{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T11:52:13Z","timestamp":1791805933027,"version":"4.3.4"},"reference-count":228,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T00:00:00Z","timestamp":1620000000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"Northwestern University Open Access Fund"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nIntroduction<\/jats:title>\nHIV self-testing (HIV-ST) is an effective means of improving HIV testing rates. Low- and middle-income countries (LMIC) are taking steps to include HIV-ST into their national HIV\/AIDS programs but very few reviews have focused on implementation in LMIC. We performed a scoping review to describe and synthesize existing literature on implementation outcomes of HIV-ST in LMIC.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nWe conducted a systematic search of Medline, Embase, Global Health, Web of Science, and Scopus, supplemented by searches in HIVST.org<\/jats:ext-link> and other grey literature databases (done 23 September 2020) and included articles if they reported at least one of the following eight implementation outcomes: acceptability, appropriateness, adoption, feasibility, fidelity, cost, penetration, or sustainability. Both quantitative and qualitative results were extracted and synthesized in a narrative manner.<\/jats:p>\n<\/jats:sec>\n\nResults and discussion<\/jats:title>\nMost (75%) of the 206 included articles focused on implementation in Africa. HIV-ST was found to be acceptable and appropriate, perceived to be convenient and better at maintaining confidentiality than standard testing. The lack of counselling and linkage to care, however, was concerning to stakeholders. Peer and online distribution were found to be effective in improving adoption. The high occurrence of user errors was a common feasibility issue reported by studies, although, diagnostic accuracy remained high. HIV-ST was associated with higher program costs but can still be cost-effective if kit prices remain low and HIV detection improves. Implementation fidelity was not always reported and there were very few studies on, penetration, and sustainability.<\/jats:p>\n<\/jats:sec>\n\nConclusions<\/jats:title>\nEvidence supports the acceptability, appropriateness, and feasibility of HIV-ST in the LMIC context. Costs and user error rates are threats to successful implementation. Future research should address equity through measuring penetration and potential barriers to sustainability including distribution, cost, scale-up, and safety.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0250434","type":"journal-article","created":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T17:46:14Z","timestamp":1620063974000},"page":"e0250434","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":52,"title":["Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2533-0818","authenticated-orcid":true,"given":"Adovich S.","family":"Rivera","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"Hernandez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regiel","family":"Mag-usara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen Nicole","family":"Sy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan R.","family":"Ulitin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda C.","family":"O\u2019Dwyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan C.","family":"McHugh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Jordan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa R.","family":"Hirschhorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,5,3]]},"reference":[{"issue":"11","key":"pone.0250434.ref001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0188890","article-title":"Can self-testing increase HIV testing among men who have sex with men: A systematic review and meta-analysis","volume":"12","author":"C Zhang","year":"2017","journal-title":"PLoS One"},{"key":"pone.0250434.ref002","first-page":"20","article-title":"Examining the effects of HIV self-Testing compared to standard HIV testing services: A systematic review and meta-Analysis","author":"CC Johnson","year":"2017","journal-title":"J Int AIDS Soc"},{"key":"pone.0250434.ref003","first-page":"1","article-title":"WHO Recommends HIV Self-Testing","volume":"0","author":"World Health Organization (WHO)","year":"2016","journal-title":"Policy Brief"},{"issue":"6","key":"pone.0250434.ref004","doi-asserted-by":"crossref","first-page":"e277","DOI":"10.1016\/S2352-3018(18)30044-4","article-title":"Reliability of HIV rapid diagnostic tests for self-testing compared with testing by health-care workers: a systematic review and meta-analysis","volume":"5","author":"C Figueroa","year":"2018","journal-title":"Lancet HIV"},{"key":"pone.0250434.ref005","unstructured":"HIVST.org. HIVST.org Evidence Map [Internet]. [cited 2019 Mar 15]. Available from: www.hivst.org\/evidence"},{"issue":"2","key":"pone.0250434.ref006","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda","volume":"38","author":"E Proctor","year":"2011","journal-title":"Adm Policy Ment Heal Ment Heal Serv Res"},{"issue":"2","key":"pone.0250434.ref007","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s11904-016-0307-y","article-title":"HIV Self-Testing: a Review of Current Implementation and Fidelity","volume":"13","author":"KS Estem","year":"2016","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"11","key":"pone.0250434.ref008","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1007\/s10461-015-1097-8","article-title":"Attitudes and Acceptability on HIV Self-testing Among Key Populations","volume":"19","author":"C Figueroa","year":"2015","journal-title":"A Literature Review. 