Expanding HIV Self-Test Kits via Community Pharmacies in Rwanda Has Improved Availability, but Affordability Remains an Issue
Bibliographic record
Abstract
Background: 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".