{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T23:36:40Z","timestamp":1787960200619,"version":"build-2784847793"},"reference-count":33,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2019,3,25]],"date-time":"2019-03-25T00:00:00Z","timestamp":1553472000000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Social, structural and systems barriers inhibit uptake of <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> testing. <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> self\u2010testing (<jats:styled-content style=\"fixed-case\">HIVST<\/jats:styled-content>) has shown promising uptake by otherwise underserved priority groups including men, young people and first\u2010time testers. Here, we use characteristics of <jats:styled-content style=\"fixed-case\">HIVST<\/jats:styled-content> kit recipients to investigate delivery to these priority groups during <jats:styled-content style=\"fixed-case\">HIVST<\/jats:styled-content> scale\u2010up in three African countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Kit distributors collected individual\u2010level age, sex and testing history from all clients. These data were aggregated and analysed by country (Malawi, Zambia and Zimbabwe) for five distribution models: local community\u2010based distributor (<jats:styled-content style=\"fixed-case\">CBD<\/jats:styled-content>: door\u2010to\u2010door, street and local venues), workplace distribution (<jats:styled-content style=\"fixed-case\">WD<\/jats:styled-content>), integration into <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> testing services (<jats:styled-content style=\"fixed-case\">IHTS<\/jats:styled-content>), or public health facilities (<jats:styled-content style=\"fixed-case\">IPHF<\/jats:styled-content>) and during demand creation for voluntary male medical circumcision (<jats:styled-content style=\"fixed-case\">VMMC<\/jats:styled-content>). Used kits were collected and re\u2010read from <jats:styled-content style=\"fixed-case\">CBD<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">IHTS<\/jats:styled-content> recipients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between May 2015 and July 2017, 628,705 <jats:styled-content style=\"fixed-case\">HIVST<\/jats:styled-content> kits were distributed in Malawi (172,830), Zambia (190,787) and Zimbabwe (265,091). Community\u2010based models, the first to be established, accounted for 519,658 (82.7%) of kits distributed, with 275,419 (53.0%) used kits returned. Subsequent model diversification delivered 54,453 (8.7%) test\u2010kits through <jats:styled-content style=\"fixed-case\">IHTS<\/jats:styled-content>, 23,561 (3.7%) through <jats:styled-content style=\"fixed-case\">VMMC<\/jats:styled-content>, 21,183 (3.4%) through <jats:styled-content style=\"fixed-case\">IPHF<\/jats:styled-content> and 9850 (1.7%) through <jats:styled-content style=\"fixed-case\">WD<\/jats:styled-content>. Men took 294,508 (48.2%) kits, and 263,073 (43.1%) went to young people (16 to 24\u00a0years). A higher proportion of male self\u2010testers (65,577; 22.3%) were first\u2010time testers than women (54,096; 17.1%) with this apparent in Zimbabwe (16.2% vs. 11.4%), Zambia (25.4% vs. 17.7%) and Malawi (27.9% vs. 25.9%). The highest proportions of first\u2010time testers were in young (16 to 24\u00a0years) and older (&gt;50\u00a0years) men (country\u2010ranges: 18.7% to 35.9% and 13.8% to 26.8% respectively). Most <jats:styled-content style=\"fixed-case\">IHTS<\/jats:styled-content> clients opted for <jats:styled-content style=\"fixed-case\">HIVST<\/jats:styled-content> in preference to standard <jats:styled-content style=\"fixed-case\">HTS<\/jats:styled-content> in each of 12 delivery sites, with those selecting <jats:styled-content style=\"fixed-case\">HIVST<\/jats:styled-content> having lower <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> prevalence, potentially due to self\u2010selection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">HIVST<\/jats:styled-content> delivered at scale using several different models reached a high proportion of men, young people and first\u2010time testers in Malawi, Zambia and Zimbabwe, some of whom may not have tested otherwise. As men and young people have limited uptake under standard facility\u2010and community\u2010based <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> testing, innovative male\u2010 and youth\u2010sensitive approaches like <jats:styled-content style=\"fixed-case\">HIVST<\/jats:styled-content> may be essential to reaching <jats:styled-content style=\"fixed-case\">UNAIDS<\/jats:styled-content> fast\u2010track targets for 2020.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25244","type":"journal-article","created":{"date-parts":[[2019,3,25]],"date-time":"2019-03-25T09:37:10Z","timestamp":1553506630000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":149,"title":["<scp>HIV<\/scp> self\u2010testing: breaking the barriers to uptake of testing among\u00a0men and adolescents in sub\u2010Saharan Africa, experiences from <scp>STAR<\/scp> demonstration projects in Malawi, Zambia and Zimbabwe"],"prefix":"10.1002","volume":"22","author":[{"given":"Karin","family":"Hatzold","sequence":"first","affiliation":[{"name":"Population Services International (PSI) Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephano","family":"Gudukeya","sequence":"additional","affiliation":[{"name":"Population Services International Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam N","family":"Mutseta","sequence":"additional","affiliation":[{"name":"Population Services International Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Chilongosi","sequence":"additional","affiliation":[{"name":"Population Services International Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mutinta","family":"Nalubamba","sequence":"additional","affiliation":[{"name":"Society for Family Health Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiwawa","family":"Nkhoma","sequence":"additional","affiliation":[{"name":"Population Services International Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hambweka","family":"Munkombwe","sequence":"additional","affiliation":[{"name":"Society for Family Health Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malvern","family":"Munjoma","sequence":"additional","affiliation":[{"name":"Population Services International Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"Mkandawire","sequence":"additional","affiliation":[{"name":"Population Services International Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varaidzo","family":"Mabhunu","sequence":"additional","affiliation":[{"name":"Population Services International Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"Smith","sequence":"additional","affiliation":[{"name":"Society for Family Health Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngonidzashe","family":"Madidi","sequence":"additional","affiliation":[{"name":"Population Services International Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussein","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Population Services International (PSI) Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taurai","family":"Kambeu","sequence":"additional","affiliation":[{"name":"Population Services International (PSI) Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Stankard","sequence":"additional","affiliation":[{"name":"Population Services International (PSI) Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl C","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of HIV World Health Organization Geneva Switzerland"},{"name":"Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth L","family":"Corbett","sequence":"additional","affiliation":[{"name":"Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine London United Kingdom"},{"name":"Malawi\u2010Liverpool Wellcome Trust Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,3,25]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"UNAIDS.Global AIDS statistics 2017. 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July 18\u201322; Durban South Africa."},{"key":"e_1_2_9_30_1","unstructured":"IndravudhP FieldingK NeumanM ChilongosiR MkandawireP NyondoE et\u00a0al.Increasing knowledge of HIV status and demand for ART using community\u2010based HIV self\u2010testing in rural communities: a cluster randomised trial in Malawi. 22nd International AIDS Conference (AIDS 2018) Amsterdam Netherlands THPDC0103."},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.09.069203"},{"key":"e_1_2_9_32_1","unstructured":"NicholsBE OfforjebeOE CeleR ShabaF LongLC RosenS et\u00a0al.;on behalf of EQUIP.Economic evaluation of HIV self\u2010testing in outpatient departments in Malawi: Results from EQUIP. 22nd International AIDS Conference (AIDS 2018) Amsterdam Netherlands THPDC0103."},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(18)30111-5"},{"key":"e_1_2_9_34_1","unstructured":"World Health Organisation.Knowing your status \u2010 then and now realizing the potential of HIV self\u2010testing. 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