Implementing HIVST

Multiple approaches to HIVST have been identified. These approaches can be generally differentiated in three ways: type of support, level of access and type of distribution method (see table below). Additional detailed definitions, see be found at: Chapter 5 of the March 2014 Supplement to the WHO Consolidated ARV Guidelines and UNAIDS & WHO Short Technical Update on Self-testing for HIV.

 

Levels of Support
Supervised Unsupervised
Involves support from a health worker or volunteer before or after individuals test themselves for HIV. Such support may include a demonstration, in a private setting, of how to use the test, pre- or post-test counselling and referrals to additional services. Refers to independent or open access to HIV self-testing. Support may or may not be indirectly provided, based on the user’s initiative, such as telephone hotlines, leaflets, referral information, support groups, legal aid and HIV treatment, care and prevention services.
Levels of Access
Clinically restricted Semi-restricted Non-restricted (open access)
Health professionals provide HIV rapid diagnostic tests for self-testing to only specific populations and groups, as decided by a country. Health workers or volunteers provide some pre-test instructions and counselling and then distribute the HIV rapid diagnostic test for self-testing to individuals, such as by health workers through a facility or through trained staff at pharmacies to patients or the general public. However, HIV self-testing is not necessarily openly available through the private sector. HIV rapid diagnostic tests for self-testing are publicly available through many types of programmes and locations, such as pharmacies, clinics, groceries, convenience stores and vending machines.
Distribution and Initiation
Community-based Facility-based Alternative venues
Distribution to community members through volunteers or community health workers. This approach involves some supervision through the support of a community health worker or volunteer before or after individuals test themselves for HIV in private. Support may include a demonstration of how to use the test and interpret the result, pre-test information on where and how to seek additional support, further testing and HIV prevention, care and treatment services as well as providing an opportunity for community members to disclose their result. This post-test support may include face-to-face counselling, peer support and referrals for additional HIV prevention, treatment and care services.
See current experience
Distribution of HIV self-test kits or initiation of HIV self-testing through facilities involves distributing HIVST kits to clients to use at home or in a private setting in a health facility. Health care providers may encourage individuals to take self-test kits home for him or herself and/or their spouses or partners. This model could also be used by health workers, their spouses or partners as well as health facility clients who want to self-test.
See current experience
Distribution of HIV self-test kits or initiation of HIV self-testing through multiple public or private venues, such as: pharmacies, groceries, kiosks, vending machines. This approach can involve over-the-counter sale of HIV self-test kits, or distribution and testing linked to a trained on-site nurse or pharmacist, depending on the location.
See current experience