BACKGROUND: In November 2021, the World Health Organization recommended HIV self-testing (HIVST) as an approach that could simplify and support pre-exposure prophylaxis (PrEP) delivery, especially in the context of COVID-19. In Nigeria, PrEP is initiated along with facility HIV testing services coupled with testing for HIV breakthrough diagnosis before PrEP refills. Frequent facility visits combined with long waiting times were some of the barriers to PrEP services uptake. The Unitaid-funded HIV Self Testing in Africa (STAR) project was implemented by Jhpiego Nigeria between 2020-2022. We aim to analyze the impact of HIVST in enhancing PrEP uptake.
METHODS: The analysis covers data collected from January 2021 to October 2022 and across 14 states. Clients were provided with HIVST and those who were non-reactive received additional laboratory investigations including confirmatory HTS prior to PrEP initiation. PrEP was provided for eligible individuals from both general and key populations. At enrolment, eligible clients received counselling on the benefits of immediate enrolment for PrEP. PrEP (combination of 300 mg of TDF and 300 mg of 3TC once daily) was then dispensed for 3 months supply. PrEP was stopped once the discontinuation criteria was met. All relevant demographic and clinical indicators were recorded in HIVST and PrEP registers.
RESULTS: A total of 200,025 HIVST kits were distributed in multiple states and across multiple service delivery models (facility, KP one stop shops, private pharmacy and community). A total of 196,442 (98.2%) reported results, 4,850 (2.5%) were HIVST reactive, 191,592 (97.5%) were HIVST non-reactive.Of these a total of 17,805 ( 9.3%) clients were initiated on PrEP.


CONCLUSIONS: The analysis shows that HIVST could be an effective entry point to promote access to and de-medicalize biomedical HIV prevention and PrEP delivery in Nigeria.

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