Table 1.

Included articles.

Theme	References	Included countries	Study population	Study design	Sample size	Main findings
HIVST uptake/Acceptability	Burke et al. (23)	Uganda	Healthcare providers and community members in high-risk fishing communities	In-depth interviews and focus groups	30 men; 25 women	Most participants were not familiar HIVST but believed there were benefits associated: privacy, convenience, and being able to test before sex. Perceived barriers included absence of professional support, poor disposal of kits, and delayed linkage to care.
	Cambiano et al. (24)	Botswana, Lesotho, Malawi, Nigeria, Rwanda, Tanzania, Uganda, Zambia, Zimbabwe	Women having transactional sex, young people, adult men	Individual-based scholastic model	Not specified	Community-based HIVST had the greatest impact with adult men with an average of 1,500 HIV infections averted.
	Choko et al. (25)	Malawi	Men and women	Formative qualitative study	8,643 men; 8,017 women	76.5% of residents self-tested during months a 12-month period. Persons aged 16–19 were most likely to test.
	Choko et al. (26)	Malawi	Pregnant women and their male partners	Formative qualitative study	18 men; 20 women	Male partners reported a preference for HIVST due to its perceived privacy and reduction of associated stigma.
	Conserve et al. (27)	Tanzania	Men	In-depth interviews	23 participants	Seventy-eight percent of participants had never heard of HIVST; sixty-five percent of participants were willing to use HIVST in the future.
	Conserve et al. (28)	Tanzania	Men	In-depth interviews	23 men	HIVST willingness was highly acceptable among both male ever-testers and never-testers. Some 72% of ever-testers vs. 67% of never-testers reported being willing to self-test.
	Dzinamarira et al. (29)	Rwanda	Key stakeholders	In-depth interviews	10 men; 3 women	Key stakeholders perceived HIVST as an effective initiative that may be used to increase uptake of testing services for underserved populations in Rwanda.
	Gumede and Sibiya (30)	South Africa	Men and women	Quantitative, non-experimental descriptive study	442 healthcare users	Most healthcare users (HCU) (69.9%), consisting of both men and women, reported having heard of HIVST in South Africa. Most HCU (81.2%) perceived HIVST as a strategy that could lead to more people knowing their HIV status.
	Harichund et al. (31)	South Africa	Men and women	Qualitative comparative cross-over	12 men; 28 women	Naïve testers were confident in performing unsupervised HIST but reported desiring more counseling support during the testing process.
	Harichund et al. (32)	South Africa	Men and women	Qualitative comparative cross-over	12 men; 28 women	Men deemed HIVST acceptable because of its convenience and efficiency.
	Harichund et al. (33)	South Africa	Men and women	Focus groups and individual interviews	63 participants	HIVST is advantageous when provided in combination with existing services. All distribution models had high male participation in the country.
	Hatzold et al. (34)	Malawi, Zambia, Zimbabwe	Adults and adolescents	Multiple models of distribution (e.g., community based, mobile outreach, workplace, public health facilities, etc.)	294,508 men; 130,223 women	Male partners believed secondary distribution of HIVST kits to be acceptable due to its convenience, confidentiality, privacy, and its ability to allowed men to avoid the clinic
	Hector et al. (35)	Mozambique	Adolescents	Demonstration study	496 students	Over 80% of participants selected directly assisted HIVST compared to standard FS testing and of those who selected HIVST, 20% opted to perform HIVST at home. More than three-fourths of participants (76%) preferred to do HIVST at the health center due to the presence of a counselor.
	Hershow et al. (36)	Malawi and Zambia	Male partners; pregnant and postpartum women	Qualitative formative study	28 male partners; 80 pregnant/	Of three male partner HIV testing strategies (HIV partner notification, partner HIV self-testing, and partner home-based HIV testing) the majority of participants (both men and women) accepted all three partner testing modalities; however, male
					post-partum women	partners were split in their preferences for the three partner testing modalities. Most women and male partners thought home-based testing and secondary distribution of HIV self-test kits were acceptable. Secondary distribution of HIVST kits was thought to be convenient, ensured confidentiality, allowed men to avoid the clinic, and allows for couples testing privately. Home-based testing was thought to be convenient and would provide savings in time and transport money, and helpful to have health workers present to provide counseling.
	Janssen et al. (37)	South Africa	Men and women	Observational cohort study	14 men; 16 women	A smartphone app used in tandem with an oral HIVST was able to help people through the self-testing process by providing counseling and care and simplifying the process of self-testing. The app was able to multiple common HIV testing barriers, such as lack of confidentiality, wait times and testing locations. The app also enabled testing services outside a clinic context or within a clinic; however, an additional layer of privacy was added by using the app. Participants were able to use the app-based HIVST strategy unsupervised at home, unsupervised alone at the Kiosk around the clinic, or supervised under direct supervision of staff at the clinic.
