VMMC outreach and partner notification with self-test kits

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. 

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.