Johnson, C.C., Kennedy, C., Fonner, V., et al. Journal of the International AIDS Society (May 2017), doi:10.7448/IAS.20.1.21594.
This systematic review examined the impact of HIV self-testing (HIVST) on HIV testing use and frequency, identification of HIV-positive individuals, care linkages, social harm, and risk behaviors.The study's objective was to inform the World Health Organization’s (WHO’s) guidance on HIV testing. Among the five randomized controlled trials identified in Australia, Hong Kong SAR, Kenya, and the United States, one examined couples testing and four examined testing among men who have sex with men. The findings indicated that HIVST doubled testing uptake and frequency. Those who participated in HIVST were twice as likely to be HIV-positive, compared to individuals who tested at facilities. Linkage to three-month facility-based confirmatory testing uptake was 25 percent. Evidence on conflicting risk behavior revealed that in the United States, HIVST participants did not report increased anal sex without condoms, while men in Hong Kong reported increased anal sex without condoms. One trial also identified two cases of intimate partner violence; one of the cases was attributed to the woman not asking for permission to enter the trial. The authors concluded that HIVST may offer sustainable increases in testing uptake and frequency, which can lead to earlier HIV diagnosis and treatment and lower mortality, particularly among men. WHO recommends HIVST as an additional HIV testing approach.