---
title: "Community-led distribution of HIV self-test kits in rural Zimbabwe: process evaluation results"
id: "pubmed-42573174"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42573174"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42573174/"
doi: "10.1093/heapol/czag101"
published_at: "2026-10-19T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Community-led distribution of HIV self-test kits in rural Zimbabwe: process evaluation results
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42573174
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42573174/)
- **DOI:** [10.1093/heapol/czag101](https://doi.org/10.1093%2Fheapol%2Fczag101)
- **Published At:** 2026-10-19T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Investigators conducted a process evaluation nested in the community-led arm of a cluster-randomized trial in rural **Zimbabwe** to assess locally designed distribution of **HIV self-test** (HIVST) kits. - Twenty communities were supported to design distribution models that fitted local context; implementation ran for 4–6 weeks per community and began after community meetings introducing the intervention. - Messaging included information on viral load suppression and the concept **U = U** (Undetectable = Untransmissible); the study team observed that this message generated interest and acted as a motivator for uptake. - Fieldwork combined methods: 20 in-depth interviews with community members, 20 with distributors, 20 with health workers, 12 focus group discussions with 91 participants, participant observation during meetings and implementation, and descriptive analysis of programme distribution data. - Programme data showed 348 distributors delivered 27,812 HIVST kits door-to-door and from homes or community venues across the participating sites. - Communities where distribution models were developed through local leaders (rather than collective processes) reported lower satisfaction and slower rollout, the investigators reported. - Health workers provided support for HIVST distribution; investigators noted areas for improvement in that support, though the abstract does not specify those opportunities in detail. - Participant observation indicated strong community engagement overall, with enthusiasm for participation during design and implementation stages. - The source abstract is truncated and did not report the complete findings about distributors’ perceptions and other potentially relevant process outcomes; the full article should be consulted for those missing details.
## Clinical Analysis & Structured Key Points
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more resources ](https://pubmed.ncbi.nlm.nih.gov/42573174/#linkout) Title & authors Abstract Conflict of interest statement Similar articles Publication types MeSH terms Related information Grants and funding LinkOut - more resources Randomized Controlled Trial Health Policy Plan Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Health+Policy+Plan%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Health+Policy+Plan%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42573174/) . 2026 Oct 19;41(9):1543-1555. doi: 10.1093/heapol/czag101. # A process evaluation of community-led distribution of HIV self-testing kits in rural communities in Zimbabwe [Itai Kabonga](https://pubmed.ncbi.nlm.nih.gov/?term=Kabonga+I&cauthor_id=42573174)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#full-view-affiliation-1 "Sexual & Reproductive Health and Maternal, Newborn and Child Health, Centre for Sexual Health and HIV/AIDS Research, 10 Coronation Drive, Harare, Zimbabwe."), [Lindiwe Mancitshana](https://pubmed.ncbi.nlm.nih.gov/?term=Mancitshana+L&cauthor_id=42573174)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#full-view-affiliation-1 "Sexual & Reproductive Health and Maternal, Newborn and Child Health, Centre for Sexual Health and HIV/AIDS Research, 10 Coronation Drive, Harare, Zimbabwe."), [Sharon Munhenzva](https://pubmed.ncbi.nlm.nih.gov/?term=Munhenzva+S&cauthor_id=42573174)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#full-view-affiliation-1 "Sexual & Reproductive Health and Maternal, Newborn and Child Health, Centre for Sexual Health and HIV/AIDS Research, 10 Coronation Drive, Harare, Zimbabwe."), [Nancy Ruhode](https://pubmed.ncbi.nlm.nih.gov/?term=Ruhode+N&cauthor_id=42573174)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#full-view-affiliation-1 "Sexual & Reproductive Health and Maternal, Newborn and Child Health, Centre for Sexual Health and HIV/AIDS Research, 10 Coronation Drive, Harare, Zimbabwe."), [Mary K Tumushime](https://pubmed.ncbi.nlm.nih.gov/?term=Tumushime+MK&cauthor_id=42573174)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#full-view-affiliation-2 "Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1 9SH, United Kingdom."), [Constancia Watadzaushe](https://pubmed.ncbi.nlm.nih.gov/?term=Watadzaushe+C&cauthor_id=42573174)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#full-view-affiliation-1 "Sexual & Reproductive Health and Maternal, Newborn and Child Health, Centre for Sexual Health and HIV/AIDS Research, 10 Coronation Drive, Harare, Zimbabwe."), [Miriam N Mutseta](https://pubmed.ncbi.nlm.nih.gov/?term=Mutseta+MN&cauthor_id=42573174)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#full-view-affiliation-3 "AIDS and TB, Ministry of Health and Child Care, Harare, Zimbabwe."), [Cheryl Johnson](https://pubmed.ncbi.nlm.nih.gov/?term=Johnson+C&cauthor_id=42573174)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#full-view-affiliation-4 "Global HIV, Hepatitis and STI, World Health Organization, Geneva, Switzerland."), [Getrude Ncube](https://pubmed.ncbi.nlm.nih.gov/?term=Ncube+G&cauthor_id=42573174)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#full-view-affiliation-3 "AIDS and TB, Ministry of Health and Child Care, Harare, Zimbabwe."), [Karin Hatzold](https://pubmed.ncbi.nlm.nih.gov/?term=Hatzold+K&cauthor_id=42573174)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#full-view-affiliation-5 "Infectious Diseases, Population Services International, Johannesburg, South Africa."), [Liz Corbett](https://pubmed.ncbi.nlm.nih.gov/?term=Corbett+L&cauthor_id=42573174)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#full-view-affiliation-6 "Department of Clinical Research, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, United Kingdom."), [Miriam Taegtmeyer](https://pubmed.ncbi.nlm.nih.gov/?term=Taegtmeyer+M&cauthor_id=42573174)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#full-view-affiliation-7 "Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom."), [Frances M Cowan](https://pubmed.ncbi.nlm.nih.gov/?term=Cowan+FM&cauthor_id=42573174)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#full-view-affiliation-8 "International Public Health, Liverpool School of Tropical Medicine, Liverpool L35QA, United Kingdom."), [Euphemia Sibanda](https://pubmed.ncbi.nlm.nih.gov/?term=Sibanda+E&cauthor_id=42573174)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#full-view-affiliation-1 "Sexual & Reproductive Health and Maternal, Newborn and Child Health, Centre for Sexual Health and HIV/AIDS Research, 10 Coronation Drive, Harare, Zimbabwe.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#full-view-affiliation-8 "International Public Health, Liverpool School of Tropical Medicine, Liverpool L35QA, United Kingdom.") Affiliations Expand ### Affiliations * 1 Sexual & Reproductive Health and Maternal, Newborn and Child Health, Centre for Sexual Health and HIV/AIDS Research, 10 Coronation Drive, Harare, Zimbabwe. * 2 Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1 9SH, United Kingdom. * 3 AIDS and TB, Ministry of Health and Child Care, Harare, Zimbabwe. * 4 Global HIV, Hepatitis and STI, World Health Organization, Geneva, Switzerland. * 5 Infectious Diseases, Population Services International, Johannesburg, South Africa. * 6 Department of Clinical Research, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, United Kingdom. * 7 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom. * 8 International Public Health, Liverpool School of Tropical Medicine, Liverpool L35QA, United Kingdom. * PMID: **42573174** * DOI: [ 10.1093/heapol/czag101 ](https://doi.org/10.1093/heapol/czag101) Free article Item in Clipboard Randomized Controlled Trial # A process evaluation of community-led distribution of HIV self-testing kits in rural communities in Zimbabwe Itai Kabonga et al. Health Policy Plan. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Health Policy Plan Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Health+Policy+Plan%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Health+Policy+Plan%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42573174/) . 2026 Oct 19;41(9):1543-1555. doi: 10.1093/heapol/czag101. ### Authors [Itai Kabonga](https://pubmed.ncbi.nlm.nih.gov/?term=Kabonga+I&cauthor_id=42573174)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#short-view-affiliation-1 "Sexual & Reproductive Health and Maternal, Newborn and Child Health, Centre for Sexual Health and HIV/AIDS Research, 10 Coronation Drive, Harare, Zimbabwe."), [Lindiwe Mancitshana](https://pubmed.ncbi.nlm.nih.gov/?term=Mancitshana+L&cauthor_id=42573174)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#short-view-affiliation-1 "Sexual & Reproductive Health and Maternal, Newborn and Child Health, Centre for Sexual Health and HIV/AIDS Research, 10 Coronation Drive, Harare, Zimbabwe."), [Sharon Munhenzva](https://pubmed.ncbi.nlm.nih.gov/?term=Munhenzva+S&cauthor_id=42573174)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#short-view-affiliation-1 "Sexual & Reproductive Health and Maternal, Newborn and Child Health, Centre for Sexual Health and HIV/AIDS Research, 10 Coronation Drive, Harare, Zimbabwe."), [Nancy Ruhode](https://pubmed.ncbi.nlm.nih.gov/?term=Ruhode+N&cauthor_id=42573174)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#short-view-affiliation-1 "Sexual & Reproductive Health and Maternal, Newborn and Child Health, Centre for Sexual Health and HIV/AIDS Research, 10 Coronation Drive, Harare, Zimbabwe."), [Mary K Tumushime](https://pubmed.ncbi.nlm.nih.gov/?term=Tumushime+MK&cauthor_id=42573174)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#short-view-affiliation-2 "Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1 9SH, United Kingdom."), [Constancia Watadzaushe](https://pubmed.ncbi.nlm.nih.gov/?term=Watadzaushe+C&cauthor_id=42573174)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#short-view-affiliation-1 "Sexual & Reproductive Health and Maternal, Newborn and Child Health, Centre for Sexual Health and HIV/AIDS Research, 10 Coronation Drive, Harare, Zimbabwe."), [Miriam N Mutseta](https://pubmed.ncbi.nlm.nih.gov/?term=Mutseta+MN&cauthor_id=42573174)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#short-view-affiliation-3 "AIDS and TB, Ministry of Health and Child Care, Harare, Zimbabwe."), [Cheryl Johnson](https://pubmed.ncbi.nlm.nih.gov/?term=Johnson+C&cauthor_id=42573174)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#short-view-affiliation-4 "Global HIV, Hepatitis and STI, World Health Organization, Geneva, Switzerland."), [Getrude Ncube](https://pubmed.ncbi.nlm.nih.gov/?term=Ncube+G&cauthor_id=42573174)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#short-view-affiliation-3 "AIDS and TB, Ministry of Health and Child Care, Harare, Zimbabwe."), [Karin Hatzold](https://pubmed.ncbi.nlm.nih.gov/?term=Hatzold+K&cauthor_id=42573174)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#short-view-affiliation-5 "Infectious Diseases, Population Services International, Johannesburg, South Africa."), [Liz Corbett](https://pubmed.ncbi.nlm.nih.gov/?term=Corbett+L&cauthor_id=42573174)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#short-view-affiliation-6 "Department of Clinical Research, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, United Kingdom."), [Miriam Taegtmeyer](https://pubmed.ncbi.nlm.nih.gov/?term=Taegtmeyer+M&cauthor_id=42573174)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#short-view-affiliation-7 "Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom."), [Frances M Cowan](https://pubmed.ncbi.nlm.nih.gov/?term=Cowan+FM&cauthor_id=42573174)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#short-view-affiliation-8 "International Public Health, Liverpool School of Tropical Medicine, Liverpool L35QA, United Kingdom."), [Euphemia Sibanda](https://pubmed.ncbi.nlm.nih.gov/?term=Sibanda+E&cauthor_id=42573174)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#short-view-affiliation-1 "Sexual & Reproductive Health and Maternal, Newborn and Child Health, Centre for Sexual Health and HIV/AIDS Research, 10 Coronation Drive, Harare, Zimbabwe.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42573174/#short-view-affiliation-8 "International Public Health, Liverpool School of Tropical Medicine, Liverpool L35QA, United Kingdom.") ### Affiliations * 1 Sexual & Reproductive Health and Maternal, Newborn and Child Health, Centre for Sexual Health and HIV/AIDS Research, 10 Coronation Drive, Harare, Zimbabwe. * 2 Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1 9SH, United Kingdom. * 3 AIDS and TB, Ministry of Health and Child Care, Harare, Zimbabwe. * 4 Global HIV, Hepatitis and STI, World Health Organization, Geneva, Switzerland. * 5 Infectious Diseases, Population Services International, Johannesburg, South Africa. * 6 Department of Clinical Research, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, United Kingdom. * 7 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom. * 8 International Public Health, Liverpool School of Tropical Medicine, Liverpool L35QA, United Kingdom. * PMID: **42573174** * DOI: [ 10.1093/heapol/czag101 ](https://doi.org/10.1093/heapol/czag101) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract Community-led distribution of HIV self-test (HIVST) kits has potential to combine the benefits of community-based HIV testing with the strengths of community-led interventions. We report the process evaluation from the community-led arm of a cluster-randomized trial in rural Zimbabwe comparing community-led versus community-based HIVST distribution where distributors were paid. Twenty communities were supported to design HIVST distribution models that suited their context. We conducted community meetings where we introduced community-led HIVST, including messages on the benefits of viral load suppression (Undetectable = Untransmissible; 'U = U'). Communities determined how, and by whom, distribution would be done. Communities implemented their distribution model over 4-6 weeks. We conducted in-depth interviews with community members (n = 20), distributors (n = 20), and health workers (n = 20) as well as 12 focus group discussions (n = 91) with community members. We triangulated findings with participant observations during community meetings and implementation and descriptively analysed programme data on HIVST distribution. Qualitative data were analysed thematically. Participant observations found communities collaboratively developed and embraced HIVST distribution, demonstrating strong enthusiasm for participation. Messaging on U = U was met with interest and surprise, as many community members were unaware of this information, and became a key motivator for HIVST implementation and uptake. Across communities, 348 distributors distributed 27 812 kits door-to-door and/or from their homes or other community venues. Communities where model development was led by local leaders-rather than collective processes-expressed lower level of satisfaction and had slow implementation. Health workers supported HIVST distribution well, with opportunities for improvement noted. While distributors felt
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