Introduction and background

HIV self-testing is a newer way to test for HIV and can be an integral component of a comprehensive testing strategy, complementing other methods such as point-of-care and laboratory testing. This approach is designed to empower individuals with the autonomy to test themselves at their convenience, thereby enhancing accessibility for first-time testers and encouraging regular testing. By diversifying testing options, HIV self-testing can address the unique needs and preferences of the communities most affected by HIV. 

In this guide, we outline practice-based recommendations for implementing HIV self-testing, aiming to maximize its benefits and address potential challenges. The recommendations were informed by individuals representing community-based organizations (CBOs) that have played a leadership role in distributing HIV self-test kits in Canada. The goal of this guide is to provide healthcare providers and CBOs with guidance to enhance the effectiveness and reach of HIV self-test kit distribution, ultimately contributing to the broader goal of ending the HIV epidemic. 

What is HIV self-testing?

HIV self-testing is a testing option that was licensed for use in Canada in November 2020. With a self-test, a person collects their own sample, conducts the test and interprets the result themselves. The self-test that is available in Canada uses a blood sample from a finger prick. It is a screening test, meaning that a reactive (positive) result needs to be confirmed by a laboratory HIV test. 

“HIV self-tests are a screening tool, a starting point for a more holistic and comprehensive sexual health journey” – Dialogue participant

HIV self-testing and reaching the undiagnosed

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An estimated 11% of people living with HIV in Canada are unaware that they have HIV. This is particularly concerning for populations disproportionately impacted by HIV, including gay, bisexual and other men who have sex with men (gbMSM); people who use drugs; as well as Indigenous people and African, Caribbean and Black communities, including a disproportionate number of women from these communities. These groups face a disproportionate burden from broader social and structural factors, such as racism, homophobia and historical and ongoing colonialism, which can create barriers to accessing health services, including HIV testing. A multifaceted approach is required to address these factors and improve access to HIV testing among these communities.

 “Decolonizing via increasing self-determination” – Dialogue participant

HIV self-testing is a low-barrier option that can increase access to testing by providing a private, convenient and accessible option for individuals; its flexibility can play an important role in broadening the reach of HIV testing efforts. HIV self-testing can be particularly effective in engaging communities that are underserved or less likely to participate in traditional testing options, such as individuals who experience stigma within the health system, people with concerns about confidentiality, those in rural and remote areas and those with busy lifestyles. HIV self-testing represents a significant opportunity to reach first-time testers. HIV self-testing can also be an important resource for repeat testers who are familiar with the testing process and seek more convenient access. 

“This work addresses stigma, lots of folks testing for the first time” – Dialogue participant

HIV self-testing is not just a method to increase testing rates; it serves as a gateway to a wider range of health and social services. HIV self-testing provides an opportunity to connect individuals with a variety of supports, ranging from sexual health education and prevention resources to mental health services and community supports. This holistic approach supports individuals to receive comprehensive care. 

CBOs are well positioned to reach the groups that are most affected by HIV and distribute HIV self-test kits within these communities. CBOs have played an essential role in developing methods to increase awareness of HIV self-testing, distributing self-test kits and related resources and supporting linkage to HIV care, prevention and related support services.

“Gives people agency over their own bodies” – Dialogue participant