A process evaluation of community-led distribution of HIV self-testing kits in rural communities in Zimbabwe.
Itai Kabonga, Lindiwe Mancitshana, Sharon Munhenzva et al.
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In 30 seconds
This process evaluation examined community-led HIV self-testing (HIVST) distribution in rural Zimbabwe, within the community-led arm of a cluster-randomized trial comparing it with paid, community-based distribution. Twenty communities designed and implemented locally tailored models over 4–6 weeks. Across communities, 348 distributors delivered 27 812 kits. Qualitative findings indicated strong enthusiasm and generally acceptable, feasible delivery models; messages about viral load suppression and “U = U” were often new to community members and helped motivate implementation and uptake. Models led by local leaders rather than collective processes were associated with lower satisfaction and slower implementation.
Key findings
- Across communities, 348 distributors delivered 27 812 HIV self-testing kits through door-to-door and community-based channels.
- Community members showed strong enthusiasm for locally designed distribution, and U = U messaging was a key motivator for implementation and uptake.
- Communities whose models were developed by local leaders rather than through collective processes reported lower satisfaction and slower implementation.
- Distributors felt proud of their role but often faced logistical burdens and needed material support.
Why it matters
The evaluation highlights that community participation can support acceptable and feasible HIV self-test distribution, while the way decisions are made may affect satisfaction and implementation pace. It also identifies practical needs for distributors and the potential value of integrating U = U information into community-based testing efforts. These findings inform programme design, although they do not establish comparative effectiveness.
What to keep in mind
This is a process evaluation of the community-led arm, not a comparative assessment of HIV testing outcomes. Implementation lasted 4–6 weeks, limiting evidence about sustainability.