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The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence setting: a cross-sectional feasibility study in Blantyre, Malawi

Choko et al.

Publication year


Type of approach

Type of assistance
Directly assisted


Study population
General population: Adults from randomly selected households

Study design

Sample size

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

Participants were offered HIVST and confirmatory HIV testing services (HTS) (parallel testing with two rapid finger-prick blood tests), standard HTS alone, or no testing. Participants were provided with a brief demonstration and illustrated instructions, and offered referrals and support from community-based health workers.

Summary of findings
283 (95.6%) of 298 selected adults participated, including 136 (48.0%) men. 175 (61.8%) had previously tested (19 known HIV-positive), although only 64 (21.5%) within the last year. HIV prevalence was 18.5%. Among 260 (91.9%) who opted to self-test after brief demonstration and illustrated instructions, accuracy was 99.2% (two false negatives). 98.5% rated the test 'not hard at all', but 10.0% made minor errors, and 10.0% required extra help. Participants indicated willingness to accept self-test kits, but not HIV testing services, from a neighbor (acceptability 94.5% versus 46.8%, p=0.001).


Acceptability details
All 260 (91.9%) participants who consented to voluntary testing and counseling also accepted to self-test.

Willingness to pay

Willingness to pay details




HIV positivity
16.9% (48/283)

Accuracy details
Overall sensitivity for self-test self-read was 97.9% (95% CI 87.9%-100.0%) with specificity of 100% (95% CI 97.8%-100%), respectively. Self-testing was highly accurate, with clear and concordant results for 256 (99.2%; 95% CI 97.0%-100.0%) of 258 participants with both self-test and blood results.

Social harm

Linkage to prevention, care and treatment
Linkage into care was not investigated in this study because self-testing was offered in a supervised context, as a first step, so that HIV counselors were able to immediately refer participants into care.


Study status

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