Reaching priority populations with different HIV self-testing distribution models in South Africa: an analysis of programme data

Mohammed Majam, Ezintsha, a division of the Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa. mmajam@ezintsha.org.
Karin Hatzold, Population Services International, Cape Town, South Africa.
Webster Mavhu, Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe.
Angela Tembo, Ezintsha, a division of the Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa.
Vincent Zishiri, Ezintsha, a division of the Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa.
Jane Phiri, Ezintsha, a division of the Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa.
Donaldson Conserve, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Zelalem Haile, Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA.
Thato Chidarikire, HIV Prevention Department, National Department of Health, Pretoria, South Africa.
Cheryl C. Johnson, Global HIV, Hepatitis and STI Programmes, World Health Organisation, Geneva, Switzerland.
Sangiwe Moyo, Population Services International, Cape Town, South Africa.
Gesine Meyer-Rath, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Francois Venter, Ezintsha, a division of the Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa.

Document Type

Journal Article

Publication Date

2-25-2025

Journal

BMC infectious diseases

Volume

22

Issue

Suppl 1

DOI

10.1186/s12879-025-10662-7

Keywords

Community-based; Facility-based; HIV self-testing; Key populations; Private sector; South Africa; Workplace

Abstract

BACKGROUND: As in much of sub-Saharan Africa, substantial HIV testing gaps remain in South Africa, particularly among adult men ages 20-35, young people ages 15-24 and key populations. Innovative strategies, such as HIV self-testing (HIVST), are needed to reach such under-served populations. We evaluated a range of HIV self-test kit distribution models' potential to reach adult men, young people and key populations in South Africa, to inform targeted approaches. METHODS: This cross-sectional study used data from community and facility-based HIV self-test kit distribution models implemented from October 2017 to April 2020. Self-test kits were distributed as part of the Unitaid-funded Self-Testing AfRica (STAR) programme. Data were collected from individuals who obtained self-test kits through five distribution models. Frequencies and proportions were used to describe the characteristics of the study populations and self-test kit distribution approaches. RESULTS: Over 2.5 years, 1 071 065 self-test kits were distributed across the five models. Community-based distribution accounted for 63% of total kits distributed, while the private sector (primarily workplace) accounted for 26%. Distribution at public sector health facilities accounted for 7% and distribution through the key population and secondary distribution models accounted for 2% each. Of those obtaining kits, and for whom we collected previous testing data (n = 771 612, 72%), 11% had never tested for HIV, 29% had not tested for at least a year, 41% had tested within the last 4-12 months and 19% had tested within the preceding three months. More men (64%) than women obtained self-test kits across all distribution models. The majority (80%) of men obtaining self-test kits were aged 20-40 years, and primarily received these at public transport terminals (36%), workplaces (18%) and hotspots (14%). A small proportion of men was reached through female sex workers. CONCLUSIONS: This analysis of programme data enabled us to identify HIV self-test kit distribution models that are best suited to reach specific priority and under-tested populations, particularly adult men and young people. Models/sub-models that reach self-test users where they live, work and spend time, are likely to result in higher HIVST uptake. Study findings can inform future HIVST scale-up in South Africa.

Department

Prevention and Community Health

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