One year outcomes following availability of community-based HIV self-testing: uptake, accuracy and linkage into care in a prospective study in Blantyre, Malawi
Choko et al.
Type of approach
Type of assistance
General population: n/a
UNAIDS HIV prevalence (2017)
16,660 adults over 16 years from 14 high-density neighbourhoods were included in a cluster randomised trial. Two residents were trained in each neighbourhood to provide HIVST from their homes (one test per resident per year). Clients received written and verbal information to promote linkage into HIV care coupled with home-initiation of HIV care if requested. Population-level uptake was estimated from enumeration denominators. Accuracy of HIVST was assessed through quality assurance re-testing with two parallel rapid tests with a 10% random sample of self-testing clients asked to retest. A strong community-based reporting system was in place for monitoring adverse events.
Summary of findings
Overall, 13966 self-test kits were distributed with 89% (n=n/a) returned as used kits with feedback forms, and uptake by 76% (12658/16660) of residents, including 67% (n=5840) of all men. The highest uptake was in the 16-19 years age group (93%, 2360/2539). The lowest uptake was in men over 50 years (41%, 298/733). Early adopters (n=2658 in 1st month) were significantly more likely to be female, adjusted odds ratio (aOR) 1.20 (95% CI 1.06-1.36); younger, and not in a couple aOR 2.22 (95% CI 1.54-3.16). In total, 9% (851/16660) of residents reported positive HIV self-test (HIVST) results, with 25% (n=n/a) already on ART and 78% (500/638) accessing HIV care. Quality assurance showed 99.1% agreement with self-reported HIVST results (sensitivity 93.8% and specificity 100%). No suicides or assaults were reported, but 2.9% (287/10007) of feedback respondents reported coercion, mainly from partners, and most commonly reported by men (3.7%, 147/266).
Willingness to pay
Willingness to pay details
Quality assurance showed 99.1% agreement with self-reported HIVST results (sensitivity 93.8% and specificity 100%).
No suicides or assaults were reported, but 2.9% (287/10007) of feedback respondents reported coercion, mainly from partners, and most commonly reported by men (3.7%, 147/266).
Linkage to prevention, care and treatment
78% (500/638) of participants with a reactive test result reported accessing HIV care.