testing is already practiced when test kits are available  61-95% of people in 8 studies reported interest, preference, or belief that self-testing should be made available  % accuracy was achieved in two studies which used current generation oral fluid kits  Few data exist, but to date there is little evidence of harm

Summary and recommendations  There is a clear need to scale up HIV testing, and self-testing has potential to be acceptable, confidential, and empowering for users  Shifts in policy have encouraged expansion of testing approaches, and countries have begun adopting self-testing  Evidence that self-testing is acceptable and good accuracy can be achieved  In light of the current scenario of unregulated self-testing, measures should be taken to either promote or discourage self-testing  Consideration should be given as to the best way forward for self- testing, to maximize benefits and reduce potential for harm