Scaling up HIV testing: the role of self-testing
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The document discusses the role and implementation of HIV self-testing (HIVST), outlining its pros and cons including accuracy, acceptability, side effects, and access. It highlights the high sensitivity of blood tests compared to oral fluid tests, the significant acceptance among users, and barriers such as lack of counseling and potential social harms. The document concludes that WHO recommends HIVST as an additional approach to enhance HIV testing services.
Scaling up HIV testing: the role of self-testing
- 1. Scaling up testing The role of HIV self-testing Karen Champenois Research Department, Maison Blanche Hospital, Paris, France
- 2. Definition of HIV self-test • HIV rapid test performed by the user – Sampling – Process – Interpretation of the result • Whole / finger-stick blood or oral fluid sample • Any positive result should be confirmed by another testing according to a national validated algorithm Source: F. Simon
- 3. HIVST available in UK (April 2015) Lab: Nazeing
- 4. www.autotest-sante.com HIVST available in France (September 2015) Instructions for use
- 5. HIVST available in France (January 2017) Lab : BiolLytical
- 6. Test stand Test DevicePouched Device Pouched Developer Vial Stepwise Instructions Pre & Post-Test Informational Booklet Package Insert HIVST available in USA (October 2012)
- 7. Policy and implementation of HIVST
- 8. HIVST – pros & cons: accuracy Pros • Sensitivity – Blood test > oral fluid test (96.4%- 98.8%) > (65.0%-97.9%) • Specificity ~ 100% • Invalid test (<5%) – Blood test > oral fluid test Cons • Low sensitivity in early infections • Window period of 3 months • Increased rate of false negative tests when people are on ART – Implication for PrEP Pant Pai et al. Plos One 2013; Figueroa et al. AIDS Conference 2016; Pavie et al. Plos One 2010; Suntharasamai et al. Plos one 2015
- 9. HIVST – pros & cons: acceptability Pros • High acceptability up to 98% • Preference – HIVST > conventional testing – Oral fluid > blood sample • Confidentiality, convenience, immediacy Cons • Remaining concerns – Lack of counseling – Risk of handling error – Test reliability Pant pai et al. Plos One 2013; Figueroa et al. AIDS Behav 2015; Greacen et al. AIDS care 2012
- 10. HIVST – pros & cons: side effects Pros • Enhance autonomy, empowerment – Controling one’s health choice – Reducing at risk behaviour • Reduce barriers as stigma Cons • Self-harm • Uncertain access to information, counseling and care • Social harm – Intimate partner violence – Coercive testing Figueroa et al. AIDS Behav 2015; Brown et al. AIDS Behav 2014; Carballo-Diéguez et al. AIDS and Behav 2012
- 11. HIVST – pros & cons: access Pros • Large availability – Pharmacies – Internet – Over the counter approaches • Privacy Cons • Actual accessibility • Internet : numerous tests of questionable quality • Price – €28 / £30 / US$40 ≠ socially vulnerable populations Figueroa et al. AIDS Behav 2015; Myers et al. AIDS Behav 2016;
- 12. Values and preferences of key populations in France • MSM – Accuracy and reliability of tests. Preference for blood-based HIVST – HIVST as a prevention tool (repeated testing), used in a context of risk behaviour • Migrants from Sub-Saharan Africa – Security for using HIVST – Benefit to know HIV status and free access to care regardless the administrative situation – Communication tool adapted (color, shape, …) • PWID – Implication of service providing specific health care and substance misuse community organisations • Transgender people – HIV testing is not the health priority
- 13. HIVST: expected to increase uptake and frequency of HIV testing mainly in key populations Encouraging first results • In France, MSM the most interested in HIVST were those who ‒ live their sexual life with men in the absolute secrecy ‒ had never been tested • In NL, HIVST succeeded in reaching first-time and infrequent testing population • In USA, using ads on Grindr increased the HIVST uptake in MSM • In USA and Australia, 2 RCTs showed an increase in testing frequency in MSM in the HIVST arm • Lack of evidence remains ‒ Reduction of the time period between infection and diagnosis ‒ Linkage to care after a HIVST in high income country Greacen et al. AIDS Care 2012; Zuure et al. AIDS Conference 2016; Huang AIDS Prev 2016; Rosengren et al. Sex Health 2016; Katz et al. IAS 2015; Jamil et al. AIDS conference 2016
- 14. As conclusion • WHO new guidelines HIV self-testing should be offered as an additional approach to HIV testing services (strong recommendation, moderate quality evidence) Available at http://www.who.int/hiv/pub/vct/hiv-self-testing-guidelines/en/
- 15. Thank you for your attention 15
- 16. SlideF.Larue
- 17. Fast-track the end of AIDS in the EU practical evidence-based interventions