Scaling up HIV self-testing in China and Africa

HIV self-testing has yet to scale up, with one exception – China. Approximately one-third of men who have sex with men (MSM) report HIV self-testing in China, with many of these self-tests representing the first time that the men ever tested [1]. HIV self-testing scale-up may be related to unmet demand, self-testing partnerships and local entrepreneurship. First, the centralised, facility-based HIV testing system in China has yet to meet the diverse needs of key populations, such as MSM. The wide range of self-testing models gives greater agency to key populations about where, when and with whom they test. Second, China has forged self-testing partnerships between city-level public health agencies and key population community-based organisations (CBOs) [2]. Public health agencies provide funding, technical support, confirmatory testing, linkage to care assistance, and quality assurance; CBOs help stimulate demand for HIV self-testing. Third, entrepreneurs in China have developed new HIV self-testing service delivery models [3]. For example, a social enterprise model could sell HIV self-test kits and then use the revenue to support social causes like MSM health services [3]. This has led to a thriving online self-test kit market in China [4]. The expansion of HIV self-test services has driven down prices in China. Self-tests cost as little as US$1 per kit, including counselling and post-test referral. This is a remarkable win for public health. It should be noted that self-testing services in China have variable quality assurance, underscoring the need for evaluation.