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Providing user support for HIV self-testing beyond instructions-for-use in Malawi

Indravudh et al.

Publication year


Type of approach

Type of assistance


Study population
General population

Study design

Sample size

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

Cross-sectional study to assess feasibility, acceptability and accuracy of semi-supervised (directly-assisted) HIVST. Two studies were conducted: (1) cognitive interviews with literate adults, attending voluntary counseling and testing in rural and urban health facilities (n=20). Respondents were provided the HIVST kits with no other assistance and administered a topic guide (unassisted). (2) Feasibility study, with participants age 16 years or older, of randomly selected households and purposively selected peer groups from two rural villages (n=340). Participants could choose from self-testing, standard testing or no testing. Self-testers received a demonstration on kit content and usage. HIVST results were then compared to a reference standard (2 parallel rapid blood-based tests by trained professionals). Study period: May to July 2016

Summary of findings
In the cognitive interviews all participants completed the self-test and accurately interpreted their results, though there were difficulties affecting timeliness and confidence in validity. In the feasibility study participants were able to self-test accurately with just the instructions-for-use. Acceptability was high, 85.6% (291/340) accepted to self-test, 3.8% (13/340) tested through standard methods, and 10.6% (36/340) declined to test.


Acceptability details
85.6% (291/340) accepted to self-tested

Willingness to pay

Willingness to pay details




HIV positivity
4.1% (14/340)

Accuracy details
Sensitivity 92.9%, 95%CI 66.1%-99.8%, specificity 99.60%, 95%CI 98%-100%. Most common error: reading results before specified time (5/291).

Social harm

Linkage to prevention, care and treatment
Linkage into care was not investigated in this study but all HIVST results were compared to reference standard testing (2 parallel rapid blood-based tests by trained professionals).

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