Utilisation of HIV Self-Testing Services in Sub-Saharan Africa: A Scoping Review of Delivery Models, Barriers and Outcomes

Abstract

Background: Sub-Saharan Africa remains the epicenter of the HIV epidemic, with persistent gaps in testing access, particularly among key and underserved populations. HIV self-testing (HIVST) has emerged as a complementary strategy to facility-based testing. Objectives: This scoping review examines the utilization of HIVST services, associated barriers and facilitators, and reported outcomes among general and key populations across the region. Methods: A scoping review was conducted using Joanna Briggs Institute manual for evidence synthesis, guided by PRISMA-ScR guidelines. A systematic search of PubMed, Google Scholar, ScienceDirect, and AJOL identified peer-reviewed articles published between 2010 and 2025. Studies were screened and charted, with data synthesized narratively across utilization trends, barriers, facilitators, and outcomes. Results: A total of 51 studies from 20 countries met the inclusion criteria. HIVST uptake varied widely—from as low as 1.2% in passive distribution settings to over 160% in studies  involving peer-led or home-based or community-based delivery models reflecting secondary distribution, repeat testing, and program-specific denominators rather than unique individuals tested. High utilization was consistently reported among men who have sex with men, sex workers, and young adults when testing was made accessible through trusted peer networks or community-based programs. Key enablers included ease of use, confidentiality, and peer support, while common barriers were low awareness, fear of positive results, stigma and lack of post-test counselling. Outcomes showed varied linkage to care, prompt ART initiation when reported, good HIV prevention and status disclosure practices and positive behavioral attitudes Conclusion: HIVST demonstrates high potential for expanding HIV testing in Sub-Saharan Africa, particularly when delivery is tailored to community preferences. Optimizing awareness, support systems, and linkage pathways is essential to fully leverage HIVST’s public health impact.