title: The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence setting: a cross-sectional feasibility study in Blantyre, Malawi.
abstract: BACKGROUND
  Although HIV testing and counseling (HTC) uptake has increased dramatically in Africa, facility-based services are unlikely to ever meet ongoing need to the full. A major constraint in scaling up community and home-based HTC services is the unacceptability of receiving HTC from a provider known personally to prospective clients. We investigated the potential of supervised oral HIV self-testing from this perspective.
  
  
  RESULTS
  Adult members of 60 households and 72 members of community peer groups in urban Blantyre, Malawi, were selected using population-weighted random cluster sampling. Participants were offered self-testing plus confirmatory HTC (parallel testing with two rapid finger-prick blood tests), standard HTC alone, or no testing. 283 (95.6%) of 298 selected adults participated, including 136 (48.0%) men. 175 (61.8%) had previously tested (19 known HIV positive), although only 64 (21.5%) within the last year. HIV prevalence was 18.5%. Among 260 (91.9%) who opted to self-test after brief demonstration and illustrated instructions, accuracy was 99.2% (two false negatives). Although 98.5% rated the test "not hard at all to do," 10.0% made minor procedural errors, and 10.0% required extra help. Most participants indicated willingness to accept self-test kits, but not HTC, from a neighbor (acceptability 94.5% versus 46.8%, p = 0.001).
  
  
  CONCLUSIONS
  Oral supervised self-testing was highly acceptable and accurate, although minor errors and need for supervisory support were common. This novel option has potential for high uptake at local community level if it can be supervised and safely linked to counseling and care.
authors: Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi. augutc@gmail.com
authors: Augustine Talumba
authors: AT
authors: Choko
authors: Nicola
authors: N
authors: Desmond
authors: Emily L
authors: EL
authors: Webb
authors: Kondwani
authors: K
authors: Chavula
authors: Sue
authors: S
authors: Napierala-Mavedzenge
authors: Charlotte A
authors: CA
authors: Gaydos
authors: Simon D
authors: SD
authors: Makombe
authors: Treza
authors: T
authors: Chunda
authors: S Bertel
authors: SB
authors: Squire
authors: Neil
authors: N
authors: French
authors: Victor
authors: V
authors: Mwapasa
authors: Elizabeth L
authors: EL
authors: Corbett
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods*; D000328:Adult; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D011933:Reagent Kits, Diagnostic
chemical_list: D011933:Reagent Kits, Diagnostic