HIV self-testing and the missing linkage

Whatever the next hottest, scientifically proven HIV treatment or prevention strategies are, they will share a common denominator for implementation: the HIV test. Whether accessing preexposure pro-phylaxis (PrEP), pursuing treatment as prevention (‘‘test and treat’’), or taking ART to improve individual clinical out-comes, each begins with learning one’s HIV status. With HIV testing as the necessary gateway to so many interven-tions, the paucity of people in resource-limited settings who have ever had an HIV test is astonishing. Despite over 100,000 facilities in low- and middle-income coun-tries with HIV testing and counseling capacity, only 34 % of women and 17% of men have ever had an HIV test in these settings [1]. These facts call for novel and far-reaching approaches to HIV screening, and self-testing is one of them. In this issue of PLoS Medicine, Augustine Choko and colleagues are among the first to describe the feasibility of an HIV self-testing approach [2]. The paper demonstrated the possible: randomly chosen participants in high-density suburbs of Blantyre, Malawi given modest direction could, and did, accurately conduct oral HIV tests and required minimal supervision. Only 8 % of subjects chose not to test, and self-testing results were 99 % concordant with rapid finger-stick tests collected in parallel. Even more promising, nearly half of the participants weremen, a demographic population that has been notoriously hard to engage in testing initiatives in resource-limited settings [1,3]