Harichund, C., and Moshabela, M. AIDS and Behavior (July 2017), 13:735, doi: 10.1007/s10461-017-1848-9.
This review summarized the literature on HIV self-testing (HIVST) in sub-Saharan Africa. The 11 eligible studies showed that men were more likely to find HIVST acceptable than women because this option incurred lower nonmedical costs and required no absenteeism from work. Advantages also included improved confidentiality and privacy, burdens on the health care system, lower risk of providers coercing patients into testing, and absence of stigma and discrimination. Participants expressed concerns about lack of in-person counseling, but the findings showed that telephone counseling may be an acceptable alternative. Linkage to care is a significant concern; one study found only 41.7 percent of individuals who used HIVST linked to care after a positive result. Additional concerns included risk for suicide and gender-based violence. The cost of the HIVST kit was a limiting factor for disadvantaged individuals. Some participants said that governments should provide HIVST without cost; others said that they would pay for HIVST if they could buy the kit in a confidential manner. Stakeholders from all three countries advocated for including HIVST within policy and regulatory frameworks for scale-up. The authors concluded that HIVST may work as a complementary approach to other HIV testing models, but additional research is required to inform its scale-up.