***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives : The current study identifies young people 's preferences for  HIV self-testing ( HIVST )  delivery , determines the relative strength of preferences and explores underlying behaviors and perceptions to inform youth-friendly services in southern Africa . Design : A mixed methods design was adopted in Malawi and Zimbabwe and includes focus group discussion s , in-depth interviews and discrete choice experiments . Methods : The current study was conducted during the formative phase of cluster-r and omized trials of oral-fluid HIVST distribution . Young people aged 16–25 years were purposively selected for in-depth interviews ( n = 15 ) in Malawi and 12 focus group discussion s ( n = 107 ) across countries . Representative sample s of young people in both countries ( n = 341 ) were administered discrete choice experiments on HIVST delivery , with data analyzed to estimate relative preferences . The qualitative results provided additional depth and were triangulated with the quantitative findings . Results : There was strong concordance across methods and countries based on the three triangulation parameters : product , provider and service characteristics .  HIVST  was highly accepted by young people , if provided at no or very low cost . Young people expressed mixed views on oral-fluid tests , weighing perceived benefits with accuracy concerns . There was an expressed lack of trust in health providers and preference for lay community distributors . HIVST addressed youth-specific barriers to st and ard HIV testing , with home-based distribution considered convenient . Issues of autonomy , control , respect and confidentiality emerged as key qualitative themes . Conclusion : HIVST services can be optimized to reach young people if products are provided through home-based distribution and at low prices , with respect for them as autonomous individuals Abstract Introduction : In the era of ambitious HIV targets , novel HIV testing models are required for hard-to-reach groups such as men , who remain underserved by existing services . Pregnancy presents a unique opportunity for partners to test for HIV , as many pregnant women will attend antenatal care ( ANC ) . We describe the views of pregnant women and their male partners on HIV self-test kits that are woman-delivered , alone or with an additional intervention . Methods : A formative qualitative study to inform the design of a multi-arm multi-stage cluster-r and omized trial , comprised of six focus group discussion s and 20 in-depth interviews , was conducted . ANC attendees were purposively sample d on the day of initial clinic visit , while men were recruited after obtaining their contact information from their female partners . Data were analysed using content analysis , and our interpretation is hypothetical as participants were not offered self-test kits . Results : Providing HIV self-test kits to pregnant women to deliver to their male partners was highly acceptable to both women and men . Men preferred this approach compared with st and ard facility-based testing , as self-testing fits into their lifestyles which were characterized by extreme day-to-day economic pressures , including the need to raise money for food for their household daily . Men and women emphasized the need for careful communication before and after collection of the self-test kits in order to minimize the potential for intimate partner violence although physical violence was perceived as less likely to occur . Most men stated a preference to first self-test alone , followed by testing as a couple . Regarding interventions for optimizing linkage following self-testing , both men and women felt that a fixed financial incentive of approximately USD$2 would increase linkage . However , there were concerns that financial incentives of greater value may lead to multiple pregnancies and lack of child spacing . In this low-income setting , a lottery incentive was considered overly disappointing for those who receive nothing . Phone call reminders were preferred to short messaging service . Conclusions : Woman-delivered HIV self-testing through ANC was acceptable to pregnant women and their male partners . Feedback on additional linkage enablers will be used to alter pre-planned trial arms Background HIV self-testing ( HIVST ) has been found to be highly effective , but no cost analysis has been undertaken to guide the design of affordable and scalable implementation strategies . Methods Consecutive HIV self-testers and facility-based testers were recruited from participants in a community cluster-r and omised trial ( IS RCT N02004005 ) investigating the impact of offering HIVST in addition to facility-based HIV testing and counselling ( HTC ) . Primary costing studies were undertaken of the HIVST service and of health facilities providing HTC to the trial population . Costs were adjusted to 2014 US$ and INT$. Recruited participants were asked about direct non-medical and indirect costs associated with accessing either modality of HIV testing , and additionally their health-related quality of life was measured using the EuroQol EQ-5D . Results A total of 1,241 participants underwent either HIVST ( n = 775 ) or facility-based HTC ( n = 446 ) .  