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Effect of optional home initiation of HIV care following HIV self-testing on antiretroviral therapy initiation among adults in Malawi: a randomized clinical trial.

MacPherson et al.

Publication year


Type of approach

Type of assistance
Directly assisted


Study population
General population

Study design

Sample size

UNAIDS HIV prevalence (2017)
9.1 [8.4 - 9.9]

Cluster-randomized trial Jan 2012-Nov 2012. Used restricted randomization of 14 community health worker catchment areas. Participants received access to home HIVST through resident volunteers. Clusters were randomly allocated to facility-based care or optional home initiation of HIV care (including 2 weeks of ART for those eligible) for participants reporting positive self-test results.

Summary of findings
Significantly greater proportion of adults in home group (2.2%) initiated ART compared to facility group (0.7%). Uptake of HIVST was high in both facility and home groups (53% and 65% respectively). Participants in the home group were significantly more likely to report positive HIVST results compared to those in the facility group. Findings suggest that for Malawi adults offered HIVST, home initiation of care could be a better option; as findings show it was linked to a significant increase in the proportion of adults initiating ART.


Acceptability details
During the 6 months of availability, a total of 9720 of 16 660 adult residents (58.3%) took an HIV self-test kit.

Willingness to pay

Willingness to pay details




HIV positivity
4.6% (768/16660)

Accuracy details

Social harm

Linkage to prevention, care and treatment
After 6 months, 52 of 181 participants (28.7%; 30/116 [25.9%] home initiators and 22/65 [33.8%] facility initiators) who initiated ART in the homegroup and 15 of 63 participants (23.8%) in the facility group were lost from ART.

Study status

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