***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: Background Achieving higher rates of partner HIV testing and couples testing among pregnant and postpartum women in sub-Saharan Africa is essential for the success of combination HIV prevention , including the prevention of mother-to-child transmission . We aim ed to determine whether providing multiple HIV self-tests to pregnant and postpartum women for secondary distribution is more effective at promoting partner testing and couples testing than conventional strategies based on invitations to clinic-based testing . Methods and Findings We conducted a r and omized trial in Kisumu , Kenya , between June 11 , 2015 , and January 15 , 2016 . Six hundred antenatal and postpartum women aged 18–39 y were r and omized to an  HIV self-testing ( HIVST ) group or a comparison group . Participants in the HIVST group were given two oral-fluid-based HIV test kits , instructed on how to use them , and encouraged to distribute a test kit to their male partner or use both kits for testing as a couple . Participants in the comparison group were given an invitation card for clinic-based HIV testing and encouraged to distribute the card to their male partner , a routine practice in many health clinics . The primary outcome was partner testing within 3 mo of enrollment . Among 570 participants analyzed , partner HIV testing was more likely in the HIVST group ( 90.8 % , 258/284 ) than the comparison group ( 51.7 % , 148/286 ; difference = 39.1 % , 95 % CI 32.4 % to 45.8 % , p < 0.001 ) . Couples testing was also more likely in the HIVST group than the comparison group ( 75.4 % versus 33.2 % , difference = 42.1 % , 95 % CI 34.7 % to 49.6 % , p < 0.001 ) . No participants reported intimate partner violence due to HIV testing . This study was limited by self-reported outcomes , a common limitation in many studies involving HIVST due to the private manner in which self-tests are meant to be used . Conclusions Provision of multiple HIV self-tests to women seeking antenatal and postpartum care was successful in promoting partner testing and couples testing . This approach warrants further consideration as countries develop HIVST policies and seek new ways to increase awareness of HIV status among men and promote couples testing . Trial Registration Clinical Trials.gov NCT02386215 BACKGROUND Frequent testing of individuals at high risk of HIV is central to current prevention strategies . We aim ed to determine if HIV self-testing would increase frequency of testing in high-risk gay and bisexual men , with a particular focus on men who delayed testing or had never been tested before . METHODS In this r and omised trial , HIV-negative high-risk gay and bisexual men who reported condomless anal intercourse or more than five male sexual partners in the past 3 months were recruited at three clinical and two community-based sites in Australia . Enrolled participants were r and omly assigned ( 1:1 ) to the intervention ( free HIV self-testing plus facility-based testing ) or st and ard care ( facility-based testing only ) . Participants completed a brief online question naire every 3 months , which collected the number of self-tests used and the number and location of facility-based tests , and HIV testing was subsequently source d from clinical records . The primary outcome of number of HIV tests over 12 months was assessed overall and in two strata : recent ( last test ≤2 years ago ) and non-recent ( > 2 years ago or never tested ) testers . A statistician who was masked to group allocation analysed the data ; analyses included all participants who completed at least one follow-up question naire . After the 12 month follow-up , men in the st and ard care group were offered free self-testing kits for a year . This trial is registered with the Australian New Zeal and Clinical Trials Registry , number ACTRN12613001236785 . FINDINGS Between Dec 1 , 2013 , and Feb 5 , 2015 , 182 men were r and omly assigned to self-testing , and 180 to st and ard care . The analysis population included 178 ( 98 % ) men in the self-testing group ( 174 person-years ) and 165 ( 92 % ) in the st and ard care group ( 162 person-years ) . Overall , men in the self-testing group had 701 HIV tests ( 410 self-tests ; mean 4·0 tests per year ) , and men in the st and ard care group had 313 HIV tests ( mean 1·9 tests per year ) ; rate ratio ( RR ) 2·08 ( 95 % CI 1·82 - 2·38 ; p<0·0001 ) . Among recent testers , men in the self-testing group had 627 tests ( 356 self-tests ; mean 4·2 per year ) , and men in the st and ard care group had 297 tests ( mean 2·1 per year ) ; RR 1·99 ( 1·73 - 2·29 ; p<0·0001 ) . Among non-recent testers , men in the self-testing group had 74 tests ( 54 self-tests ; mean 2·8 per year ) , and men in the st and ard care group had 16 tests ( mean 0·7 per year ) ; RR 3·95 ( 2·30 - 6·78 ; p<0·0001 ) . The mean number of facility-based HIV tests per year was similar in the self-testing and st and ard care groups ( mean 1·7 vs 1·9 per year , respectively ; RR 0·86 , 0·74 - 1·01 ; p=0·074 ) . No serious adverse events were reported during follow-up . INTERPRETATION HIV self-testing result ed in a two times increase in frequency of testing in gay and bisexual men at high risk of infection , and a nearly four times increase in non-recent testers , compared with st and ard care , without reducing the frequency of facility-based HIV testing . HIV self-testing should be made more widely available to help increase testing and earlier diagnosis . FUNDING The National Health and Medical Research Council , Australia In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if a body of evidence is associated with a high risk of publication bias . Even when individual studies included in best- evidence summaries have a low risk of bias , publication bias can result in substantial overestimates of effect . Authors should suspect publication bias when available evidence comes from a number of small studies , most of which have been commercially funded . A number of approaches based on examination of the pattern of data are available to help assess publication bias . The most popular of these is the funnel