Background: The World Health Organisation recommends HIV Self-Testing (HIVST) as a supplementary approach for HIV testing. HIVST can provide under-tested populations with the option to privately screen themselves for HIV but presents challenges in collecting data on test usage and linkage to care. Using behavioural economic principles, we assessed whether short message service (SMS) reminders and interactive voice response hotline aided reporting of HIVST use and linkage to care.
Methods: In a large-scale implementation science study, over 10500 HIVST´s were distributed between October 2018 and February 2019 in inner-city Johannesburg, South Africa. Participants were encouraged to contact a hotline or access a website to report HIVST results, and received two SMS messages, three days and five days after receiving a test, encouraging them to do so. On the seventh day after receiving a kit, all participants who had not reported HIVST use received an automated phone call with a recorded survey. In addition to their test result, participants were asked about linkage into care and their willingness to pay (WTP).
Results: 9,504 unique phone numbers were registered by participants, of whom 5,056 were male (53%). 59% of respondents had taken an HIV test in the previous 3 months, 86% in the last year. In total, 1,933 (20.3%) respondents reported their test result, substantively higher than other HIVST programs not using a hotline. 313 (16%) reported a positive HIVST. Men were slightly more likely than women to have made an inbound call (10.2% vs 9.1%, p=0.01). Of those reporting a positive result, 204 (65%) reported that they had or intended to link to care. There was weak evidence that HIV prevalence was high among females (p=0.2) and among those who called into the system compared to those called by the system (p=0.2). Median WTP was ZAR50 ($3.47).
Conclusions: Self-reporting HIVST results through an automated hotline system is a promising option for implementation programs, and yielded higher response rates than comparable reporting systems, Recorded hotlines are low-cost and could be easily integrated into larger implementation programmes. This modality was successful in reaching men and young people and should be explored further.

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