Scaling HIV self-testing to improve health equity among cisgender gay, bisexual and other men who have sex with men, trans and gender-diverse people in the United Kingdom: An HIV self-testing implementation action framework.

backgroundHIV self-testing (HIVST) is feasible, highly acceptable and can increase HIV testing uptake/frequency without harm while also reducing costs. Despite HIVST's benefits, UK service provision has been sporadic partially due to policymakers and commissioners' reluctance over concerns about linkage to care/surveillance, which ultimately reduces user choice.

methodsWe synthesized current evidence and in a multidisciplinary collaboration developed an Implementation Action Framework to facilitate and promote person-centred HIVST provision, focusing on reducing health inequalities among gay, bisexual and other men who have sex with men (GBMSM), trans and gender-diverse people. We do this by exploring implementation context, establishing a standard level of support for HIVST interventions and outlining intervention adaptations to support priority subgroups in the United Kingdom. RESULTS AND DISCUSSION: A large body of published evidence demonstrates that HIVST is feasible to deliver, highly acceptable, easy to perform and can make a meaningful difference to HIV testing behaviours among GBMSM, trans and gender-diverse people without leading to substantial harm or decreases in linkage to care. Synthesizing 29 publications from the United Kingdom or other high-income settings, we demonstrate that the UK implementation context can be harnessed by emphasizing the need to expand testing to meet the 2030 HIV elimination goals. Concerns around linkage to care/surveillance can be addressed by highlighting successful linkage approaches and the importance of respecting patient autonomy. We establish a minimum standard level of support for HIVST interventions, including a results reporting system with a user opt-out option, clear information on linkage to care, inclusion of a helpline and guidance to link to clinical follow-up for those who report reactive HIVST results. To address health inequalities, person-centred intervention adaptations include innovative approaches to HIVST delivery to reach underserved groups, provision of additional tests for other sexually transmitted infections (STIs), targeted demand generation and tailored support for the most marginalized.

conclusionPerson-centred HIVST is critical to improving HIV testing uptake by responding to, and ultimately reducing, entrenched health inequalities in the United Kingdom. Our Framework provides a person-centred roadmap for implementing HIVST across a range of high-income settings.