BACKGROUND:
Social-stigma, gender-norms, and structural-barriers continue to limit HIV-testing uptake in Nigeria, particularly among men. HIV self-testing (HIVST) offers privacy, autonomy, and decentralized access that may overcome these barriers. The Promoting Access to HIV-Self Testing (PATHS II) project evaluated whether community-led HIVST distribution, including through private channels such as community pharmacies (CPs) and patent proprietary medicine vendors (PPMVs), could reduce testing-related discrimination and improve reach among underserved populations Description: The PATHSII project utilized a Total Market Approach, engaging private-sector actors (Pharmacies, PPMVs and CBOs) across 23 sites in three Nigerian-states, shifting the testing from clinical facilities to private & community settings. Site selection prioritized regulatory compliance, geography, and infrastructure. HIVST distribution was integrated with counseling, referral and linkage support, and follow up, with outcomes disaggregated by age and sex using national data tools. Lessons Learnt: The project demonstrated a breakthrough in male engagement, with an almost equal distribution of HIVST kits between men, 2339(49.9%) and women, 2345(50.1%). This suggests that privacy of HIVST mitigates social barriers that deter men from facility testing based on the NDHS 2024 data “A significantly higher proportion of men (69%) have never been tested for HIV compared to women (63%). Adolescents and young adults accessed testing discreetly, indicating improved autonomy and reduced fear of discrimination. Furthermore, the 93% (4338/4684) reporting rate indicates high trust and acceptance of the protocol. Community-assisted models proved vital in maintaining 98% linkage rate, suggesting that privacy in testing doesn't necessarily lead to loss-to-follow-up if supported by a strong community-private sector framework.

CONCLUSIONS:
HIVST is an effective approach for de-stigmatizing HIV services. Community embedded models promotes acceptance, improve equity in access, providing private-testing options through community-vendors making it a scalable-strategy to improve male engagement. Scaling HIVST through community-channels should be prioritized to address social and structural determinants limiting HIV testing uptake.