Conserve, D

Ong, J

Pan, S

Tang, W

Tucker, Joseph D

LSHTM Research Online

Scaling up HIV self-testing in China and AfricaJoseph D Tucker1–3*, J Ong1,3, D Conserve4, S Pan1,2 and W Tang1,21 University of North Carolina at Chapel Hill Project-China, Guangzhou, China2 University of North Carolina at Chapel Hill, Institute of Global Health and Infectious Diseases, USA3 London School of Hygiene and Tropical Medicine, UK4 Arnold School of Public Health, Columbia, SC, USAHIV 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-testsrepresenting the first time that the men ever tested [1]. HIVself-testing scale-up may be related to unmet demand, self-testingpartnerships and local entrepreneurship. First, the centralised,facility-based HIV testing system in China has yet to meet thediverse needs of key populations, such as MSM. The wide rangeof self-testing models gives greater agency to key populationsabout where, when and with whom they test. Second, China hasforged self-testing partnerships between city-level public healthagencies and key population community-based organisations(CBOs) [2]. Public health agencies provide funding, technicalsupport, confirmatory testing, linkage to care assistance, andquality assurance; CBOs help stimulate demand for HIV self-testing.Third, entrepreneurs in China have developed new HIV self-testingservice delivery models [3]. For example, a social enterprise modelcould sell HIV self-test kits and then use the revenue to supportsocial causes like MSM health services [3]. This has led to a thrivingonline self-test kit market in China [4]. The expansion of HIVself-test services has driven down prices in China. Self-tests costas little as US$1 per kit, including counselling and post-test referral.This is a remarkable win for public health. It should be noted thatself-testing services in China have variable quality assurance,underscoring the need for evaluation.China‘s strategies for scaling up HIV self-testing may be usefulfor African countries that are now expanding self-testing. Keypopulation CBOs in China and many African nations are thwartedby harsh local environments that challenge service delivery withCBOs. However, these partnerships are critical as government andCBOs each bring valuable contributions to HIV self-testingprogrammes. In addition, entrepreneurship is an essentialcomponent of expanding self-testing because market dynamics,supply chain issues, and consumer pricing are all fundamentallyabout the business of self-testing. Creating a viable market forself-testing will require a broader set of players than conventionalcampaigns. Given the overall momentum for China–Africa co-operation and specific interest in China–Africa HIV collaboration,further implementation research [5] on HIV self-testing iswarranted. The WHO now recommends HIV self-testing as anadditional testing strategy, helping to make the policy argumentin favour of HIV self-testing. The experience of China scaling upHIV self-testing may be helpful for low- and middle-incomecountries moving in the same direction.AcknowledgementsContributionsJT wrote the first draft of the manuscript. All co-authors havemade contributions and approved the final version of themanuscript.FundingThis research was supported by the National Institutes of Health.The funders had no role in the decision to submit for publication,design, interpretation, or any aspect pertaining to the study.None of the authors has been paid to write this article by apharmaceutical company or other agency. Corresponding author,Joseph Tucker had full access to all the data in the study and finalresponsibility for the decision to submit for publication.Declaration of interestsThe authors declare no conflicts of interest.References1. Qin Y, Tang W, Nowacki A et al. Benefits and potential harms of humanimmunodeficiency virus self-testing among men who have sex with men in China:an implementation perspective. Sex Transm Dis 2017; 44: 233–238.2. Zhong F, Tang W, Cheng W et al. Acceptability and feasibility of a socialentrepreneurship testing model to promote HIV self-testing and linkage to careamong men who have sex with men. HIV Med 2016; 18: 379–382.3. Tucker JD, Fenton KA, Peckham R, Peeling RW. Social entrepreneurship for sexualhealth (SESH): a new approach for enabling delivery of sexual health services amongmost-at-risk populations. PLoS Med 2012; 9: e1001266.4. Liu F, Han L, Tang W et al. Availability and quality of online HIV self-test kits inChina and the United States. Conference on Retroviruses and Opportunistic Infections.February 2015. Seattle, WA, USA. Abstract 1096.5. Tucker JD, Wei C, Pendse R, Lo YR. HIV self-testing among key populations: animplementation science approach to evaluating self-testing. J Virus Erad 2015; 1:38–42.*Corresponding author: Joseph D Tucker, University of North Carolina atChapel Hill Project-ChinaNumber 2 Lujing Road, Guangzhou, China, 510095Email: jdtucker@med.unc.eduJournal of Virus Eradication 2017; 3: 167 LETTER© 2017 The Authors. Journal of Virus Eradication published by Mediscript LtdThis is an open access article published under the terms of a Creative Commons License. 167

Scaling up HIV self-testing in China and Africa.

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Scaling up HIV self-testing in China and Africa.

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