The mean societal cost per participant tested through HIVST ( US$ 9.23 ; 95 % CI : US$ 9.14-US$9.32 ) was lower than through facility-based HTC ( US$ 11.84 ; 95 % CI : US$ 10.81 - 12.86 ) . Although the mean health provider cost per participant tested through HIVST ( US$ 8.78 ) was comparable to facility-based HTC ( range : US$ 7.53-US$10.57 ) , the associated mean direct non-medical and indirect cost was lower ( US$ 2.93 ; 95 % CI : US$ 1.90-US$3.96 ) . The mean health provider cost per HIV positive participant identified through HIVST was higher ( US$ 97.50 ) than for health facilities ( range : US$ 25.18-US$76.14 ) , as was the mean cost per HIV positive individual assessed for anti-retroviral treatment ( ART ) eligibility and the mean cost per HIV positive individual initiated onto ART . In comparison to the facility-testing group , the adjusted mean EQ-5D utility score was 0.046 ( 95 % CI : 0.022 - 0.070 ) higher in the HIVST group . Conclusions HIVST reduces the economic burden on clients , but is a costlier strategy for the health provider aim ing to identify HIV positive individuals for treatment . The provider cost of HIVST could be substantially lower under less restrictive distribution models , or if costs of oral fluid HIV  test  kits become comparable to finger-prick kits used in health facilities We evaluated performance , accuracy , and acceptability parameters of unsupervised oral fluid ( OF ) HIV self-testing ( HIVST ) in a general population in western Kenya . In a prospect i ve validation design , we enrolled 240 adults to perform rapid OF HIVST and compared results to staff administered OF and rapid fingerstick tests . All reactive , discrepant , and a proportion of negative results were confirmed with lab ELISA . Twenty participants were video-recorded conducting self-testing . All participants completed a staff administered survey before and after HIVST to assess attitudes towards OF HIVST acceptability . HIV prevalence was 14.6 % . Thirty-six of the 239 HIVSTs were invalid ( 15.1 % ; 95 % CI 11.1–20.1 % ) , with males twice as likely to have invalid results as females . HIVST sensitivity was 89.7 % ( 95 % CI 73–98 % ) and specificity was 98 % ( 95 % CI 89–99 % ) . Although sensitivity was somewhat lower than expected , there is clear interest in , and high acceptability ( 94 % ) of OF HIV self-testing Objective To evaluate HIV self-testing performance and results interpretation among female sex workers ( FSWs ) in Kampala , Ug and a , who performed unassisted HIV self-testing . Methods In October 2016 , 104 participants used an oral HIV self-test while under observation by research assistants . Participants were not assisted on HIV self-test use prior to or during testing , and were only given the manufacturer ’s pictorial and written instructions to guide them . Research assistants recorded if participants completed and /or had difficulties with steps in the HIV self-testing process on a prespecified checklist . R and omly drawn , used HIV self-tests were interpreted by FSWs . We calculated the concordance between FSWs ’ interpretations of self-test results with those indicated in the manufacturer ’s instructions . Results Only 33 % ( 34/104 ) of participants completed all of the key steps in the HIV self-testing process , and the majority ( 86 % , 89/104 ) were observed having difficulties with at least one of these steps . Misinterpretation of HIV self-test results were common among FSWs : 23 % ( 12/56 ) of FSWs interpreted HIV-negative self-test results as HIV positive and 8 % ( 3/37 ) of FSWs interpreted HIV-positive self-test results as HIV negative . The concordance between FSWs ’ interpretations of self-test results and that indicated in the instructions was 73 % ( 95 % CI 56 % to 86 % ) for HIV-positive self-tests and 68 % ( 95 % CI 54 % to 80 % ) for HIV-negative self-tests . Conclusions FSWs in Kampala , who performed unassisted HIV self-testing , skipped steps in the HIV self-testing process and had difficulties correctly interpreting self-test results . Training on use and interpretation of HIV self-tests may be necessary to prevent errors in the HIV self-testing process and to avoid the negative consequences of false-positive and false-negative HIV self-test results among FSWs . Trial registration number NCT02846402 
    Output:
    
Perceived facilitators of the uptake of HIVST  were autonomy and self-empowerment , privacy , confidentiality , convenience , opportunity to test , including couples HIV testing , and ease of use .
Actual HIVST users expressed preference of oral-fluid self-testing because of ease of use , and that it is less invasive and painless compared to finger-stick/whole blood-based HIV tests .
Lack of clear instructions on how to use self-test kits , and existing different products of HIVST increases rates of user errors .