1. What Have We Learned About HIV Self- Testing?
Anna Heard
Senior Evaluation Specialist, 3ie
International AIDS Society Conference
24 July 2017

2. Kenya results-previous
ANC/PPC: HIVST for women to take home and test with partner (UNC/IRDO) increased HIV testing rates of partners by almost 40 percentage points (52% to 91%)
ANC with enhanced control: increased HIV testing rates of partners by almost 50 percentage points (28% vs 37% vs 83% men self report, 28%, 37%, 79% women reported husband tested) (Jhpiego)
Truck drivers: Slightly increased testing with choice: (73% vs 87%) [80% supervised].
ANC: antenatal care
PNC: post-natal care

3. ANC/PPC
Large increases in partner testing, even among those who have not tested previously
Self-report, but corroborated by both male and female partners in two studies
May increase or facilitate disclosure
Increases couples testing, and may increase conditional on testing
Linkage to care difficult to assess

4. Female sex workers
Peer educators highly effective in delivering intervention
Self-test kits, especially direct provision of kits, increased rates of testing
Fixed sites for pick-up may not be as effective, and may delay both testing and linkage to care
Linkage to care needs more attention
Text messaging to alert of availability of HIV self-test kits increased odds of testing over messages to come to clinic for test, however, testing rates were not high—more sensitization and awareness may be necessary

5. Truck drivers
HIVST increased testing among truck drivers offered a choice of testing methods.
Text message alerts for truck drivers were more effective for self-testing than clinic testing
Photo: Dave Chidley/

6. Door-to-door
Door-to-door offer of test choice or to leave kits for individuals who decline to test or are not present resulted in greater knowledge of status (self-report HIV+ or tested) than standard provider-performed test,
Difference was largely in men, young adults, and those that had not accepted testing in previous rounds.
Linkage to care make take longer

7. Conclusion Self-testing increases testing
Some people are comfortable with clinics, but others are reached through self-testing, and many prefer
Self-testing needs careful roll-out with attention to instruction and availability of counseling
Different distribution methods should be considered—secondary distribution may be a good way to reach those who hesitate to test or to go to facilities, or mobile or busy.
Few instances of IPV and coercion
More information is needed about linkage to care

8. Recommendations
Multiple mechanisms for accessing HIV testing, including self-testing, should be offered
Additional ways to link people to care or follow-up after provision of a self-test kit should be considered (SMS, CHW?)
Providing support, at least initially, to ensure proper test use and interpretation of results will likely be important
Don’t underestimate the power of persuasion: peers can be a very useful “tool”

9. Policy implications
WHO recommends adding self-tests as an additional method OraQuick and BioSure and Insti have been approved for use with Global Fund funds. OraQuick is pre-qualified Countries writing self-testing into concept notes and operational plans, drafting guidelines for self-testing >>Operational guidelines should include guidance about distribution methods and adequate instructions >>Provision of HIV self-tests could decongest busy clinics by screening out HIV- people