Setting
The trial was conducted in 40 rural communities across Zimbabwe. Communities were defined as headman units, an official administrative unit through which rural community-level activities are typically implemented in Zimbabwe. Communities were only eligible if they contained at least three census enumeration areas (EAs) and were separated by at least 20km. Communities were randomly selected. Communities were randomised 1:1 to either a paid distribution arm, whereby HIVST kits were distributed by a paid distributor, or community-led whereby members of the community were responsible for organising and conducting the distribution of HIVST kits. Within the community-led arm, community engagement activities were carried out over a period of 2–3 weeks, both to introduce the idea of community-led HIVST and to teach communities the concept of undetectable = untransmissible (U = U). Paid HIVST distributors in each community were given training to promote and support HIVST and to promote uptake of confirmatory testing for those with reactive tests and HIV prevention (VMMC) following a negative self-test. Paid HIVST distributors completed door to door visits to distribute kits. Both community led and community based implementors received training materials on HIV, HIVST and treatment for preventing transmission. In addition to this, the community-led arm also received posters and flyers which could be distributed to the community. Observed community-led distribution models included 1) door-to-door distribution only or 2) door-to-door distribution as well as collection of kits directly from distributors at their homes or at various locations in the communities [