	Kebede et al. (38)	Ethiopia	HCWs	Cross-sectional study design triangulated with qualitative method	307 HCWs	Both oral swab and finger-prick methods had high acceptability. Ease of access and the availability of the test were cited as being of importance.
	Knight et al. (39)	South Africa	Men and women	In-depth interviews	50 lay users	Individual motivations for HIVST included perceived benefits of access to treatment. HIVST was regarded as convenient, confidential, reassuring and an enabling new way to test with one's partner.
	Kumwenda et al. (40)	Malawi	Cohabitating couples	Analysis of baseline data within a 12-month qualitative longitudinal cohort study nested into a cluster randomized trial	17 couples (34 participants)	Men sometimes required persuasion even though they believe HIVST is more flexible than traditional testing.
	Kurth et al. (41)	Kenya	Men and women	Prospective validation study	161 men; 78 women	The acceptability rate for HIVST was 94%. The main theme in the behavioral study was affordability; participants were willing to pay up to 111 Ksh (around $1.25 USD) for an HIVST kit.
	Lebina et al. (42)	Uganda	Men and women	HIV self-screening demonstration project	808 men; 809 women	Some 68.7% of participants selected unsupervised HIVST while 25% opted for supervised HIVST and 6.3% chose semi-supervised.
	Lyons et al. (43)	Senegal	Men and women	Experimental design	1,959 participants	Most participants (74.5%) were comfortable using HIVST, 86.1% found the instructions easy to follow, and 94.4% believed their family or friends would use it.
	Majam et al. (44)	South Africa	Lay users	Cross-sectional study	777 men; 633 women	Participants had a high average usability index of 93.8% for HIVST; some 96.6% of participants found HIVSTs easy to use.
	Makusha et al. (45)	South Africa	Key stakeholders	In-depth interviews	12 participants	Stakeholders expressed high enthusiasm regarding HIVST, its scale-up, and the development of HIVST policies and programming. Perceived barriers included a lack of counseling and Difficulty in ensuring linkages to care among those with positive results.
	Martínez-Pérez et al. (46)	South Africa	Men and women	Mixed-methods research	9 men; 11 women	Participants believed that home O-HIVST uptake would not necessarily lead to higher uptake. It was also believed that men that would show the most interest in using home O-HIVST compared to their female counterparts.
	Martínez-Pérez et al. (47)	South Africa	Men and women	Cross-sectional study	741 men; 1,457 women	Only 3.9% of men had heard about oral HIVST prior to the study. Uptake of oral HIVST was 25.4%
	Matovu et al. (48)	Uganda	Pregnant women and their male partners	Cross-sectional qualitative study	62 FGD participants with pregnant women and 30 IDI with male partners of pregnant women	Most women were willing to take the kits to their male partners and male partners reported being willing to use HIVST kits provided to them by their female partner. Women believed that HIVST could help to improve couples' HIV testing.
	Matovu et al. (49)	Uganda	Pregnant women and their male partners	In-depth interviews	32 participants	Men reported skepticism regarding HIVST and whether or not the kits could actually test for HIV, but this was not a deterrent to its use. Both men and women believed HIVST is a strategy that could address men's lack of time to go to the health facilities to test for HIV.
	Mokgatle and Madiba (50)	South Africa	Technical vocational education and training college students	Cross-sectional survey	1,565 male and 2,040 female students recruited from 13 colleges	Less than half of students (46.2%) were knowledgeable of what HIVST is prior to the administration of the survey. Still, HIVST acceptability was high among the students (87.1%); three-quarters of students were willing to purchase an HIVST kit and many reported being willing to self-test with their partners.
	Njau et al. (51)	Tanzania	Individuals, community leaders, experts	Focus groups and in-depth interviews	21 men; 33 women	Participants reported positive attitudes toward HIVST, supportive perceived norms, and self-efficacy.
	Peck et al. (52)	Kenya, Malawi, South Africa	Lay users	Formative usability research—In-depth interviews	150 Participants	Users found instructions for HIVST to be confusing and/or difficult to follow. Less than 25% of participants completed the test successfully without errors. Results interpretation was difficult for participants.
	Ritchwood et al. (53)	South Africa	Young adults	Focus groups and direct observation	19 men; 16 women	Participants deemed HIVST acceptable due to its privacy, ease of use, and trustworthiness.
	Sibanda et al. (54)	Zimbabwe	Men and women	Discrete choice experiment	128 men; 168 women	The strongest preference for kits was price—every $1 increase in price increased disutility. Door-to-door delivery of kits was highly preferred compared to kit distribution to batch deliveries.
