Sales of HIV self-tests (HIVST) and pharmacists' knowledge, attitudes and perceptions regarding the distribution of HIVST in community pharmacies in Belgium: a cross-sectional survey

OBJECTIVES: 

HIV self-testing (HIVST) through community pharmacies offers a complementary, confidential and convenient testing option. Despite the availability of HIVST kits in Belgian pharmacies since 2017, little is known about sales and pharmacists' experiences. This study assessed HIVST sales and pharmacists' knowledge, attitudes and perceptions regarding its provision.

METHODS: 

We conducted a cross-sectional web-based survey among all community pharmacies (~4700) in Belgium between 14 May and 31 July 2025. Participants were recruited via newsletters from national and regional pharmacists' associations and a pharmacy network. We analysed responses on HIVST sales and pharmacists' knowledge, attitudes and perceptions descriptively. Associations between sales and pharmacy or pharmacist characteristics were examined using χ2, Fisher's exact or Mann-Whitney tests.

RESULTS: 

Among 235 respondents, 33.2% (78/235) reported selling HIVST, of whom 69.2% (54/78) sold ≤2 kits annually. Most sold the finger-prick Autotest HIV (65/78, 83.3%). Retail prices ranged from €26 to €35 (58/78, 74.4%). Half procured kits on request (37/78, 47.4%), only 12.8% (10/78) displayed kits. Sales were associated with pharmacist age (p=0.04) and location, with Brussels pharmacies more likely to sell kits than those in Flanders or Wallonia (p<0.001). Selling ≥3 HIVST kits annually occurred in 90.0% (9/10) of respondents with kits visibly displayed, compared with 41.4% (12/29) for behind-the-counter storage and 5.4% (2/37) for on-request provision (p<0.001). While 76.6% (180/235) considered HIVST a valuable complement to facility-based testing, only 19.6% (46/235) actively recommended it. Only 15.3% (36/235) had attended HIVST training; 31.9% (75/235) reported discomfort advising clients due to limited experience (85.3%) or low knowledge (78.7%).

CONCLUSIONS: 

The opportunity to purchase HIVST in community pharmacies remains underutilised in Belgium. Enhancing pharmacists' training, confidence, visibility of kits and affordability may increase uptake, strengthening the role of pharmacists as complementary providers of HIVST. Future research should include clients' perspectives on HIVST.