Following consultations with local community leaders and stakeholders in Malawi, HIV self-testing (HIVST) was integrated into outpatient department settings in certain high-burden health facilities, as part of a cluster-randomized trial. Trained lay providers at the intervention sites provided HIV education to clients who were waiting for general outpatient (OPD) services, followed by an HIVST demonstration and group-based pre-test counselling. HIV self-test kits were then distributed for use in the outpatient waiting areas, where private testing booths had been set-up, and assistance was available if needed. Disclosure was voluntary, but clients were encouraged to discuss their HIVST results during their routine appointment for other outpatient services. Rapid testing after a positive HIVST followed the national algorithm, and same-day ART initiation was offered to those who were confirmed to be HIV positive.
Impact: The HIVST intervention engaged significantly more clients in same-day HIV testing than the two alternative provider-initiated testing approaches utilized in the study (clinician referred testing and waiting room offer of one-on-one lay provider testing). HIVST was highly acceptable with 99% of clients reporting that they would use HIVST again. HIVST resulted in a much higher uptake of same day facility-based HIV testing (51%) compared with provider-initiated testing approaches (13-14%). While the yield was similar among the study arms (2-3%), the number of new HIV diagnoses was more than three times higher for the HIVST group as a result of the increased testing uptake.
This intervention demonstrated that OPD-based HIVST may be an efficient, effective and person-centred way to increase health facility testing uptake in resource-limited settings.
Building Blocks
Mobilizing
What
10 minute health talk about the importance of HIV testing and availability of HIVST
15 minute demonstration of the Oraquick HIVST kit
Group pre-test counselling
When
While waiting for other routine OPD services
Where
OPD waiting areas
Who
Lay provider
Testing
What
HIVST in private booth in OPD
HIVST assistance if requested
For clients who chose to disclose result during routine OPD appointment:
Rapid testing according to Malawi testing algorithm
When
While waiting for other routine OPD services
Where
OPD waiting areas and private booths within OPD waiting area
Who
Lay provider
Linking
What
Post-test counselling and referral for additional treatment services
Offer of same day on-site ART initiation
When
During routine OPD appointment
Where
OPD consultation room
Who
Clinician
Variations
Facility-based entry point testing, targeting infants and children, Nigeria
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Community-based mobilization to facility-based integrated sexually transmitted infection and HIV testing services, South Africa
In a rural district of the Limpopo province in South Africa, three community-based strategies were employed to mobilize adults with symptoms suggestive of sexually transmitted infection (STI) to access facility-based…
Further information and resources
Published evidence for facility-based individual models
The limited evidence for facility-based individual models suggests increased cost effectiveness for the health system, improved quality of care and improved client outcomes.
