Introduction Higher effectiveness in HIV testing programmes is needed in order to achieve the WHO target of diagnosing 90% of people living with HIV. Based on the success of two national pilots, Public Health England (PHE), with support of Local Authorities, launched a nation-wide HIV self-sampling service for most at-risk populations for HIV acquisition in November 2015. The service delivers reactive results through a community organisation that provides emotional support while linking individuals into the clinical pathway for confirmatory testing and care. Self-sampling is distinct from self-testing in which the individual performs the test themselves and receives the results there and then. The aim of this analysis was to determine who is accessing the service and whether it reached most at-risk groups (including MSM and Black African communities) and first-time testers.

Methods Disaggregated anonymised data was collected from all service users requesting a HIV self-sampling kit from the national service (www.freetesting.hiv). Data included ethnicity, gender, sexual orientation, local authority residency, and HIV testing information from 28 657 service users between 11 November 2015 and 31 December 2016.

Results During this time period there were 55 726 kits ordered of which 52.5% (n=29,233) were returned. 28 657 kits were tested with a 1.1% reactive rate (n=311); 67% (n=19079) of users returning their kits, reported never testing or testing over a year ago. 74% of kits tested were from MSM (n=21,309) with 1.4% reactive rate (n=291) of kits tested by heterosexuals (n=6,689), 50% (n=3316) were from ethnic minority communities showing a reactivity rate of 1.3% (n=43).

Conclusions The service has been successful at engaging most at-risk populations for HIV acquisition. Service users in their majority were different from those attending clinical settings as reported in the high numbers of first time testers and those not testing regularly. A joined commissioning model allowed for a cost-efficient service that increases access to testing for those in higher need.