HIV Self-testing in Sub-Saharan Africa: Strategies to Enhance and Measure Linkage to Care

HIV self-testing is gaining traction as an additional strategy for increasing access to knowledge of HIV status in sub-Saharan Africa. This approach may reinforce individual autonomy and is potentially more convenient compared to other HIV testing techniques. Given the global push toward early antiretroviral therapy, HIV self-testing may appear ineffective in assuring linkage to HIV care. Approaches to improve this critical outcome of HIV self-testing include utilization of unique personal identifiers, fingerprint scanning, phone-based reminders and queries, and centralized databases to follow up clients who test themselves. To enable jurisdictions in sub-Saharan Africa to measure coverage of HIV self-testing and the associated linkage to care, the centralized databases ought to be linked to HIV care clinic data. Current information systems like household surveys can also be adapted for surveillance of linkage to care post self-testing. However, the affordability and cost-effectiveness of these innovations need to be evaluated. Since self-testing is a new behavior, a deeper understanding of the trajectory of clients after testing is necessary in order to design appropriate interventions for linkage to care. Policy makers, implementers, researchers, and technology experts in sub-Saharan Africa should seize the opportunity to scale-up high-quality self-testing programs, improve the HIV care cascade, and contribute to the decline of new HIV infections.