What if people everywhere could find out if they have HIV without having to sidle into a testing site, without having to face the judgement of another person, and without worrying the whole neighborhood would learn about their test and its results?
Dr. Nitika Pant Pai of McGill University believes that without those barriers more people living with the virus would know it, would get into care earlier, take steps to avoid transmitting the virus, and that those changes, in turn would lower HIV incidence and health care costs.
Dr. Pai is the lead author of a paper released today on PLOS Medicine that examines an answer to those obstacles, noting they are part of the reason six in 10 people remain unaware of their positive HIV status. The answer, testing in the privacy of home, is is at hand, but, the feasibility of its use has been little explored, according to the paper. Supervised and Unsupervised Self-Testing for HIV in High and Low-Risk Populations: A Systematic Review, examines what is, and isn’t known so far about how and where non-facility based testing could be used.
“We have all these tools out there,” she told Science Speaks, “and we believe that self-testing will expand access, improve knowledge of sero-status, increase community engagement, and that that will be empowering.”
The U.S. Food and Drug Administration approved the OraQuick test for over-the-counter sales in July 2012, because of the opportunity it offered to help more people to know if they have the virus. Still the potential for the test to be used in diverse settings and make a difference in places where its possible benefits are needed most, has remained unexplored, the authors of the paper say.
They undertook a review of what they narrowed down to 21 studies for findings on whether the tests are a desired alternative to facility-based testing and why, whether they are used correctly, produce accurate results, can lead to appropriate care, and what people would be willing to pay for the tests. The settings and populations included healthcare workers in Kenya, urban American men who have sex with men, a general population in Malawi, and attendees of a rapid testing site in Spain. Some findings varied by setting. While University students in Canada were willing to pay up to $10 for tests, and some in the U.S. were willing to pay as much as $20, healthcare workers in Kenya felt the government should pay for the tests, as HIV was seen an occupational hazard. In settings where education levels were low, problems with using the tests correctly were more common. In those settings, authors noted supervised self-testing may be needed. And while Canadian students showed some interest in accessing counseling following results over the Internet or telephone as well as community clinic based counseling), most Malawians in a study preferred in-person counseling.
Around the world, and across the diversity of settings, though, authors found that the privacy and convenience the tests could provide made the tests acceptable and preferred. Much more, however, needs to be learned on how the tests can lead to efficient and confidential links to care, the paper concludes.