Expanding HIV Self-Test Kits via Community Pharmacies in Rwanda Has Improved Availability, but Affordability Remains an Issue

Amon Nsengimana,1 Emmanuel Biracyaza,2 Augustin Manirakiza,3 Yvette Nsekonziza,3 Emmanuel Niyonsenga,3 Frederic Ntirenganya,4 Théoneste Umumararungu3 1USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) Project, Kigali, Rwanda; 2School of Rehabilitation Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; 3Department of Pharmacy, University of Rwanda, Kigali, Rwanda; 4Department of HIV/AIDS, Diseases Prevention and Control, Rwanda Biomedical Centre (RBC), Kigali, RwandaCorrespondence: Amon Nsengimana, Email [email protected]: The World Health Organization (WHO) recommends HIV self-testing (HIVST) to complement the existing HIV testing services. Pursuant to this, Rwanda approved the over-the-counter sale of Oral Quick HIV self-tests in community pharmacies, facilitating home testing and addressing accessibility issues. However, the availability and affordability of HIVSTs in these settings remains unexplored. Hence, this study determined the availability and affordability of HIVST kits in Community Pharmacies across Rwanda.Methods: This cross-sectional study was conducted among 220 licensed community pharmacists between February and May 2023. Tools standardized by WHO and Health Action International (HAI) were used to evaluate the affordability of HIVST kits. An ANOVA followed by a post-hoc test examined significant price differences across regions. Bivariate and multivariate logistic regression analyses were used to identify the factors associated with the availability of HIVST kits.Results: The availability was 76%, with 53% being finger-stick tests. Pharmacies owned by pharmacists were almost twice as likely to have HIVST available (AOR=1.858; 95%: 1.280– 2.629, p=0.007) than their counterparts. Pharmacies in Kigali were more likely to stock HIVST (AOR=3.549; 95%: 1.283– 9.814, p=0.015) than in other regions. Pharmacies experiencing frequent requests for HIVST were more likely to have HIVST available (AOR=0.22; 95%: 0.07– 0.66, p< 0.001) than those with fewer requests. Both oral quick and finger-stick HIVST were priced beyond the affordability of low-income earners. Moreover, significant price differences for Oral Quick HIVST (F=11.349; p< 0.001) were observed across regions, with Kigali’s prices significantly differing from those in the southern (p< 0.001) and western Provinces (p=0.004).Conclusion: HIVSTs are not economically priced for the lowest-paid workers, with variations in availability and prices across the country. Policymakers should apply subsidies or price regulation strategies to make HIVST more affordable, ensuring equitable access to all regions and income levels.Keywords: community pharmacies, HIV-self tests, availability, affordability