Someone may know that HIV/STI testing is important and still avoid testing. Often times, the problem is not from lack of information but fear, stigma, lack of funding or avoiding generalized care.

Person-centered prevention means designing prevention around lived experiences, preferences, concerns and circumstances rather than expecting everyone to fit in the same service model. This approach is a critical attribute of high-quality healthcare, promoting quality of life and improving an individual’s interaction with the health system[1]. However, achieving this in resource limited settings is often a challenge constrained by factors like the fear of being recognized, confidentiality and privacy concerns, healthcare provider judgment, cost of transportation to the facility, long waiting times, inconvenient clinic hours, or fear of having a positive result. There are also gender and age-related barriers, limited access to youth-friendly services, concerns around STI specifically and digital and health-literacy barriers.

Understanding the presence of these barriers should help change the conversation from asking about the strategies to get more people into clinics to what would make testing easier for these people. In line with WHO’s global strategy on HIV for 2022–2030 and UNAIDS’ targets set in 2021, a person-centered approach is essential to allow for this transformation of health systems and health services must offer an integrated response to the evolving health needs[2]. Therefore, person-centricity should be at the core of every healthcare initiative. In practice, this means moving away from the idea that HIV and STI testing must happen in one place, at one time, and through one approach. Different people face different barriers, so testing services should offer different ways to access care.

For some people, community-based testing and outreach services can bring testing closer to where people live, work, study, or gather, reducing the time and transport required to reach a health facility. For others, HIV self-testing, where appropriate and supported by clear linkage-to-care pathways, may provide greater privacy and control over when and where they test. Pharmacy-based services can also create another point of access for people who already seek health products and advice in these settings, while mobile services can reach communities that are poorly served by fixed facilities.

Digital tools can complement these approaches by providing information, reminders, risk assessment, referral support, or guidance on where and how to access testing. Similarly, flexible clinic models, including extended hours or appointment options, can make services more accessible to people whose work, school, caregiving responsibilities, or other circumstances make conventional clinic schedules difficult.

The important point is not that one of these approaches is better than the others. Their value depends on the barriers faced by the people they are intended to serve. A person-centered system therefore asks not only whether testing is available, but whether it is available in a way that is acceptable, accessible, private, convenient, and connected to the care and prevention services a person may need afterwards.

In practice, this may mean bringing testing closer to people rather than expecting everyone to come to a clinic. Community and mobile testing can reduce distance and transport barriers, while self-testing, where appropriate, can offer greater privacy and control. Pharmacy-based services, outreach, digital support, and flexible clinic hours can provide additional pathways for people who may find conventional services difficult to access. The goal is not to choose one model over another, but to create options that respond to different realities.

A young person, a sex worker, a rural resident, a university student, and someone concerned about an STI may face very different barriers to testing. For one person, it may be distance. For another, privacy, stigma, cost, or fear of judgement.

This is why understanding people’s experiences matters. At PeCHIVReT, our human-centered research approach reminds us that people should not only be the subjects of research. Their experiences should help shape the questions we ask and the services we design. Testing should also not be treated as an isolated event. What happens before testing, during the interaction, and after the result all matter. A person-centered approach should connect testing with the services people may need next, including PrEP, STI care, treatment, counselling, partner services, and ongoing support.

Measuring how many people tested is important, but it does not tell us whether they felt respected, supported, or able to access the next step. As researchers and program facilitators, we can start by asking communities what they actually need and also involve them in program design. We can measure more than uptake by considering privacy, trust, accessibility, and acceptability, while testing different service-delivery models and adapting them based on evidence.

Most importantly, low testing uptake should not automatically be interpreted as low awareness. Sometimes, people know a service exists but face barriers that make using it difficult. If prevention is meant to protect people, then people must be part of how prevention is designed. Person-centered prevention asks us to look beyond whether someone tested and understand what made testing possible, difficult, or unacceptable in the first place. For PeCHIVReT, this means using research not only to describe communities, but to help build health services that respond to their realities.