Free HIV self-testing: Best practices, positivity rates, and associated costs

Key take-home messages

• HIV self-testing is highly acceptable but could be cost prohibitive, especially for individuals at high risk of acquiring HIV and communities with high rates of poverty, HIV infection, and limited access to screening and care services.
• Subsidizing and implementing HIV self-testing programs in communities with high rates of infection may present a public health opportunity, particularly among individuals reporting condomless sex with multiple partners, concurrent sexual partnerships, and those with incarceration and substance use histories. By removing the barrier of cost and tailoring delivery methods with community input, HIV self-test programs can engage individuals not reached by other testing programs. HIV self-testing strategies may be adapted to different jurisdictions to supplement routine testing and traditional outreach testing.
• The distribution of HIV self-tests to social network members increases access to other at-risk persons and significantly increases yield of new diagnoses.
• HIV self-testing, through internet recruitment and the distribution of tests by mail, could be a promising new strategy to reach more at-risk persons at a relatively low cost.
• The costs associated with free HIV self-testing programs may vary widely depending on many factors. A large study in the U.S. calculated the cost per self-test completed, cost per person tested at least once, and incremental cost per new HIV diagnosis as USD 61, USD 145 and USD 9,365 respectively, which was considered to be cost-saving. Public Health England’s National HIV Self-Sampling Service indicates GBP 949 as a cost per reactive self-sampling test.
• Positivity rates of HIV self-testing and self-sampling vary widely between 0.3% and 6.14% depending on study and program design, self-testing types, population groups, risk behaviours, length of observation, jurisdictions, measuring methodologies, and other factors.

• Epidemiology and Determinants of Health
  • Epidemiology
• Population(s)
  • Men who have sex with men
  • Ethnoracial communities
  • General HIV+ population
  • General HIV- population
• Testing
  • Testing
• Health Systems
  • Delivery arrangements