Background: To reach the global and national testing goals, innovative strategies such as HIV self-test (HIVST) might be needed. We evaluated the effectiveness of HIVST in Cameroon and identified predictors of seropositivity among self-testers (ST).
Method: The study was conducted from 2021-2022 in Centre, Littoral & South regions. The HIVST kits were distributed according to 5 models: (i)-Antenatal, postnatal and maternal and child clinics (ANC/PNC/MCH) (M1), (ii)-partners of other HIV+ (M2), (iii)-workplace (M3), (iv)-community (M4) & (v)-HIV testing services (HTS) (M5). Reactive/invalid tests were confirmed following national algorithm.
Results: Overall, 42697 people received an HIVST kits, 15.6% were HIV first-testers (FT). 84% reported the test outcome; 2.3% (n=825) were reactive, of them, 75.8% came for confirmation (M1: 74.0%, M2: 85.7%, M3: 71.8%, M4: 47.1% & M5: 71.4%, p<0.001). 11.3% (n=93) of reactive tests were non-reactive after confirmation.
Overall, HIV seroprevalence was 1.5% [95% CI: 1.4-1.6] (M1: 1.9%, M2: 6.9%, M3: 0.5%, M4: 0.1% and M5: 7.0%, p<0.001), with 1.2% positivity among FT. Youths <25 years had lower seroprevalence (0.4%) vs. older-age (2.6% & 2.7% for 25-39 and ≥40 years respectively), p<0.001. Seropositivity was negatively predicted by secondary distribution vs. primary, M3&M4 vs. M1, <25 vs. ≥40 years; while M2 [aOR: 4.007 (3.265-4.017)] & M5 [aOR: 2.906(1.457-5.794)] vs. M1, and FT [aOR (95% CI): 1.702 (1.312-2.208)] vs. those who tested ≥1 time) positively predicted seropositivity (Table 1).
Of the HIV+, 95.5% (95% CI: 93.5-97.0) were linked to ART. According to distribution model, a lower proportion was seen in M4 (87.5%) vs. 98.7% in M2, p<0.001. Those who were tested ≥1 time for HIV showed a higher proportion linked to ART (96.2%) vs. FT (93.2%), p=0.034.
Conclusion: HIVST using M1, M2 & M5 distribution models is an effective testing strategy in Cameroon. Moreover, linkage to treatment is very high through HIVST strategy.