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oai:figshare.com:article/33867227 2026-09-16T17:48:45Z category_7 category_12 category_13 category_21 category_272 category_734 category_106 category_132 category_133 portal_5 item_type_3 month_year_09_2026

Costs of HIVST kits. Reuben Granich (183798) Somya Gupta (766282) Isabelle Munyangaju (11824586) Mike Ruffner (24998888) Medicine Cell Biology Genetics Biotechnology Environmental Sciences not elsewhere classified Biological Sciences not elsewhere classified Science Policy Infectious Diseases Plant Biology technology effectively positioned suppressed market development mandatory public reporting likely avoidable burden level volume series ghsd &# 8217 assisted delivery reconstituted 2026 &# 8211 21 million kits specific distribution target early supervised self 6 million people 11 million people publicly accessible africa 177 million self missed opportunity impossible hivst commodity volumes div > treatment cascade research capture procurement conservatism period reached onward transmissions nearly half income countries hivst ), demonstration projects delay carries default model confirmed procurement accountability failure 2030 memoranda <div>Summary pointsIn 2015, a survey-based analysis across 16 sub-Saharan African countries estimated that nearly half of people living with HIV were undiagnosed, implying ~11 million people in the region were outside the treatment cascade. However, HIV self-testing (HIVST), a technology effectively positioned to close this gap, was deployed at negligible scale for a decade following WHO recommendation in 2016. The gap has narrowed, but through conventional testing rather than HIVST, and 2.6 million people in sub-Saharan Africa and 4.9 million globally still did not know their HIV status in 2025. The decade of delay carries a likely avoidable burden of millions of illnesses, deaths and onward transmissions, though this has not been formally modelled.The need for HIVST in low- and middle-income countries was estimated at 177 million self-tests in 2020, rising to 192 million by 2025. Confirmed procurement over the same period reached only 21 million kits in total, an average of 5.3 million per year, or 3% of estimated annual need.Four interlocking structural failures explain this missed opportunity: 1) research capture through demonstration projects that substituted for population-scale deployment; 2) the early supervised self-testing paradox in which provider-assisted delivery reconstituted the clinic barriers HIVST was designed to bypass; 3) procurement conservatism that suppressed market development; and 4) an accountability failure with no publicly accessible Africa-level volume series, making the scale of the missed opportunity impossible to measure from published data.Four actions could improve access: 1) mandatory public reporting of HIVST commodity volumes; 2) a dedicated Africa-specific distribution target of at least 50 million kits per year within the UNAIDS 95-95-95 framework; 3) community-based distribution as the default model for the general population; and 4) explicit HIVST volume commitments in the GHSD’s 2026–2030 memoranda of understanding and work plans.</div> 2026-09-16T17:48:39Z Dataset Dataset 10.1371/journal.pmed.1005241.t003 https://figshare.com/articles/dataset/_p_Costs_of_HIVST_kits_p_/33867227 CC BY 4.0