VANCOUVER, Canada – HIV self-testing has been a hot topic at this meeting beginning with the release of new HIV testing guidelines by the World Health Organization here that include it, and its potential role in meeting the first 90 of the UNAIDS 90-90-90 framework. The number of people in the HIV epicenter that is southern Africa who do not know their status remains enormous, and for men who have sex with men, the numbers are higher — some 70 percent in South Africa alone, according to Sherri Lippman, of University of California, San Francisco, who presented today on the potential value of HIV self-testing for men who have sex with men in Africa.
Nevertheless, most of the information about gay men and HIV self testing comes from the United States — one of two countries in the world that actually have licensed products and national guidelines about self-testing. The other is the United Kingdom. Whether the acceptability of HIV self testing found in U.S. studies are generalizable to the African context remains to be seen, but studies done in Peru and Brazil suggest that HIV self tests might be welcomed by men who have sex with men who have been reluctant to seek testing in health care settings. Even less is known about how successfully men who have sex with men who self-test can be linked to care but as Lippman noted, “I don’t know that we can do worse.”
Men in general in Africa, who lag well behind women, migrants, and older individuals who have not been convinced they are at risk also could be helped by self testing, said Peter MacPherson, of Wellcome Trust Clinical Research Programme in Malawi. So far, according to MacPherson, most studies in Africa have focused on the general acceptability of testing by community members but a great many studies are currently under way. The notable exception to this is information from demonstrations in Malawi, which explored delivery venues for the tests and was reported here from a presentation of its results at CROI 2014.
In addition to indicating widespread acceptability of HIV self-testing, the Malawi demonstration showed that HIV self-testing is cheaper than facility-based testing — ranging from $.69 to $4.40 per test depending on what test is used.
MacPherson noted there are many critical research and implementation questions and challenges that need to be explored from evaluating new technologies and new tools to improving linkage to care, developing context appropriate tools to improve accuracy, and evaluating HIV self-testing in a wide range of groups, especially men, other populations with high incidence and low access to services, and older individuals. Also important, MacPherson said, are improvements to policies and regulations at the country level to make the products available to those who want to use them. Population Services International and UNITAID have a project aimed at improving the market for self-testing, and price reduction will be vital to ramping up the use of this testing method to reach those who need it most in poor, high HIV burden countries.