Background Information:

In 2017, it estimated that 36.9 million (31.1-43.9millions) people where living with HIV, and 21.7 million (19.1 -22.6millions] people were accessing Antiretroviral therapy (ART) globally. Also, 1.8million (1.4-2.4 million) become newly infected with HIV while the mortality of people who died from AIDS-related illness in 2017 was 904000 worldwide (1).

The UNAIDS has introduced an ambitious global 95-95-95 goals by 2030. The aim is to reach 95% of people living with HIV knowing their HIV status, 95% of the who are HIV positive are enrolled in ART services, and 95% of those who are on ART have attained viral suppression by 2030. However, existing conventional HIV testing services (HTS) have failed to achieve universal access to HIV prevention, treatment and care, especially non-testers with low access and those at higher risk of HIV acquisition and hard to reach populations (1).

In sub-Sahara Africa (SSA), only 40% of people living with HIV (PLHIV) know their HIV status despite in large number of HIV testing centers (1). In Tanzania, 62% of PLHIV aged 15- 49 years know their HIV positive status, with higher proportions among female compared to their male counterparts. Also, 90.9% of those who know their status are on treatment and 87.7% on treatment are virally suppressed (2). The low uptake of conventional HTS is associated with stigma and discrimination (3-6), ignorance on the low-risk HIV acquisition, perceived lack of privacy and distance to testing sites, travel costs, opportunity costs due to spending many unproductive hours and lack of confidentially of the test results (5-9).

Existing evidences suggests that by allowing people to test discreetly and conveniently, HIV self-testing (HIVST) may increase uptake of HIV testing among people not reached by other HIV testing services (10). According to World Health Organization (WHO), HIVST is defined a process whereby someone collects his or her sample (either oral fluid or blood) and then performs an HIV test and interprets the result, often in a private setting, either alone or with someone he or she trusts”. Benefits of HIVST reported in the literature, including reaching first-time testers, older men, and very young and vulnerable people, commercial sex workers, and transgender (10-15). Also, HIVST advantages of the convenience, privacy, anonymity, and a short a short time to get results, confidentiality and accessibility. HIVST also has the potential to circumvent barriers related to visiting health facilities or HIV testing points associated with stigma and fear of visibility (10-12).

The WHO has introduced HIVST guidelines recommending HIVST as a potential innovation that could complement the existing HTS to close critical gaps in HIV coverage globally (11). Despite the WHO recommendations, many African countries, including Tanzania are lagging behind the adoption of HIVST in their national HTS policies (12, 16). The main challenges put forwards by HIV policymakers and government stakeholders related to adoption and implementation of HIVST including perceived risk of inaccurate results, psychological risks because of lack of counseling and linkage to care of individuals receiving HIV positive results (10, 12, 16-19). Despite limited evidence of potential of psychological risks from HIV self- testing, most arguments against HIVST are mainly based on vague fears (10, 20-23). However, lack of face-to-face counseling, which is unique for HIVST, remain the most argument against HIVST (10-12, 16, 17, 21, 24-27)

Tanzania’s HIV testing acknowledge the importance of HIVST and may be considered as the Tensible option in the future but currently, HIV self-testing and HIV kits are not permitted for public use in Tanzania, unless for research purposes only. Despite the above-mentioned policy challenge, it is imperative to gather information on knowledge, attitudes, barriers, and facilitators on HIV self-testing among undergraduates at Catholic university of Health and Allied Sciences (CUHAS) in Mwanza region in Tanzania. Medical students, most of whom fall under the age group of 18 to 28 years are not exempted from the increased risk of HIV acquisition. A recent Tanzania’s HIV indicators report indicate that prevalence is 4.8% among those of age group of 15-49 years (national HIV prevalence 4.6%). However, awareness of HIV-positive status is 62% in the same age group (28).