PSI HIV Self-Testing Africa Project (STAR) phase two
Hatzold et al.
Type of approach
Type of assistance
Fingerstick/whole blood, Oral-fluid
Mixed: Key population (female sex workers), general population (adult men 25-49 years), young people (males and females 16-24 years) and parent-assisted HIVST for children
UNAIDS HIV prevalence (2017)
Phase two of the STAR project was conducted between July 2017 and June 2020. The project evaluated several HIV self-testing (HIVST) distribution models in six countries (Malawi, Zambia, Zimbabwe, Lesotho, Swaziland and South Africa): community-based distribution (door-to-door), distribution at workplaces, private HIV testing services (HTS) facilities, public HTS facilities (outpatients department), secondary distribution of HIVST through HIV-positive index patients at public sector health facilities, secondary distribution through HIV-positive index patients at private HTS facilities, secondary distribution through pregnant and lactating mothers to their sexual partners (attending maternal and child health services), distribution to female sex workers at sex worker clinics and through peer educators, sex workers secondary distribution to sexual partners and clients in Zimbabwe, distribution to men who have sex with men through peer distribution, distribution to men working for the uniformed services in Lesotho through health care facilities and peer distribution, distribution at voluntary medical male circumcision (VMMC) centres (offering HIVST as an alternative testing model to provider-delivered HIV testing) and through VMMC mobilisers to increase demand for VMMC. In all distribution models in which HIVST kits were directly distributed to beneficiaries, the directly-assisted approach was used (brief description of HIVST and demonstration or video by provider). The unassisted approach (only instructions for use included with kit) was used in all secondary distribution and in some cases in direct community-based distribution when outlets did not have prior in-person or video demonstrations of HIVST. HIV positivity among self-testers was assessed through facility-based HIVST, if self-testers disclosed their status. Social harms registers were monitored through the different distribution models and evaluated any social harms associated with HIVST. Costing studies were conducted in South Africa, Lesotho and Swaziland using micro-costing and expenditure analysis. Many studies were conducted in phase two including: an impact evaluation (Zimbabwe, Malawi and Zambia), cohort study to assess impact of uptake of HIVST through secondary distribution of MCH attendees (Zambia), intended-user-intended-setting accuracy study following secondary distribution of HIVST kits as part of secondary distribution through antenatal care (ANC) (Malawi), a pragmatic cluster-randomised trial of secondary distribution of HIVST through ANC and HIV testing services (Malawi), research on integration of self-testing into public healthcare delivery (Zimbabwe), case studies of different delivery models (Zambia), randomised controlled trial (Zimbabwe), randomised controlled trial, diagnostic accuracy and acceptability study (Lesotho, Swaziland and South Africa), and more.
Summary of findings
Willingness to pay
Willingness to pay details
Linkage to prevention, care and treatment