HIV self-testing offers a discreet and convenient way to test, with the potential to reach individuals in need of HIV testing services but who may not otherwise test. For many years informal HIV self-testing was common, particularly among health workers, but its potential as a strategy for reaching the first 90 target had yet to be explored. In 2015 the Unitaid Self-Testing Africa (STAR) Initiative began the largest evaluation of HIV self-testing. The STAR Initiative’s first phase generated crucial information about how to distribute HIVST products effectively, ethically and efficiently. Implemented initially in Malawi, Zambia and Zimbabwe, the first phase of the STAR Initiative was designed to address critical challenges to the development of the HIVST market. The STAR Initiative’s second phase built on the evidence generated in the first phase to scale access to HIVST across sub-Saharan Africa and expanded implementation to three additional countries, Eswatini, Lesotho and South Africa with the aims of generating large-scale experience and evidence, contributing to reaching the first 90 target, creating an enabling environment and catalysing a global market.
The STAR Initiative provides a strong foundation for other countries in Africa and globally to introduce HIV self-testing and allow for rapid scale-up based on the rich evidence already gathered. Learning from efforts to date, and with sustained coordination and acceleration of market development, HIV self-testing can help address the testing gap and provide a focused and cost-effective means to expand access to treatment and prevention services. HIV self-testing will play a crucial role in ensuring the achievement of global HIV treatment and prevention goals.