Who is reached by HIV self-testing?: individual factors associated with self-testing within a community-based program in rural Malawi

Pitchaya P Indravudh, Bernadette Hensen, Rebecca Nzawa, Richard Chilongosi, Rose Nyirenda, Cheryl C Johnson, Karin Hatzold, Katherine Fielding, Elizabeth L Corbett, Melissa Neuman

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INTRODUCTION: HIV self-testing (HIVST) is an alternative strategy for reaching population subgroups underserved by available HIV testing services. We assessed individual factors associated with ever HIVST within a community-based program.

SETTING: Malawi.

METHODS: We conducted secondary analysis of an end line survey administered under a cluster-randomized trial of community-based distribution of HIVST kits. We estimated prevalence differences and prevalence ratios (PRs) stratified by sex for the outcome: self-reported ever HIVST.

RESULTS: Prevalence of ever HIVST was 45.0% (475/1055) among men and 40.1% (584/1456) among women. Age was associated with ever HIVST in both men and women, with evidence of a strong declining trend across categories of age. Compared with adults aged 25-39 years, HIVST was lowest among adults aged 40 years and older for both men [34.4%, 121/352; PR 0.74, 95% confidence interval (CI): 0.62 to 0.88] and women (30.0%, 136/454; PR 0.71, 95% CI: 0.6 to 0.84). Women who were married, had children, had higher levels of education, or were wealthier were more likely to self-test. Men who had condomless sex in the past 3 months (47.9%, 279/582) reported a higher HIVST prevalence compared with men who did not have recent condomless sex (43.1%, 94/218; adjusted PR 1.37, 95% CI: 1.06 to 1.76). Among men and women, the level of previous exposure to HIV testing and household HIVST uptake was associated with HIVST.

CONCLUSIONS: Community-based HIVST reached men, younger age groups, and some at-risk individuals. HIVST was lowest among older adults and individuals with less previous exposure to HIV testing, suggesting the presence of ongoing barriers to HIV testing.

Original languageEnglish
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number2
Pages (from-to)165-173
Number of pages9
Publication statusPublished - 2020


  • Adolescent
  • Adult
  • Delivery of Health Care
  • Diagnostic Tests, Routine/statistics & numerical data
  • Female
  • HIV Infections/diagnosis
  • Health Behavior
  • Humans
  • Malawi/epidemiology
  • Male
  • Rural Population
  • Self-Testing
  • Sexual Behavior
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Unsafe Sex
  • Young Adult


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