Overview

In Malawi, to increase the proportion of men and young people who know their HIV status, a study to introduce HIV
self-testing was conducted.

Approaches for distributing HIV self-test kits focused on distribution by trained individuals through: (a) those
responsible for mobilizing men to access VMMC; (b) pregnant women who could deliver a kit to their male
partners; and (c) distribution by a trained community member going door to door to households and local
hangouts. Distributers would demonstrate the self-test for HIV and provide information on what do to after a positive
and negative self-test. 

Mobilizing

WHAT

Community and ANC facility
mobilization to explain and
promote HIV self-testing in
community and clinic

WHEN

Fixed period
over one month

WHERE

Community
ANC

WHO

Trained community
member/
mobilizer

Testing

WHAT

HIV self-testing using
OraQuick HIV Self-Test

WHEN

Once per year in community
Routine offer to women with
untested male partners at first
ANC visit

WHERE

Test conducted at home or
other private place

WHO

Individual tests themselves
alone or with partner

Linking

WHAT

For prevention: same-day
referral for VMMC (for men)
For ART initiation: home-based
ART initiation and/or same-day
referral to closest ART clinic

WHEN

Referral cards
distributed with
self-test kits

WHERE

Any health facility offering HIV
testing and VMMC sites

WHO

Trained community
member/mobilizer

Summary of evidence

HIV self-testing implementation through community-based distribution and VMMC models reached 26% and 68% of
first-time testers, respectively. Uptake of HIV self-testing was highest among young people (50%) and men (49%).
Secondary distribution to male partners of pregnant women was shown to increase uptake of HIV testing among men
receiving standard of care invitation letters from 17% to 92% when HIV self-testing was offered.

Overall, HIV positivity was approximately 5%, with 1% positivity among men at VMMC sites, 1% positivity among
men in secondary distribution, and 4% positivity in community-based distribution. This is comparable to average positivity of 3% in facilities in Malawi. When home-based ART initiation was offered, linkage was three times higher than referral to facilities.

Location

VMMC outreach and partner notification with self-test kits
Malawi