Impact of assisted HIV self-testing on case-finding rate and positive HIV diagnoses in Burundi: A province-level difference-in-difference analysis

Background HIV self-testing (HIVST) is a testing strategy to reach individuals not engaged in healthcare. We evaluated ICAP’s Reaching Impact, Saturation and Epidemic Control (RISE) program’s healthcare-worker-assisted HIVST on the number of persons testing HIV-positive (PTP) and HIV case finding rate (CFR) in “hard-to-reach” members of the general population in targeted provinces in Burundi. Methods Using routine data from October 2020 to September 2023, with October-December 2021 as the scale-up quarter, we used difference-in-difference analysis to assess changes in PTP and CFR after versus before scale-up-onset in “mature” versus “less mature” provinces. Provinces were chosen to approximate more and less exposed comparison units. We performed subgroup analyses by sex and age (10-24, ≥25 years). Results HIVST averaged 1.46% (mature) and 3.07% (less mature) of pre-scale-up testing, and 13.59% (mature) and 9.84% (less mature) of post-scale-up testing. PTP trends declined more in the mature versus less mature provinces post-scale-up (−34.25, 95% CI -84.87-16.37) although this was not significant. We found no difference in the CFR change between provinces post versus pre-scale-up (0.06%, 95% CI -0.29%-0.41%). Results were robust to subgroup and sensitivity analyses. Conclusions We found no changes in PTP and CFR after RISE’s HIVST scale-up. After results were reported to implementers, they implemented strategies to better meet programmatic goals.