Published in PLOS One on 2025-12-29, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Lekey Khandu, Jonathan Hallett, Gemma Crawford, Justine E Leavy, Daniel Vujcich, Mulualem Endeshaw, Yury E Khudyakov
Source: PLOS One • DOI 10.1371/journal.pone.0338639
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
HIV self-testing (HIVST) enhances case diagnosis, but information on its integration for index testing to partner notification is limited. Assessing the acceptability and feasibility of index HIVST and partner testing among people living with HIV (PLHIV) and undiagnosed key populations is critical to ending the AIDS epidemic.
A mixed-methods systematic review using a convergent segregated approach was conducted using the Joanna Briggs Institute’s methodology. Four databases were used to conduct a literature review from October 2023 to March 2024, which included studies published between 2016 and 2023. Rayyan software was used for full-text screening. Meta-analysis was deemed infeasible; however, a qualitative meta-aggregation approach was conducted.
A total of 4076 studies were retrieved, and 76 studies met the inclusion criteria after a full review. Most of these studies were from the African region, with only one from South Asia and a few from East Asia. Index HIVST and partner testing were found acceptable and feasible among PLHIV and key populations. Despite low partner elicitation ratios through assisted partner notification, a higher positivity rate was noted among notified individuals. Preferences for index HIVST and partner testing varied, with more inclination for assisted and passive partner referrals to overcome the risk of HIV status disclosure. Assisted partner notification (aPN) showed a low cost per infection averted, indicating it’s a cost-effective intervention. Available evidence was skewed towards married couples, with less evidence on unmarried and undiagnosed key populations.
The index HIVST was found to be acceptable and feasible in reaching index partners, including untested and undiagnosed partners of key populations, when various testing approaches are used. Understanding the index HIVST among unmarried HIV index cases, and partner testing of undiagnosed key populations is important, particularly in the Southeast Asian region, to bridge the current HIV case detection gaps. Although no specific cost-effectiveness studies were found for the index HIVST, the aPN was found to be cost-effective.
PROSPERO Number: CRD42023475417 dated 2023. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023475417.
Introduction
HIV testing is vital for timely diagnosis, linkages to care, and treatment [1]. However, access to HIV testing was prevented due to stigma and discrimination, particularly among sexual and gender minorities [2]. HIV self-testing (HIVST) enhances testing access, especially for key populations, helping to bridge the case detection gap [3]. It enables key populations to test privately without visiting health centres [4]. Structural, social, economic, political, and environmental factors inhibit HIV testing uptake [5]. Promising uptake of HIVST has been observed among key populations such as men who have sex with men (MSM), transgender (TG) persons, female sex workers (FSWs), people who inject drugs (PWID), and first-time testers [6]. Community-based testing (CBT) approaches increase HIV testing uptake among key populations compared to healthcare provider-based testing services [7–9]. As HIV incidence decreases, partner notification becomes crucial for identifying new cases among contacts of newly diagnosed PLHIV [10]. Evidence shows intensified testing strategies, including HIVST as an alternative testing option [11], but concerns exist regarding poor or absent pre-test counselling, which poses challenges in confirming results and linking to the continuum of care [12,13].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2025 Lekey Khandu, Jonathan Hallett, Gemma Crawford, Justine E Leavy, Daniel Vujcich, Mulualem Endeshaw, Yury E Khudyakov. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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