MONITORING HIVST. PEPFAR’s MER includes an HTS_SELF indicator that measures distribution of HIVST kits and, where possible, measures intended use of HIVST. Disaggregates of HTS_SELF include age/sex of recipient, point of distribution, intended use (primary or secondary distribution). HTS registers can be adapted to include reason for visit, including at HTS sites, in both community and facility settings, as well as at treatment sites. Reason for visit can include having a reactive HIV self-test and needing confirmatory testing. This is a proxy measure to assess whether individuals with a reactive HIV self-test have actually linked to HTS for confirmatory testing. HIVST indicators or metrics that indicate downstream clinical impacts (e.g., numbers and proportions linked to confirmatory testing, both in PEPFAR and non-PEPFAR-supported sites, and to ART initiation) should be developed by OU teams. Methodologies to track outcomes of HIVST may include activities such as survey questions on HIVST use at treatment and testing intake, follow-up surveys or tracking among a sample of HIVST kit recipients (this can be done via phone, SMS, or direct in-person follow-up), return of kits to provider to estimate positivity on the same day, or drawing inferences from target HIVST population and increase in uptake of testing and treatment within that population. In addition, programs should attempt to track adverse events associated with HIVST, including instances of self-harm or intimate partner violence, and including events related to secondary distribution where possible. See section 5 on Monitoring and Evaluation of HIVST.
