Is HIV self-testing an answer, or another obstacle?

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McGillScience Speaks staff writer and Global Health Policy Research Coordinator Rabita Aziz is attending and writing from McGill Summer Institute in Infectious Diseases and Global Health this week.

MONTREAL — Access to self-testing for HIV is critical to reaching goals that UNAIDS has projected would end the pandemic by 2030, that begin with 90 percent of all people living with the virus knowing it, a speaker here said this week.

Globally, forty-six percent of people infected with HIV don’t know it. Fear of the stigma, discrimination, and lack of confidentiality that patients may face at healthcare centers when seeking HIV testing, Dr. Nikita Pant Pai of McGill University said in a discussion of diagnostic technologies Tuesday, is a major reason for that gap.

First approved by the Food and Drug Administration in 2012, HIV self-tests, she said, are not only efficient and private but also pave the way for people who take a test but are not infected with HIV to move forward and consider using prevention measures that can include pre-exposure prophylaxis, circumcision, and post-exposure prophylaxis.

HIV self-tests are also empowering, she said, and can “democratize the process of testing” by putting it into the hands of patients, especially patients who may face heightened stigma and discrimination in places where “an HIV diagnosis is not well received.”

Participants in the discussion expressed concern that  by taking self-testing to areas and populations where testing isn’t normally available, it’s also going where health systems to support people who test positive also aren’t available. In that case, linkage to care, as well as to testing for other sexually transmitted infections could be further out of reach, they noted.

For the HIV self-test to be effective in reaching 90-90-90 goals, “a functional health system has to be there in the background,” Stephen John of the State AIDS Agency of Nigeria said.

To address these and other concerns about the HIV self-test, Pai and colleagues developed HIVSmart, an open-source smartphone application and self-test that informs individuals on how to self-test and links them to care. The app was field tested in South Africa, Pai said, and will be taken to scale this year when 3000 adults in 18 townships in South Africa will be enrolled in a larger study. Pai also plans on field testing the app among Canadian men who have sex with men.

Still the discussion outlined some of the challenges to self-testing that may lie ahead.

Reaching marginalized populations with self-testing remains difficult, Rosanna Peeling of the London School of Medicine said. And it’s not only marginalized populations that are hard to reach in high burden, resource-limited countries, and even in wealthier countries.

“Botswana has around 81 percent of people living with HIV knowing their status,” Bill Rodriquez of FIND, said. “We’re really looking for the 75,000 who don’t know their status, and they’re probably mostly young men.”

“For the typical young man going out on a Friday night, picking up a self-test isn’t a priority on their list of things to do,” he said. “It’s hard in every part of the world to link a 20 year old man to a health system, they’re just not aware or uninterested.”

Follow Rabita on twitter at @AzR86


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