Introduction: HIV testing services in Malawi are predominantly through facility-based provider testing. In 2016, the World Health Organization recommended HIV self-testing (HIVST) to complement existing testing approaches. HIVST services are provided in both facility and community settings through primary (direct distribution to the final user) or secondary distribution (distribution through an index or sexual contact who will pass the kit along to the final user). In this thesis, I evaluated the impact of distributing HIVST free at the point of use on costs, access, and socioeconomic equity in HIV testing in Malawi. I had four main questions: 1) what was the cost of accessing facility-based provider HIV testing services in Malawi?; 2) what was the cost of providing HIVST in Malawi, South Africa, Zambia, and Zimbabwe?; 3) how can socioeconomic status be measured in a low-income setting such as Malawi?; 4) how does HIVST affect socioeconomic equity in uptake of HIV testing and the distribution of subsidies from HIV testing in Malawi? Data: I used a combination of nationally representative publicly available datasets and data collected as part of the Self-Testing AfRica (STAR) project which was a multi-country project aimed at generating evidence and catalysing the market for HIVST. Methods: There were four main evaluations that were conducted as part of this thesis. The first was an evaluation of costs of accessing testing. The costs of accessing HIV testing services were collected as part of a baseline household survey evaluating the impact of community- based distribution of HIVST in Malawi. The second evaluation was a descriptive analysis of costs of providing HIV testing services in four countries in Southern Africa. I used ingredient-based costing approach combining bottom-up and top-down costing approaches. The third evaluation was the construction of a standard of living index using secondary data collected in a Living Standards Measurement Study for Malawi. I constructed a shorter standard of living index that can be easily incorporated in household surveys. The aim of this objective was to develop an index that could be used in the equity evaluation of this thesis. The final evaluation explored socioeconomic equity in uptake of HIV testing and over-testing for HIV using the STAR endline household survey data. Combining the provider cost and uptake data, I further evaluated the distribution of subsidies from HIV testing using benefit incidence analysis (BIA). Results: From the cost evaluation, the self-reported average cost of accessing HIV testing services in Malawi was US$3.18 (range: U$2.66-3.71). Men reported user costs twice as high as women with lost income on average, accounting for 83% of total costs. The costs of providing HIV testing varied with the testing approach. Facility-based provider testing had lower unit costs than HIVST, regardless of HIVST distribution modality. The cost of providing HIV testing services ranged from USS$5.77 (range: US$3.46-9.76) in facility-based provider testing to US$15.09 in secondary distribution of HIVST integrated in public primary healthcare facilities. Cost of the test kits and personnel were key cost drivers across all testing approaches. I also constructed a standard of living index for Malawi with the aim of using it to measure socioeconomic status in the equity evaluation. This standard of living index comprised of housing characteristics, household assets and human capital variables. Finally, I evaluated socioeconomic equity in uptake of HIV testing services and the distribution of subsidies from testing for HIV. Full sample showed equity in the socioeconomic distribution of testing and subsidies from HIV testing. Over-testing in standard of care was associated with a higher degree of inequalities concentrated among the richer than in areas with HIVST. Distribution of subsidies was not in accordance with need especially for the poorest in areas with HIVST. Full sample analysis concealed socioeconomic inequalities that were evident when analysis was disaggregated by gender. Conclusion: Conventional testing, despite having lower provider costs than HIVST, is associated with higher user costs. HIVST is recommended to improve testing uptake among populations left behind. HIVST improves uptake of testing in such groups but is associated with increasing socioeconomic inequalities. Socioeconomic equity implications associated with HIVST should be considered when implementing and scaling up HIVST.