HIV self-testing: lessons learnt and priorities for adaptation in a shifting landscape

Abstract

### Summary box HIV self-testing (HIVST) has shifted the paradigm for HIV testing, the first step in the care continuum. Although HIVST, whereby the person performs the test and interprets the results, was conceived early in the HIV epidemic, wider access to HIVST in low-income and middle-income countries (LMICs) is a recent phenomenon. A decade ago, large-scale HIVST use was limited due to concerns about accuracy, feasibility and safety. Through coordination between the WHO and implementation projects, including the Unitaid-funded HIV Self-Testing Africa (STAR) Initiative, HIVST is now part of the approach to HIV diagnosis in a growing number of high burden settings, with lessons for HIV programmes, other disease control efforts and the wider universal health coverage agenda.1 This shift to HIVST was driven by a need for better HIV diagnostic strategies, particularly in sub-Saharan Africa where under 50% of people living with HIV (PLHIV) knew their status in 2013.2 Despite no precedent for self-testing, no registered commercial assays and several implementation barriers, researchers and funders, set out to inform guidelines, policy development and regulatory frameworks. This effort shed light on the feasibility and effectiveness of large-scale implementation of HIVST by establishing preferred distribution channels, thereby generating demand. We describe key lessons learnt from HIVST in LMICs to …

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