Background: HIV self-testing (HIVST) has the potential to help achieve the UNAIDS 90-90-90 targets. However, evidence is limited about how to ensure linkage to care (LTC) among individuals with HIV-positive results. We report LTC findings from a HIVST cluster-randomised trial nested within the HPTN071 (PopART) trial in Zambia. The PopART intervention was delivered in “annual rounds” from 1/12/2013-31/12/2017, during which community-HIV-care-providers (CHiPs) visited all households, and offered home-based HIV testing with a rapid diagnostic test using fingerprick blood (RDT), referral to routine clinic services, and support (including follow-up visits) for LTC.
Methods: In December 2016, 4 of the PopART intervention communities in Zambia, comprising 66 zones, were included in a cluster-randomised trial of adding oral HIVST to the standard intervention. Self-testing was offered in-person, supervised or unsupervised, and to absent partners via secondary distribution. We estimated the time from CHiP referral to LTC among individuals who were (re-)enumerated as a household member during 1/2/2017-30/4/2017, aged ≥16 years, and diagnosed HIV-positive based on initial or confirmatory (following HIVST) RDT. We used the Kaplan-Meier method for “time-to-event” analysis, and follow-up information to 30/9/2017.
Results: Among 13,267 individuals in 33 HIVST zones, 195 were diagnosed HIV-positive; additionally 20 tested HIV-positive with supervised/unsupervised self-testing but did not have confirmatory RDT, and 13 tested HIV-positive following secondary distribution but were not contacted in-person by CHiPs. Among 13,706 individuals in 33 non-HIVST zones, 204 were diagnosed HIV-positive. Among those diagnosed, 94% (184/195) in HIVST and 98% (199/204) in non-HIVST zones were referred to care. We estimated that 65% in HIVST, and 64% in non-HIVST, zones were LTC by 3 months after referral (hazard ratio 1.11, 95%CI 0.78-1.58; Figure 1,Table 1). In HIVST zones, there was a suggestion that LTC was slower for individuals who tested with unsupervised self-testing or via secondary distribution, compared with those who tested with RDT (Table 1).
Conclusions: LTC following an HIV-positive diagnosis and CHiP referral was not undermined by offering HIVST as a testing option, in the context of LTC support. Strategies to facilitate confirmatory RDT following an initial HIVST, and LTC following unsupervised self-testing and secondary distribution, may be important.

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