Scaling Up HIV Self-Testing in Africa: Insights From National Programmatic Data in Eight Countries

Area of Science:

• Public Health
• Epidemiology
• Global Health

Background:

• Limited data exists on the scale-up of HIV self-testing (HIVST) from routine national programs.
• Understanding HIVST integration into national testing strategies is crucial for effective HIV/AIDS response.

Purpose of the Study:

• To examine the scale-up of HIV self-testing (HIVST) across eight African countries.
• To describe the integration of HIVST into national testing strategies and its impact on testing coverage, positivity, and antiretroviral therapy (ART) linkage.

Main Methods:

• Retrospective analysis of national program data from January 2019 to December 2023 in Kenya, Lesotho, Malawi, Mozambique, South Africa, Tanzania, Uganda, and Zimbabwe.
• Data disaggregated by quarter and subnational district, including HIVST kits distributed, conventional testing volumes, new HIV diagnoses, and ART initiations.
• Derived key indicators: testing rates, positivity, ART linkage, and stability of HIVST distribution over time.

Main Results:

• HIVST scale-up varied significantly, contributing up to 63% of total testing in Lesotho, but less than 15% in Kenya, Tanzania, Uganda, and South Africa.
• In Malawi, Lesotho, and Zimbabwe, HIVST offset declines in conventional testing during the COVID-19 pandemic.
• Despite shifts in testing modalities, new HIV diagnoses and ART initiations remained stable in most countries, indicating program adaptability.

Conclusions:

• HIVST has been scaled to varying degrees, influenced by national contexts and distribution models.
• Incomplete reporting and inability to distinguish first-time vs. repeat testers limit interpretation.
• Findings offer guidance for optimizing HIV testing services to achieve global HIV targets and end AIDS by 2030.