Pai doesn't see self-testing as a replacement for testing in medical settings or the work done by community based organizations. According to Pai, self-testing is a middle road: a way to reach people who are either inaccessible to our other systems or don't get tested due to fear of stigma and discrimination. Convenience, confidentiality, and affordability may make self-testing attractive to some people who would not otherwise get tested.
Pai also mentioned that implementers of self-testing options should be careful to educate providers and community health care workers. In her research, she found that many people in the HIV workforce were leery of self-testing, partly due to fear that their own jobs might be in jeopardy. She thought it was important to frame the self-test as a bridge to care for people who don't normally access care and who, after first experiencing self-testing, may ultimately become more comfortable with more traditional forms of testing.
She also addressed criticisms of self-testing, including whether people in coerced relationships (intimate partner violence, sex workers with pimps, etc.) would be forced to test and, if found positive, further targeted for violence, or whether people who fear a positive diagnosis would commit some form of self-harm or even suicide without the testing help of a provider or community health worker. She made it very clear that little evidence exists of these things occurring due to self-testing.
However, Pai did discuss one major factor that remains a potential barrier: the cost of the home test. "We need affordable self-tests," said Pai. "And we need affordable self-tests not just for the African continent, but we need them for middle- and high-income countries too. We cannot sell them for $40 or $80 when they cost just maybe $10."