TY - JOUR T1 - HIV self-testing: lessons learnt and priorities for adaptation in a shifting landscape JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2020-004418 VL - 6 IS - Suppl 4 SP - e004418 AU - Ankur Gupta-Wright AU - Ruanne V Barnabas AU - Heather Ingold AU - Philippe Duneton AU - Ibrahim Abubakar Y1 - 2021/07/01 UR - http://gh.bmj.com/content/6/Suppl_4/e004418.abstract N2 - Summary boxHIV self-testing has rapidly become part of the approach to HIV diagnosis in many high-burden settings through large-scale research and implementation projects, which have developed a robust evidence-base and tackled market and policy implementation barriers.The changing HIV epidemic, with declining prevalence of undiagnosed HIV and increasing importance of key populations, will bring new challenges to HIV testing, which will need to reach these key populations.Lessons learnt from implementation and scale-up of HIV self-testing are highly relevant to COVID-19, the looming epidemic of chronic disease and health system challenges more broadly.HIV self-testing (HIVST) has shifted the paradigm for HIV testing, the first step in the care continuum. Although HIVST, whereby the person performs the test and interprets the results, was conceived early in the HIV epidemic, wider access to HIVST in low-income and middle-income countries (LMICs) is a recent phenomenon. A decade ago, large-scale HIVST use was limited due to concerns about accuracy, feasibility and safety. Through coordination between the WHO and implementation projects, including the Unitaid-funded HIV Self-Testing Africa (STAR) Initiative, HIVST is now part of the approach to HIV diagnosis in a growing number of high burden settings, with lessons for HIV programmes, other disease control efforts and the wider universal health coverage agenda.1This shift to HIVST was driven by a need for better HIV diagnostic strategies, particularly in sub-Saharan Africa where under 50% of people living with HIV (PLHIV) knew their status in 2013.2 Despite no precedent for self-testing, no registered commercial assays and several implementation barriers, researchers and funders, set out to inform guidelines, policy development and regulatory frameworks. This effort shed light on the feasibility and effectiveness of large-scale implementation of HIVST by establishing preferred distribution channels, thereby generating demand. We describe key lessons learnt from HIVST in LMICs to … ER -