The contribution of HIV self-testing in achieving the UNAIDS first ‘95’ target
Context
The UNAIDS 95-95-95 targets are a set of ambitious goals aimed at ending the AIDS epidemic by 2030. The first of these targets is to ensure that 95% of all people living with HIV are aware of their HIV status. Achieving this target is crucial, as knowing one’s status is the first step towards accessing treatment and preventing further transmission.
HIV self-testing (HIVST) has emerged as a pivotal tool in this endeavor. By offering a convenient, private, and accessible means for individuals to test themselves, HIVST addresses many of the barriers associated with traditional testing methods that include stigma, discrimination, and the logistical challenges of accessing healthcare facilities.
According to current global statistics on HIV awareness and testing, as of 2023, approximately 86% of people living with HIV globally knew their HIV status. This means about 5.4 million people were unaware of their HIV status and still needed access to testing services.
Exploring HIV self-testing
Typology :
There are two main types of HIV self-tests available, namely, Rapid Self-Tests that can be done at home and provide results within 20-40 minutes and typically involve collecting a sample of oral fluid or a small amount of blood from a finger prick, and Mail-In Self-Tests which require the collection of a sample (usually blood from a finger prick) that is sent to a laboratory for analysis. Results are typically available within a few days.
Both types of tests are designed to be user-friendly and provide a confidential way to know one’s HIV status.
Potential :
HIV self-testing (HIVST) significantly improves accessibility and convenience in several ways, namely:
- Confidentiality and Privacy: HIVST allows individuals to test themselves in the privacy of their homes, reducing the fear of stigma
- Convenience: People can perform the test at a time and place that suits them, without the need to schedule appointments or travel to healthcare facilities
- Empowerment: HIVST empowers individuals by giving them control over their health. It encourages people who might not otherwise get tested, such as those in high-risk populations or those who have never been tested before.
- Increased Reach: HIVST can reach populations that are underserved by traditional healthcare systems, including those in remote or rural areas.
- Rapid Results: Most HIV self-tests provide results within 20-40 minutes, allowing for quick decision-making and linkage to care if needed.
Accuracy and reliability:
Most HIV self-tests have high sensitivity (ability to correctly identify those with HIV) and specificity (ability to correctly identify those without HIV). For example, many sel-tests have a sensitivity af around 99.7% and specificity of about 99.9%. The accuracy of self-tests can be affected by the ‘window period’ which is the time between potential exposure to HIV and the point when the test can reliably detect the virus. Most self-tests are less effective at detecting very recent infections (within the last few weeks) because they primarily detect antibodies, which take time to develop. The reliability of self-tests can also depend on how well the user follows the instructions. Studies have shown that most people can accurately use self-testing devices, but incorrect usage can lead to false results. However, a positive result from a self-test should always be confirmed with a follow-up test conducted by a healthcare professional to ensure accuracy.
Challenges and limitations
HIV self-testing offers many benefits but also comes with certain challenges and limitations.
In addition to the ‘window period’ mentioned earlier and the fact that the accuracy of self-tests can be compromised if users do not follow the instructions correctly, there are other limitations such as lack of counseling, linkage to care, stigma and discrimination to some extent, and cost and accessibility:
- Unlike traditional testing at healthcare facilities, HIVST does not provide immediate access to professional counseling and support, which can be particularly challenging for individuals who test positive and need emotional support and guidance on the next steps.
- Ensuring that individuals who test positive with HIVST seek confirmatory testing and subsequent care can be difficult. Without proper follow-up, people might not receive the necessary treatment and support.
- While HIVST can reduce stigma by allowing private testing, individual who test positive might still face stigma and discrimination, which can deter them from seeking further care.
- In some regions, the cost of HIVST kits can be a barrier and availability might be limited in remote or underserved areas.
Successful case studies and pilot programmes
The following cases illustrate the successful implementation of HIV Self-Testing intiatives in some regions:
- STAR Initiative in Africa: The HIV Self-Testing Africa (STAR) Initiative, funded by Unitaid, has been one of the largest and most successful HIVST programs. Implemented in several African countries, including Zimbabwe, Malawi, and Zambia, the initiative has distributed millions of HIVST kits. It has significantly increased testing rates, especially among high-risk populations, and has been instrumental in normalizing HIV testing.
- PrEP and HIVST Integration: Studies have shown that integrating HIVST with pre-exposure prophylaxis (PrEP) programs can be highly effective. For example, a program in Kenya provided HIVST kits to individuals on PrEP, which helped in regular monitoring and early detection of HIV, ensuring timely linkage to care.
The Vital Role of community organizations and Healthcare providers
Community organizations and healthcare providers play crucial roles in promoting HIV self-testing. Community organizations often distribute HIVST kits making them accessible to people who might not visit healthcare facilities. This includes reaching out to high-risk populations and those in remote areas.
Both community organizations and healthcare providers develop and disseminate educational materials about HIVST. They conduct awareness campaigns to inform people about the availability, benefits and proper use of self-tests, provide pre and post-test counseling to individuals who use HIVST to help them understand their results and take appropriate next steps, whether it’s seeking confirmatory testing or accessing prevention and treatment services.
In addition, community organizations often create safe and supportive environments where individuals can feel comfortable discussing their HIV status and accessing self-testing kits while healthcare providers play a vital role in ensuring that individuals who test positive with HIVST are linked to confirmatory testing and subsequent care. They help navigate the healthcare system and provide necessary medical support
Both community organizations and healthcare providers advocate for policies that support the integration of HIVST into national HIV strategies. They work to reduce stigma and discrimination, making it easier for people to access and use self-tests.
Recommendations
To maximize the impact of HIVST, the following recommendations are proposed:
- Accelerate the regulatory approval process for HIVST kits to increase their availability.
- Implement widespread awareness campaigns to educate the public about HIVST
- Develop robust systems to ensure individuals who test positive with HIVST are promptly linked to confirmatory testing and treatment services.
- Integrate HIVST into existing HIV prevention and treatment programs to enhance their reach and
Conclusion
HIV self-testing is a pivotal innovation in the fight against HIV/AIDS when effectively implemented and supported. By addressing the challenges and implementing the recommended strategies, HIVST can significantly contribute to achieving the first UNAIDS “95” target, ultimately moving closer to ending the AIDS epidemic by 2030.
by Rose Meku