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university students in a Peri-Urban area of the Democratic Republic of Congo (DRC)","volume":"31","author":"BB Izizag","year":"2018","journal-title":"Pan Afr Med J"},{"issue":"1","key":"pone.0250434.ref037","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-020-08855-7","article-title":"Use and awareness of and willingness to self-test for HIV: An analysis of cross-sectional population-based surveys in Malawi and Zimbabwe","volume":"20","author":"C Johnson","year":"2020","journal-title":"BMC Public Health"},{"issue":"SUPPL. 4","key":"pone.0250434.ref038","article-title":"Factors associated with acceptability of HIV self-testing among health care workers in Kenya","volume":"18","author":"S Kalibala","year":"2014","journal-title":"AIDS Behav"},{"issue":"4","key":"pone.0250434.ref039","doi-asserted-by":"crossref","first-page":"332","DOI":"10.2989\/16085906.2019.1686032","article-title":"HIV testing preferences among pregnant women attending antenatal care and their male partners: a discrete choice experiment in Uganda","volume":"18","author":"JE Korte","year":"2019","journal-title":"African J AIDS Res"},{"issue":"4","key":"pone.0250434.ref040","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1007\/s10461-015-1213-9","article-title":"Accuracy and Acceptability of Oral Fluid HIV Self-Testing in a General Adult Population in Kenya","volume":"20","author":"AE Kurth","year":"2016","journal-title":"AIDS Behav"},{"issue":"4","key":"pone.0250434.ref041","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1590\/0102-311X00008913","article-title":"Acceptability of self-conducted home-based HIV testing among men who have sex with men in Brazil: data from an on-line survey","volume":"30","author":"SA Lippman","year":"2014","journal-title":"Cad Saude Publica"},{"issue":"11","key":"pone.0250434.ref042","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0206849","article-title":"Ability to use oral fluid and fingerstick HIV self-testing (HIVST) among South African MSM","volume":"13","author":"SA Lippman","year":"2018","journal-title":"PLoS One"},{"issue":"3","key":"pone.0250434.ref043","first-page":"1","article-title":"High Acceptability and Increased HIV Testing Frequency Following Introduction of HIV Self-Testing and Network Distribution among South African MSM","volume":"77","author":"SA Lippman","year":"2018","journal-title":"JAIDS J Acquir Immune Defic Syndr"},{"issue":"s2","key":"pone.0250434.ref044","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1007\/s10461-019-02552-2","article-title":"Use and Acceptability of HIV Self-Testing Among First-Time Testers at Risk for HIV in Senegal","volume":"23","author":"CE Lyons","year":"2019","journal-title":"AIDS Behav"},{"issue":"3","key":"pone.0250434.ref045","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1080\/17441692.2014.947303","article-title":"HIV self-testing in Nigeria: Public opinions and perspectives","volume":"10","author":"B Brown","year":"2015","journal-title":"Glob Public Health"},{"issue":"1","key":"pone.0250434.ref046","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0227198","article-title":"Usability assessment of seven HIV self-test devices conducted with lay-users in Johannesburg, South Africa","volume":"15","author":"M Majam","year":"2020","journal-title":"PLoS One"},{"key":"pone.0250434.ref047","doi-asserted-by":"crossref","first-page":"1","DOI":"10.11604\/pamj.2019.33.213.14160","article-title":"The effects of HIV self-testing kits in increasing uptake of male partner testing among pregnant women attending antenatal clinics in Kenya: A randomized controlled trial","volume":"33","author":"T Marwa","year":"2019","journal-title":"Pan Afr Med J"},{"issue":"1","key":"pone.0250434.ref048","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0169765","article-title":"High acceptability of HIV self-testing among technical vocational education and training 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Feasibility of online HIV counselling and testing among Thai men who have sex with men and transgender women and factors associated with service uptake","volume":"21","author":"N Phanuphak","year":"2018","journal-title":"J Int AIDS Soc"},{"issue":"6","key":"pone.0250434.ref059","first-page":"407","article-title":"Uptake of HIV Self-testing among Men Who have Sex with Men in Beijing, China: a Cross-sectional Study","volume":"30","author":"XL Ren","year":"2017","journal-title":"Biomed Environ Sci"},{"issue":"3","key":"pone.0250434.ref060","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s40258-019-00549-5","article-title":"Promoting HIV Testing by Men: A Discrete Choice Experiment to Elicit Preferences and Predict Uptake of Community-based Testing in Uganda","volume":"18","author":"EM Schaffer","year":"2020","journal-title":"Appl Health Econ Health Policy"},{"issue":"S2","key":"pone.0250434.ref061","first-page":"35","article-title":"An implementation study of oral and 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