Journal of the International AIDS Society | 2019
Challenges in measurement of linkage following HIV self‐testing: examples from the STAR Project
Abstract
Knowledge of HIV status through HIV testing constitutes the \nfirst step towards HIV treatment and prevention services. HIV \nself-testing (HIVST), whereby individuals collect their own \nspecimen, conduct their own test and interpret the results, \nallows individuals to learn their HIV status conveniently and \nprivately, as well as to decide when and where to attend posttest \nservices. Accurate estimation of the proportion of those \ntested who link to additional HIV care, treatment and prevention \nservices is critical in quantifying the health impact of HIV \ntesting. As HIVST becomes integrated into testing programmes \nworldwide, implementers in diverse settings will \nneed to measure the effectiveness of their programmes to \nensure self-testers link to onward care and services. This can \nbe challenging, and community health programmes in many \ncontexts find it difficult to track referral uptake and equity [1]. \nWe draw upon experience from the Self-Testing in AfRica \n(STAR) Initiative in 2015 to 2017 to identify three lessons for \nmeasurement of linkage following HIVST. In STAR, two pragmatic \ncluster-randomized trials evaluated the effectiveness of \ncontinuous HIVST distribution over 12 months in increasing \ntesting coverage and linkage to care in Malawi and Zambia. A \nthird trial, in Zimbabwe, evaluated the effectiveness of an \nincentive to promote linkage following a short, campaign-style \nHIVST distribution programme, and included a non-randomized \ncomponent assessing the association between HIVST distribution \nand antiretroviral therapy (ART) initiations in nearby clinics. \nDetails are provided elsewhere [2,3]. Each trial incorporated a \nhousehold survey and data collection from health facilities to \nevaluate changes in HIV testing coverage and linkage to confirmatory \ntesting, care and prevention (Table 1).