plot ; all , however , have substantial limitations . Publication bias is likely frequent , and caution in the face of early results , particularly with small sample size and number of events , is warranted Reaching universal HIV-status awareness is crucial to ensure all HIV-infected patients access antiretroviral treatment ( ART ) and achieve virological suppression . Opportunities for HIV testing could be enhanced by offering self-testing in population s that fear stigma and discrimination when accessing conventional HIV Counselling and Testing ( HCT ) in health care facilities . This qualitative research aims to examine the feasibility and acceptability of  unsupervised oral self-testing for home use in an informal settlement of South Africa . Eleven in-depth interviews , two couple interviews , and two focus group discussion s were conducted with seven healthcare workers and thirteen community members . Thematic analysis was done concurrently with data collection . Acceptability to offer home self-testing  was demonstrated in this research . Home self-testing might help this population overcome barriers to accepting HCT ; this was particularly expressed in the male and youth groups . Nevertheless , pilot interventions must provide evidence of potential harm related to home  self-testing  , intensify efforts to offer quality counselling , and ensure linkage to HIV/ART-care following a positive self-test result Background : Self-testing may increase HIV testing and decrease the time people with HIV are unaware of their status , but there is concern that absence of counseling may result in increased HIV risk . Setting : Seattle , Washington . Methods : We r and omly assigned 230 high-risk HIV-negative men who have sex with men to have access to oral fluid HIV self-tests  at no cost versus testing as usual for 15 months . The primary outcome was self-reported number of HIV tests during follow-up . To evaluate self-testing 's impact on sexual behavior , we compared the following between arms : non – HIV-concordant condomless anal intercourse and number of male condomless anal intercourse partners in the last 3 months ( measured at 9 and 15 months ) and diagnosis with a bacterial sexually transmitted infection ( STI : early syphilis , gonorrhea , and chlamydial infection ) at the final study visit ( 15 months ) . A post hoc analysis compared the number of STI tests reported during follow-up . Results : Men r and omized to self-testing reported significantly more HIV tests during follow-up ( mean = 5.3 , 95 % confidence interval = 4.7 to 6.0 ) than those r and omized to testing as usual ( 3.6 , 3.2 to 4.0 ; P < 0.0001 ) , representing an average increase of 1.7 tests per participant over 15 months . Men r and omized to self-testing reported using an average of 3.9 self-tests . Self-testing was noninferior with respect to all markers of HIV risk . Men in the self-testing arm reported significantly fewer STI tests during follow-up ( mean = 2.3 , 95 % confidence interval = 1.9 to 2.7 ) than men in the control arm ( 3.2 , 2.8 to 3.6 ; P = 0.0038 ) . Conclusions : Access to free HIV self-testing increased testing frequency among high-risk men who have sex with men and did not impact sexual behavior or STI acquisition IMPORTANCE Self-testing for HIV infection may contribute to early diagnosis of HIV , but without necessarily increasing antiretroviral therapy ( ART ) initiation . OBJECTIVE To investigate whether offering optional home initiation of HIV care after HIV self-testing might increase dem and for ART initiation , compared with HIV self-testing accompanied by facility-based services only . DESIGN , SETTING , AND PARTICIPANTS Cluster r and omized trial conducted in Blantyre , Malawi , between January 30 and November 5 , 2012 , using restricted 1:1 r and omization of 14 community health worker catchment areas . Participants were all adult ( ≥16 years ) residents ( n = 16,660 ) who received access to home HIV self-testing through resident volunteers . This was a second-stage r and omization of clusters allocated to the HIV self-testing group of a parent trial . INTERVENTIONS Clusters were r and omly allocated to facility-based care or optional home initiation of HIV care ( including 2 weeks of ART if eligible ) for participants reporting positive HIV self-test results . MAIN OUTCOMES AND MEASURES The preplanned primary outcome compared between groups the proportion of all adult residents who initiated ART within the first 6 months of HIV self-testing availability . Secondary outcomes were uptake of HIV self-testing , reporting of positive HIV self-test results , and rates of loss from ART at 6 months . RESULTS A significantly greater proportion of adults in the home group initiated ART ( 181/8194 , 2.2 % ) compared with the facility group ( 63/8466 , 0.7 % ; risk ratio [ RR ] , 2.94 , 95 % CI , 2.10 - 4.12 ; P < .001 ) . Uptake of HIV self-testing was high in both the home ( 5287/8194 , 64.9 % ) and facility groups ( 4433/8466 , 52.7 % ; RR , 1.23 ; 95 % CI , 0.96 - 1.58 ; P = .10 ) . Significantly more adults reported positive HIV self-test results in the home group ( 490/8194 [ 6.0 % ] vs the facility group , 278/8466 [ 3.3 % ] ; RR , 1.86 ; 95 % CI , 1.16 - 2.97 ; P = .006 ) . After 6 months , 52 of 181 ART initiators ( 28.7 % ) and 15 of 63 ART initiators ( 23.8 % ) in the home and facility groups , respectively , were lost from ART ( adjusted incidence rate ratio , 1.18 ; 95 % CI , 0.62 - 2.25 , P = .57 ) . CONCLUSIONS AND RELEVANCE Among Malawian adults offered HIV self-testing , optional home initiation of care compared with st and ard HIV care result ed in a significant increase in the proportion of adults initiating ART . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01414413 
    Output:
    
Across all RCTs , there was no indication of harm attributable to HIVST and potential increases in risk-taking behaviour appeared to be minimal .
HIVST is associated with increased uptake and frequency of testing in RCTs .
Such increases , particularly among those at risk who may not otherwise test , will likely identify more HIV-positive individuals as compared to st and ard testing services alone .