Table 3 CERQual evidence profile

 1. HIV experts, HIV policymakers, and health care providers felt that the availability of HIVST would increase uptake of HIV testing, repeat testing, identifying first-time testers, and early diagnosis, leading to decreased HIV transmission in the general population [21, 23].

Minor methodological limitations (2 studies with unclear evidence of reflexivity).

High coherence (2 studies demonstrating a good fit between the review finding and the underlying data).

Moderate concerns about adequacy of data (2 studies offering thin data contributing to the review finding).

High relevance (2 studies among HIV experts and HIV stakeholders from Kenya, Malawi, and South Africa with direct relevance to the review question).

Moderate confidence

The 2 studies of moderate quality, with minor methodological limitations, no concerns about coherence, relevance and moderate concerns about adequacy of data.

 2. HIV experts, HIV policy makers, health care providers, and potential HIVST users identified the potential of HIVST to decreased stigma and discrimination associated with HIV testing, and increase their motivation and uptake of self-testing [5, 21, 23,24,25,26].

Moderate methodological limitations (5 studies with unclear evidence of reflexivity and 1 study with unclear methods for data collection).

High coherence (6 studies demonstrating a good fit between the review finding and the underlying data).

No concerns about adequacy of data (6 studies offering adequately rich data contributing to the review finding).

High relevance (6 studies among HIV experts, HIV stakeholders, and potential HIVST users from Tanzania, South Africa, Malawi, and Kenya with direct relevance to the review question).

Moderate confidence

The 6 studies of moderate quality with moderate methodological limitations, no concerns about coherence, adequacy, and relevance.

 3. HIV experts, HIV policy makers, health care providers, and potential HIVST users felt that HIVST will provide an opportunity to test for HIV which will circumvent facility-based barriers, leading to increased uptake of testing [5, 21, 23,24,25,26].

Moderate methodological limitations(5 studies with unclear evidence of reflexivity and 1 study with unclear methods for data collection)

High coherence (6 studies demonstrating a good fit between the review finding and the underlying data).

No concerns about adequacy of data (6studies offering adequately rich data contributing to the review finding).

High relevance (6 studies among HIV experts, HIV stakeholders, and potential HIVST from Tanzania, South Africa, Malawi, and Kenya with direct relevance to the review question).

Moderate confidence

The 6 studies of moderate quality with moderate methodological limitations, no concerns about coherence, adequacy, and relevance.

 4. HIV experts, HIV policy makers, health care providers, and potential HIVST users felt that self-testing in private would increase the acceptability of HIV testing [23,24,25,26,27].

Moderate methodological limitations (4 studies with unclear evidence of reflexivity and 1 study with unclear methods for data collection)

High coherence (5 studies demonstrating a good fit between the review finding and the underlying data).

No concerns about adequacy of data (5 studies offering adequately rich data contributing to the review finding).

High relevance (5 studies among HIV experts, HIV stakeholders, and potential HIVST from Malawi, Zimbabwe, Tanzania, and South Africa with direct relevance to the review question).

Moderate confidence

The 5 studies of moderate quality with moderate methodological limitations, high coherence, high relevance, and no concerns about adequacy of data.

 5. The autonomy to make one’s own choice of HIV testing and self-empowerment to take responsibility for HIV testing was perceived by HIV experts, HIV policy makers, health care providers, and potential HIVST users as creating a more active role in the decision-making process for HIV testing [5, 21, 23,24,25,26].

Moderate methodological limitations (5 studies with unclear evidence of reflexivity and 1 study with unclear methods for data collection).

High coherence (6 studies demonstrating a good fit between the review finding and the underlying data).

No concerns about adequacy of data (6 studies offering adequately rich data contributing to the review finding).

High relevance (6 studies among HIV experts, HIV stakeholders, and potential HIVST from Malawi, Zimbabwe, Tanzania, and South Africa with direct relevance to the review question).

Moderate confidence

The 6 studies of moderate quality with moderate methodological limitations, high coherence, high relevance, and no concerns about, adequacy of data.

