HIV self-testing: money matters.

TO THE EDITOR—We read with interest the recent review by Napierala Mavedzenge et al [1], which highlights human immunodeficiency virus (HIV) self-testing as a possible approach to increase HIV testing and contribute toward universal access to treatment and care. Widespread support among potential end users, across multiple settings, is a factor favoring uptake of HIV self-testing. In a recent study of the accuracy and user acceptability of an oral fluid–based rapid test kit in Singapore, which involved 994 subjects (200 known HIV-positive patients and 794 atrisk participants with unknown HIV status) in an observed setting [2], we found that 868 (87.4%) participants would purchase over-the-counter self-test kits if available. After conducting self-tests, 939 (94.9%) would recommend the test kit to others. Our study highlighted test cost as a potential significant barrier to accessing HIV self-tests, even in an economically developed setting, where only 277 (28%) of respondents would pay at least US$15 for the test kit [2]. Similarly, in a study of 108 men who have sex with men in Seattle, 13% would only use a self-test if it was free, and only 42% would pay US $20 or more for a self-test [3]. Cost barriers to self-test access are likely to be greater in developing countries. In research settings, the most widely available HIV oral fluid–based self-tests cost US $11–$17 when purchased in high volumes [4]. The current online retail price for the first US Food and Drug Administration– approved over-the-counter HIV self-test is approximately US$40 [5]. Cost issues could severely limit access to HIV selftesting across all settings, especially among economically disadvantaged, marginalized populations—often the populations most in need of increased HIV testing. For HIV self-testing to be truly a tool for public health advancement and not solely the domain of the wealthy “worried well,”