	Spyrelis et al. (55)	South Africa	Men and women	Focus group discussions	118 participants	HIVST was deemed acceptable; however, men had concerns (potential suicidality) regarding the lack of HIV counseling associated with HIVST. Privacy and confidentiality were perceived benefits of HVST.
	van Dyk (56)	South Africa	Men and women	Semi-structured questionnaire	147 men; 319 women	Preferences of testing were associated with patient autonomy, violation of human rights, confidentiality and privacy, fear of discrimination and stigma, and an aversion to mandatory face-to-face counseling.
	van Dyk (57)	South Africa	Men and women	Semi-structured questionnaire	147 men; 319 women	Twenty-two percent of participants preferred HIVST; however, 66% of participants (mostly men) preferred client-initiated testing. Participants reported being willing to use HIVST if it included telephone counseling and if it were available in their communities.
	van Rooyen et al. (58)	Kenya, Malawi, South Africa	Government policy makers, academics, activists, donors, procurement specialists, laboratory practitioners, and health providers	In-depth interviews	54 participants	Participants were in support of the idea of an accurate, easy-to-use, rapid HIVST and believed that this could increase testing across all populations.
	Zanoli et al. (59)	Zambia	Households	Structured survey questionnaire	1,617 Participants	After being informed about HIVST, 91% of participants reported being comfortable with using a self-test; 87% believed that HIVST would increase their likelihood of testing.
Intervention strategies	Asiimwe et al. (60)	Uganda	Men and women	Un-blinded randomized non-inferiority trial	141 men; 105 women	Participants were randomized to either an unsupervised HIVST group or a provider supervised HIVST group. Unsupervised HIVST was able to identify 90% of HIV-infected persons.
	Chang et al. (61)	Zimbabwe	Men and women	Randomized clinical trial	1,155 men; 2,841 women	Participants were provided vouchers to be redeemed for HIVST within 1 month at prices between $0 and $3 at multiple sites. A high sensitivity to price for HIVST was realized among men, rural residents, and persons who had never tested for HIV. Reduced-priced or free tests increased demand
	Choko et al. (25)	Malawi	Men and women	Prospective study nested within a cluster-randomized trial	6,124 men; 7,868 women	Participants received pre-test counseling, instructions on how to perform HIVST, and were asked to demonstrate their understanding of how to use the kit; 10% of participants required help or made errors while using the kits. The estimated uptake of HIVST was >80%. Uptake was greater among women than men.
	Choko et al. (62)	Malawi	Adult members of 60 households and 72 members of community peer groups	Population-weighted randomized clustering	298 adult participants	Participants were offered self-testing plus confirmatory HTC (parallel testing with two rapid finger-prick blood tests), standard HTC alone, or no testing. Some 91.9% of participants chose to self-test following a demonstration and illustrated instructions.
	Choko et al. (63)	Uganda	Men	Single-arm pilot-trial of secondary distribution of HIVST kits	116 men	Seeds (peer distributors) distributed HIVST kits to men. Eighty-two percent of men accepted HIVST kits. Ninety-seven percent of recruited men and 100% of seeds reported being willing to recommend HIVST to their friends and family.
	Choko et al. (64)	Malawi	Pregnant women and male partners	Adaptive multi-arm, multi-stage cluster randomized trial	676 men; 2,349 women	Secondary distribution of HIVST kits provided by women to their male partners increased the proportion of men who tested and linkage to care and prevention services if accompanied by financial incentives and reminder calls.
	Gichangi et al. (65)	Kenya	Pregnant women and male partners	Randomized controlled trial	362 men; 387 women	Three-arm randomized control study of participants randomized to receive either standard-of-care plus standard information card, an information card referencing male HIV testing, or two oral HIVST kits, and HIV testing information. In the intervention group (arm 3), 82% of men reported HIV testing as a couple, compared with 28% in arm one and 37%in arm two.
	Hensen et al. (66)	Zambia	Men and women	Randomized controlled trial	3,677 men; 5,428 women	PopART intervention used door-to-door delivery of HTS and included HIVST. Uptake of secondary distribution of HIVST was 9.1%, of which, 55.8% of kits were reported to have been used.
	Kalibala et al. (67)	Kenya	HCWs	Semi-structured pretested questionnaire and in-depth interview	842 HCWs	Thirty-four of surveyed HCWs used the kit on themselves; seventy-three percent provided a kit to their partner.