 6. Awareness of self-testing was perceived by HIV experts, HIV policy makers, health care providers, and potential HIVST users to be facilitated through educational campaigns to the general public using clear information about benefits of HIVST, accompanied by post-testing counseling using advanced technology (i.e., phone-based counseling) [5, 21, 23,24,25,26].

Moderate methodological limitations(5 studies with unclear evidence of reflexivity and 1 study with unclear methods for data collection).

High coherence (6 studies demonstrating a good fit between the review finding and the underlying data).

No concerns about adequacy of data (6 studies offering adequately rich data contributing to the review finding).

High relevance (6 studies among HIV experts, HIV stakeholders, and potential HIVST from Malawi, Zimbabwe, Tanzania, and South Africa with direct relevance to the review question).

Moderate confidence

The 6 studies of moderate quality with moderate methodological limitations, high coherence, high relevance, and no concerns about adequacy of data.

 7. HIV experts, HIV policy makers, health care providers, and potential HIVST users reported that the convenience of self-testing in privacy brings testing services closer to users. They believed this would attenuate traveling costs, waiting time, and save time for other income-generating activities [23,24,25,26,27].

Moderate methodological limitations (4 studies with unclear evidence of reflexivity and 1 study with unclear methods for data collection).

High coherence (5 studies demonstrating a good fit between the review finding and the underlying data).

No concerns about adequacy of data (5 studies offering adequately rich data contributing to the review finding).

High relevance (5 studies among HIV experts, HIV stakeholders, and potential HIVST from Malawi, Zimbabwe, Tanzania, and South Africa with direct relevance to the review question).

Moderate confidence

The 5 studies of moderate quality with moderate methodological limitations, high coherence, high relevance, and no concerns about adequacy of data.

 8. Potential HIVST users believed that HIVST might increase the couple’s HIV testing through face-to-face communication, that could facilitate the disclosure of HIV serostatus, and may reduce gender-based violence related to HIV positive results [22, 25].

Minor methodological limitations (2 studies with unclear evidence of reflexivity).

High coherence (2 studies demonstrating a good fit between the review finding and the underlying data).

Moderate concerns about adequacy of data (2 studies offering thin data contributing to the review finding).

Minor concerns about relevance (2 studies among potential HIVST users from Malawi with partial relevance to the review question).

Moderate confidence

The 2 studies of moderate quality, with minor methodological limitations, high coherence, moderate concern about adequacy of data, and minor concerns about relevance.

 9. Potential HIVST users perceived that they might fail to afford HIVST kits because of concerns about the cost of buying the self-testing kits [23, 27].

Minor methodological limitations (3 studies with unclear evidence of reflexivity).

High coherence (3 studies demonstrating a good fit between the review finding and the underlying data).

Minor concerns about adequacy of data (3 studies offering moderately rich data contributing to the review finding).

Minor concerns about relevance (3 studies among potential HIVST users from Malawi, Zimbabwe, Tanzania, and South Africa with partial relevance to the review question).

Moderate confidence

The 3 studies of moderate quality, with minor methodological limitations, high coherence, and minor concerns about adequacy of data and relevance.

 10. HIV experts, HIV policymakers, and health care providers believed that the type of distribution points for delivery of self-test kits might hinder the uptake of HIVST kits. Having a variety of distribution points for delivery of self-test kits that would ensure privacy and confidentiality were perceived to increase the uptake of HIVST kits [21, 23].

Minor methodological limitations (2 studies with unclear evidence of reflexivity).

High coherence (2 studies demonstrating a good fit between the review finding and the underlying data).

Moderate concerns about adequacy of data (2 studies offering thin data contributing to the review finding).

High relevance (2 studies among HIV experts and HIV stakeholders from Kenya, Malawi, and South Africa with direct relevance to the review question).

Moderate confidence

The 2 studies of moderate quality, with minor methodological limitations, high coherence, high relevance, and moderate concerns about adequacy of data.

 11. Some potential HIVST users perceived that the inability of potential clients to read, particularly in rural settings, might hinder uptake of HIVST kits [15].

Moderate methodological limitation (1 study with unclear evidence of reflexivity and insufficiently rigorous data analysis).

