HIV self-testing (HIVST) delivered by trained volunteers may prove to be widely used, safe, accurate, and acceptable in urban settings of sub-Saharan Africa, according to a study published this week in PLOS Medicine. This community-based prospective study also showed that HIVST may lead to acceptable linkage into HIV care services and have a very low incidence of major social harms such as partner violence.
In sub-Saharan Africa, only one quarter of adults have had a recent test and only half of people with HIV know their status. Home-based HIV testing and counseling (HTC) can achieve high uptake of testing, but requires heavy involvement of trained healthcare workers. Here, researchers evaluated an alternative to home-based HTC - HIV self-testing (HIVST) - in a two-year community-based prospective study in Blantyre, Malawi. HIVST involves training individuals to perform and interpret their own HIV test. Three-quarters of the residents in the study self-tested and more than half of the 1257 participants who discovered they were HIV-positive accessed HIV care. Importantly, 94.6% of the participants reported that they were "highly satisfied" with HIVST even though 2.9% reported being forced to take the test, usually by a main partner. No HIVST-related partner violence or suicides occurred. Finally, HIVST and repeat HTC results agreed in 99.4% of participants selected as a quality assurance sample (1 in 20 of the participants).
The authors acknowledge limitations in the study design that will have introduced some imprecision around the estimates of uptake and linkage into care, and also that the acceptability and accuracy of HIVST may differ between, for instance, urban and rural communities. Nevertheless, these findings suggest that scaling-up HIVST could complement existing strategies for the control of the HIV/AIDS epidemic.
Based on material originally posted by PLOS.