HIV self-testing relative to the landscape of HIV testing in Ontario, Canada

BackgroundHIV self-testing may help achieve the UNAIDS 95-95-95 targets because it has the potential to increase testing among equity-denied communities. In 2023, the Public Health Agency of Canada made a one-time $8 million investment into HIV self-testing. We sought to evaluate the outcomes of HIV self-testing, compared to serology in Ontario, Canada.MethodsWe submitted data requests to all agencies involved HIV self-test distribution in Ontario, Canada for 2022-2023. We obtained matching data from the Public Health Ontario Laboratory. We then analyzed for unique test, unique tester, and positivity rate per testing modality.ResultsDuring the analysis period, we found that the laboratory completed an average of 53,606 tests per month for an average number of 44,671 unique persons. For self-tests, there was an average of 1700 tests distributed per month to an average of 678 unique persons. The positivity rate for self-testing was 0.27%, compared to 0.1% for serology.ConclusionsOur results highlight that self-testing can play a role but will not, alone, achieve the UNAIDS 95-95-95 targets. In our jurisdiction, self-testing corresponded with a higher positivity rate but accounted for only a minority of new diagnoses. In short, HIV self-testing is a tool, but not the solution to the HIV epidemic.