Initially implemented in eSwatini, Lesotho, Malawi, South Africa, Zambia, and Zimbabwe, the HIV Self-Testing Africa Initiative (STAR) has provided a strong foundation for introducing HIV Self-Testing (HIVST) in low and middle-income countries (LMICs).
In addition, HIVST plays a critical role in ensuring the continuity of HIV testing services during the COVID-19 pandemic. HIVST provides an opportunity to adhere to physical distancing guidance and reduces the risk of exposure transmission for both beneficiaries and health care providers.
STAR aims to show that HIVST is an easy, cost-effective way to bring HIV testing to populations that are currently unreached by conventional testing programs, including that of adult men. Reaching men who are at risk for HIV but not currently testing has the potential for substantial health impact, not just for these men but also for their sexual partners and families, resulting in reduced HIV-related morbidity, mortality and incidence.
The Initiative’s work has progressed through three phases in the 7 years of its operations, expanding its geographical reach from three to thirteen countries, and shifting its focus from evidence generation to widespread implementation and scale-up, as the scientific evidence base for HIVST has expanded. Between 2015 and 2022, close to 6 million HIVST have been distributed through the STAR project.
HIVST for Men:
- Many aspects of self-testing resonate with men: increased privacy, convenience and control, plus the ability to test when and where they choose.
- STAR tested a range of HIVST distribution models and proved that these work well to reach men who are not using conventional testing services:
- The offer of free HIVST kits at taxi ranks or other urban sites where men congregate, ideally with onsite confirmatory testing and linkage support;
- Access to free or low-cost HIVST kits at pharmacies – both brick and mortar, and online;
- Secondary distribution of HIVST kits to men by their partners, either from antenatal clinics (ANC) or as part of index testing; or thorough female sex workers to their clients and partners.
- Distribution at workplaces dominated by men such as mines, industry, or farms.
- In every case, men are provided with information on how to use the kit, as well as online or phone support for follow-on care.
- Good HIVST programs don’t simply replace a provider-used kit with a self-test kit. They redesign the testing experience so that the client is in control, with help if he needs it, but without pressure.
- STAR has also developed innovative mHealth solutions to follow-up and promote linkages of HIV self-testers to treatment and care, which also facilitates monitoring of linkage after HIV self-testing. One example uses WhatsApp for Business to provide interactive support to the client, helping him navigate both the use of the kit and follow up based on his result.
What Makes HIVST Unique/Different:
“I wanted to know my status, I just didn’t want a stranger to tell it to me.”Zimbabwean male self-tester
We know that for many men, feeling in control and being in control are very important, especially when it comes to sensitive matters like sexual health. Provider-delivered HIV testing – even when done with sensitivity and care – takes control away from the man and gives it to a stranger. A strong HIVST program inverts the typical HIV testing experience, by putting the man in charge. It also gives him tools to get the help he needs when he is ready.
STAR’s scale and scope enabled us to test a wide range of HIVST approaches, identify those that work best for male clients and then develop appropriate linkage tools for those models. No other HIVST program in the world has STAR’s depth of experience and research when it comes to men.
- New HIV cases (yields) have, in some cases, more than doubled those found via conventional testing. This demonstrates the ability to reach beyond the capabilities of conventional settings.
- Introduced health system efficiencies by triaging out clients with a negative HIVST.