Coherence could not be assessed as only 1 contributing study.

Serious concerns about adequacy of data (1 study offering very thin data contributing to the review finding).

Minor concerns about relevance (1 study among potential HIVST users from Tanzania with partial relevance to the review question).

Low confidence

One study of low quality, with moderate methodological limitations, unclear coherence, minor concerns about relevance and serious concerns about adequacy of data.

 12. The fear and anxiety of receiving a positive test result were perceived by potential HIVST users as a barrier to uptake of HIVST kits. Buying HIVST kits was compared with buying death or poison for committing suicide [24].

Minor methodological limitation (1 study with unclear evidence of reflexivity).

Coherence could not be assessed as only 1 contributing study.

Minor concerns about adequacy of data (1 study offering moderately rich data contributing to the review finding).

Minor concerns about relevance (1 study among potential HIVST users from Tanzania with partial relevance to the review question).

Moderate confidence

One study of moderate quality, with minor methodological limitations, unclear coherence, high relevance, and minor concerns about adequacy.

 13. Potential HIVST users were concerned that the oral-fluid self-test kits may fail to accurately test for HIV because they believed HIV is present in the blood only. Some potential HIVST users expressed their fear about misinterpretation of the self-test results when alone [5, 15, 24].

Moderate methodological limitation (3 studies with unclear evidence of reflexivity and 1 study with insufficiently rigorous data analysis).

High coherence (4 studies demonstrating a good fit between the review finding and the underlying data).

Minor concerns about adequacy of data (1 study offering thin data, and 3 studies offering adequately rich data contributing to the review finding).

Minor concerns about relevance (4 studies among potential HIVST users from Tanzania, Kenya, Malawi, and South Africa with partial relevance to the review question).

Moderate confidence

The 4 studies of moderate quality, with moderate methodological limitations, no concerns about coherence, relevance, and minor concerns about adequacy.

 14. HIV experts, HIV policymakers, and health care providers expressed concerns about human rights issues related to HIVST. They believed that HIVST was ethical as it provides more freedom, choices and options, and power to individuals to test for HIV. However, some HIV experts cautioned that HIVST might be unethical if it increases vulnerabilities such as forced or coerced testing [21, 23].

Minor methodological limitations (2 studies with unclear evidence of reflexivity).

High coherence (2 studies demonstrating a good fit between the review finding and the underlying data).

Minor concerns about adequacy of data (2 studies offering moderately rich data contributing to the review finding).

High relevance (2 studies among HIV experts and HIV stakeholders from Kenya, Malawi, and South Africa with direct relevance to the review question).

Moderate confidence

The 2 studies of moderate quality, with minor methodological limitations, high coherence, high relevance, and minor concerns about adequacy of data.

 15. HIV experts, HIV policymakers, and health care providers believed that linkage of care was an important component and inextricably linked to pre and post-test counseling. They also pointed out that a follow-up confirmatory laboratory test after a positive self-test might facilitate linkage to HIV care, treatment, and support [21, 23, 24, 27].

Moderate methodological limitations (4 studies with unclear evidence of reflexivity and 1 study with unclear methods for data collection).

High coherence (5 studies demonstrating a good fit between the review finding and the underlying data).

No concerns about adequacy of data (5 studies offering adequately rich data contributing to the review finding).

High relevance (5 studies among HIV experts and HIV stakeholders from Malawi, Zimbabwe, Tanzania, Kenya, and South Africa with direct relevance to the review question).

Moderate confidence

The 5 studies of moderate quality, with moderate methodological limitations, high coherence, high relevance, and no concerns about adequacy of data.

 16. HIV experts, HIV policymakers, and health care providers expressed concerns about the absence of face-to-face HIV counseling. Lack of counseling was perceived as a key limitation of HIVST and may increase the risk of psychopathic tendencies, suicidal ideation, and coercion [21, 23].

Minor methodological limitations (2 studies with unclear evidence of reflexivity).

High coherence (2 studies demonstrating a good fit between the review finding and the underlying data).

