Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review

Abstract

Introduction HIV self-testing (HIV-ST) is an effective means of improving HIV testing rates. Low- and middle-income countries (LMIC) are taking steps to include HIV-ST into their national HIV/AIDS programs but very few reviews have focused on implementation in LMIC. We performed a scoping review to describe and synthesize existing literature on implementation outcomes of HIV-ST in LMIC. Methods We conducted a systematic search of Medline, Embase, Global Health, Web of Science, and Scopus, supplemented by searches in HIVST.org and other grey literature databases (done 23 September 2020) and included articles if they reported at least one of the following eight implementation outcomes: acceptability, appropriateness, adoption, feasibility, fidelity, cost, penetration, or sustainability. Both quantitative and qualitative results were extracted and synthesized in a narrative manner. Results and discussion Most (75%) of the 206 included articles focused on implementation in Africa. HIV-ST was found to be acceptable and appropriate, perceived to be convenient and better at maintaining confidentiality than standard testing. The lack of counselling and linkage to care, however, was concerning to stakeholders. Peer and online distribution were found to be effective in improving adoption. The high occurrence of user errors was a common feasibility issue reported by studies, although, diagnostic accuracy remained high. HIV-ST was associated with higher program costs but can still be cost-effective if kit prices remain low and HIV detection improves. Implementation fidelity was not always reported and there were very few studies on, penetration, and sustainability. Conclusions Evidence supports the acceptability, appropriateness, and feasibility of HIV-ST in the LMIC context. Costs and user error rates are threats to successful implementation. Future research should address equity through measuring penetration and potential barriers to sustainability including distribution, cost, scale-up, and safety.

Editorial: Assessing the power of HIV self-testing in unreachable populations in sub-Saharan Africa

“…HIV self-testing has been touted as the game-changer in HIV testing uptake with high HIV testing rates reported in studies conducted in low and middle-income countries, a majority of which were conducted in sub-Saharan Africa ( 1 ). In this highly successful Research Topic, we assessed the power of HIV self-testing in reaching unreachable populations in sub-Saharan Africa.…”

Evaluation of the Practicability of Biosynex Antigen Self-Test COVID-19 AG+ for the Detection of SARS-CoV-2 Nucleocapsid Protein from Self-Collected Nasal Mid-Turbinate Secretions in the General Public in France

“…Widespread use of self-testing for SARS-CoV-2 infection could help improve the control of the spread of the SARS-CoV-2 epidemic [ 16 , 17 , 18 , 19 , 20 , 21 ]. Previous experience with HIV self-testing showed that a self-test can be performed perfectly well by a layperson and gives reliable and accurate results, and that HIV self-testing is considered as an acceptable and useful tool to improve HIV testing coverage worldwide to improve HIV epidemic control [ 22 , 23 ]. Lateral flow tests for the SARS-CoV-2 antigen are appropriate for use as an antigen-detecting rapid diagnosis self-test (Ag-RDST) because of their low cost, ease of use, and prompt result [ 12 , 14 , 24 ].…”

Assessment of the Sedia HIV Self-Test Device: Usability and Performance in the Hands of Untrained Users in Johannesburg, South Africa

“…If this is the case, then the oral HIVST has the potential to speed up testing behaviour and balloon the number of people aware of their HIV status. In addition, the large majority indicating that they would prefer to perform the HIVST at home, implies that HIVST can be an attractive way to reach large numbers of the population who may be anxious about undergoing initial tests in more public facilities such as clinics [30].…”