	Kelvin et al. (68)	Kenya	Truck drivers	Randomized controlled trial	305 male truck drivers	Participants were recruited from two roadside wellness clinics in Kenya. Participants were randomized on a 1:1 basis to either the SOC arm (provider-administered FS test) or the Choice arm (choice of SOC test or self-administered oral rapid test). The Choice arm had significantly greater odds of testing uptake. Of those in the Choice arm who tested, 26.9% selected the SOC test, 64.6% chose supervised self-testing in the clinic, and 8.5% took a test kit for home use. Participants varied in the HIV test they selected when given choices.
	Kelvin et al. (69)	Kenya	Truck drivers	Randomized controlled trial	2,262 male truck drivers	Texting about the availability of HIVST kits increased testing rates from 1.3 to 3.5%.
	Kisa et al. (70)	Uganda	Pregnant women and male partners	Cross-sectional study nested within a cluster randomized HIVST trial	51 women; 44 men	Most participants (94.7%) underwent repeat HIVST with a returned 2.1% positivity rate.
	Kumwenda et al. (71)	Malawi	Men and women	In-depth interviews nested in a cluster randomized trial	33 participants	Community counselors provided HIVST to community members through a community-based model prior to the interviews. More men than women declined joint HIVST due to fear of their infidelity being exposed.
	Lippman et al. (72)	South Africa	MSM	Three-phase trial	133 MSM	Men were recruited over three phases (different locations) of which they were given HIVST kits. Errors were committed by persons in both the OF and FS group; however, participants successfully performed the OF test while FS was less consistent. FS was a more preferred option than OF.
	Lippman et al. (73)	South Africa	MSM	Longitudinal study	127 MSM	Men were given up to nine test kits, either OF or FS, to use themselves or to provide to their social networks. Almost all MSM (91%) self-tested. A majority of men (80%) preferred HIVST to testing at a clinic.
	Marwa et al. (74)	Kenya	Pregnant women and male partners	Randomized controlled trial	1,107 couples	Three-arm RCT of participants randomized to either arm one (SOC), arm two (letter of invitation for partner to test, and arm three (letter and instructions on how to use HIVST and two HIVSTs with counseling). Men in arm three were twelve times more likely to test when compared to arm one. improved male invitation letter increased the likelihood of male partner testing by twelve times.
	Masters et al. (10)	Kenya	Men and women	Randomized controlled trial	600 women	Participants were randomized in a 1:1 ratio using balanced block randomization to an HIVST group or a comparison group. Participants in the HIVST group received two oral-fluid-based rapid HIV tests alongside written instructions and a brief demonstration of how to use the test. Male partner HIV testing was higher (90.8 vs. 51.7%) among participants in the HIVST group. Couples testing was also more likely in this group (75.4 vs. 45.8%).
	Moore et al. (75)	South Africa	Men and women	Cohort study	33 men; 606 women	The sending of short message service (SMS) to participants aided participants in reporting HIVST results.
	Mugo et al. (76)	Kenya	Pharmacy clients	Exploratory feasibility study	225 men; 238 women	Staff at five pharmacies recruited clients and offered participants HIVST kits for $1 USD. Participants were contacted for post-test data collection and counseling. Almost all testers stated they would like to use HIVST again in the future, and that they were likely (19%) or very likely (80%) to recommend self-testing to a friend, partner or family member.
	Pintye et al. (77)	Kenya	Women and their male partners	Implementation project	3,620 women	Some 93% of women offered an HIVST to their male partner. Of those women, 95% of male partners used a self-test.
	Schaffer et al. (78)	Uganda	Men	Discrete choice experiment	203 men	When presented as a choice, distribution of HIVST kits at local pharmacies reported the lowest predicted uptake and was higher among men who perceive a higher relative risk of having HIV.
	Strauss et al. (79)	Kenya	Truck drivers	Discrete choice experiment	305 male truck drivers	Participants were presented with hypothetical options of making trade-offs between different characteristics of HIV testing services delivery models by making hypothetical choices in a series of paired HIV testing scenarios to identify which HIV testing characteristics influenced the selection of preferred options. Drivers who had previous testing experience preferred oral testing and counseling via telephone while drivers with no testing experience preferred clinic-based testing.
	Strauss et al. (80)	Kenya	Truck drivers	Randomized control trial	150 male truck drivers	Cost drove the preference of between self-testing and provider administered testing. Self-testers preferred oral-testing vs. finger-prick testing.
	Thirumurthy et al. (81)	Kenya	Women	Cohort study	280 participants	Study staff instructed one arm of women on how to use OF based rapid HIV tests and provided them multiple test kits. The other arm was given three test kits each and FSW IPs were given five test kits each. Ninety-one percent of women in antenatal care and 86% in post-partum care distributed HIVST kits to their primary sexual partners. Seventy-five percent of female sex workers distributed HIVST kits to their clients.