Minor concerns about adequacy of data (2 studies offering moderately rich data contributing to the review finding).

High relevance (2 studies among HIV experts and HIV stakeholders from South Africa, Kenya, and Malawi with direct relevance to the review question).

Moderate confidence

The 2 studies of moderate quality, with minor methodological limitations, high coherence, high relevance, and minor concerns about adequacy of data.

 17. Lack of effective regulation of medicines and laboratory test such as rapid HIV tests was perceived by HIV experts, HIV policymakers, and health care providers, as a major concern about quality assurance for HIVST kits. They believed that state regulation was an essential requirement to achieve quality assurance and protect users from fake/defective HIVST kits [21, 23].

Minor methodological limitations (2 studies with unclear evidence of reflexivity).

High coherence (2 studies demonstrating a good fit between the review finding and the underlying data).

Minor concerns about adequacy of data (2 studies offering moderately rich data contributing to the review finding).

High relevance (2 studies among HIV experts and HIV stakeholders from South Africa, Kenya, and Malawi with direct relevance to the review question).

Moderate confidence

The 2 studies of moderate quality, with minor methodological limitations, high coherence, high relevance, and minor concerns about adequacy of data.

 18. HIV experts, HIV policy makers, health care providers, and potential HIVST users expressed fear of low quality of HIVST kits, because of their previous experiences with fake medical equipment, and false advertisements because of a lack of or poor quality assurance measures [15, 23, 26].

Moderate methodological limitations (3 studies with unclear evidence of reflexivity and 1 study with insufficiently rigorous data analysis).

High coherence (4 studies demonstrating a good fit between the review finding and the underlying data).

Moderate concerns about adequacy of data (1 study offering thin data, and 2 studies offering moderately rich data contributing to the review finding).

High relevance (4 studies among HIV experts, HIV stakeholders and potential HIVST users from Malawi, Zimbabwe, Tanzania, and South Africa with direct relevance to the review question).

Moderate confidence

The 4 studies of moderate quality, with moderate methodological limitations, high coherence, high relevance, and moderate concerns about adequacy of data.

 19. Some HIVST users believed that HIVST creates an opportunity for previous ART users to re-start treatment, after stopping using ART because of the negative attitudes of some health care providers [5, 25].

Minor methodological limitations (2 studies with unclear evidence of reflexivity).

High coherence (2 studies demonstrating a good fit between the review finding and the underlying data).

Minor concerns about adequacy of data (2 studies offering moderately rich data contributing to the review finding).

High relevance (2 studies among actual HIVST users from Malawi, Kenya, and South Africa with direct relevance to the review question).

Moderate confidence

The 2 studies of moderate quality, with minor methodological limitations, high coherence, high relevance, and minor concerns about adequacy of data.

 20. Most HIVST users felt self-test kits were easy to use, with most preferring oral-fluid based tests to finger stick/whole blood-based tests because they do not use a needle prick [5, 25].

Minor methodological limitations (2 studies with unclear evidence of reflexivity).

High coherence (2 studies demonstrating a good fit between the review finding and the underlying data).

Minor concerns about adequacy of data (2 studies offering moderately rich data contributing to the review finding).

High relevance (2 studies among actual HIVST users from Malawi, Kenya, and South Africa with direct relevance to the review question).

Moderate confidence

The 2 studies of moderate quality, with minor methodological limitations, high coherence, high relevance, and minor concerns about adequacy of data.

 21. Some HIVST users expressed confusion about how to use the self-test kits because of the lack of clear instructions on some steps on how to use the kits, leading to user errors and poor accuracy of test results [5, 25].

Minor methodological limitations (2 studies with unclear evidence of reflexivity).

High coherence (2 studies demonstrating a good fit between the review finding and the underlying data).

Minor concerns about adequacy of data (2 studies offering moderately rich data contributing to the review finding).

High relevance (2 studies among actual HIVST users from Malawi, Kenya, and South Africa with direct relevance to the review question).

Moderate confidence

The 2 studies of moderate quality, with minor methodological limitations, high coherence, high relevance, and minor concerns about adequacy of data.