Review 1: "What Role do Community-level Factors Play in HIV Self-testing Uptake, Linkage to Services and HIV-related Outcomes? A Mixed Methods Study of Community-led HIV Self-testing Programmes in Rural Zimbabwe"

Abstract

Review:The study found low uptake (22%) of HIV self-testing (HIVST), regardless of the community-led distribution model used.There was no significant association between community cohesion and uptake of HIVST or confirmatory testing, voluntary medical male circumcision, pre-exposure prophylaxis, or viral load suppression.However, there was a significant association between community cohesion and new HIV diagnoses based on self-reporting.The authors conducted a secondary analysis of data from a published cluster randomized trial.The study aimed to identify factors associated with successful community-led distribution of HIV self-test kits by paid distributors.The study revealed low uptake of HIV self-testing (HIVST) at approximately 22%, with no significant difference between distribution models.While community cohesion did not have an impact on some primary outcomes, including HIVST uptake and linkage to confirmatory testing, voluntary medical male circumcision (VMMC), pre-exposure prophylaxis (PrEP), or viral load suppression, it was significantly associated with new HIV diagnoses based on self-reporting.Overall, this well-written manuscript provides an important addition to existing literature.However, I have some suggestions for improving its quality.Major Comments:Reliable.The main study claims are generally justified by its methods and data.The results and conclusions are likely to be similar to the hypothetical ideal study.There are some minor caveats or limitations, but they would/do not change the major claims of the study.The study provides sufficient strength of evidence on its own that its main claims should be considered actionable, with some room for future revision.