Ethical implications of HIV self-testing: the game is far from being over

Bain, Luchuo Engelbert; Ditah, Chobufo; Awah, Paschal Kum; Ekukwe, Nkoke Clovis

doi:10.11604/pamj.2016.25.114.8303

Cited by 6 publications

(5 citation statements)

References 9 publications

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“…ART initiation was lower in the HIVST arms compared to the standard-of-care arm, although it approximately doubled between the 1- and 4-month visits, from 25% to 50%. Both linkage to care and ART initiation increased rapidly in the HIVST arms, approaching the standard-of-care arm by 4 months, supporting the hypothesis that linkage to care and ART initiation take longer with HIVST, and mitigating some concern that individuals who self-test will not link to care [ 30 ]. By 4 months, ART initiation in the standard testing arm approached previously described estimates of ART coverage among FSWs in Zimbabwe [ 14 ] and exceeded a previous global estimate of 36% among FSWs in low- and middle-income countries [ 31 ].…”

Section: Discussionmentioning

confidence: 80%

HIV self-testing among female sex workers in Zambia: A cluster randomized controlled trial

Chanda¹,

Ortblad

Mwale³

et al. 2017

PLoS Med

122

173

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BackgroundHIV self-testing (HIVST) may play a role in addressing gaps in HIV testing coverage and as an entry point for HIV prevention services. We conducted a cluster randomized trial of 2 HIVST distribution mechanisms compared to the standard of care among female sex workers (FSWs) in Zambia.Methods and findingsTrained peer educators in Kapiri Mposhi, Chirundu, and Livingstone, Zambia, each recruited 6 FSW participants. Peer educator–FSW groups were randomized to 1 of 3 arms: (1) delivery (direct distribution of an oral HIVST from the peer educator), (2) coupon (a coupon for collection of an oral HIVST from a health clinic/pharmacy), or (3) standard-of-care HIV testing. Participants in the 2 HIVST arms received 2 kits: 1 at baseline and 1 at 10 weeks. The primary outcome was any self-reported HIV testing in the past month at the 1- and 4-month visits, as HIVST can replace other types of HIV testing. Secondary outcomes included linkage to care, HIVST use in the HIVST arms, and adverse events. Participants completed questionnaires at 1 and 4 months following peer educator interventions. In all, 965 participants were enrolled between September 16 and October 12, 2016 (delivery, N = 316; coupon, N = 329; standard of care, N = 320); 20% had never tested for HIV. Overall HIV testing at 1 month was 94.9% in the delivery arm, 84.4% in the coupon arm, and 88.5% in the standard-of-care arm (delivery versus standard of care risk ratio [RR] = 1.07, 95% CI 0.99–1.15, P = 0.10; coupon versus standard of care RR = 0.95, 95% CI 0.86–1.05, P = 0.29; delivery versus coupon RR = 1.13, 95% CI 1.04–1.22, P = 0.005). Four-month rates were 84.1% for the delivery arm, 79.8% for the coupon arm, and 75.1% for the standard-of-care arm (delivery versus standard of care RR = 1.11, 95% CI 0.98–1.27, P = 0.11; coupon versus standard of care RR = 1.06, 95% CI 0.92–1.22, P = 0.42; delivery versus coupon RR = 1.05, 95% CI 0.94–1.18, P = 0.40). At 1 month, the majority of HIV tests were self-tests (88.4%). HIV self-test use was higher in the delivery arm compared to the coupon arm (RR = 1.14, 95% CI 1.05–1.23, P = 0.001) at 1 month, but there was no difference at 4 months. Among participants reporting a positive HIV test at 1 (N = 144) and 4 months (N = 235), linkage to care was non-significantly lower in the 2 HIVST arms compared to the standard-of-care arm. There were 4 instances of intimate partner violence related to study participation, 3 of which were related to HIV self-test use. Limitations include the self-reported nature of study outcomes and overall high uptake of HIV testing.ConclusionsIn this study among FSWs in Zambia, we found that HIVST was acceptable and accessible. However, HIVST may not substantially increase HIV cascade progression in contexts where overall testing and linkage are already high.Trial registrationClinicalTrials.gov NCT02827240

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Section: Discussionmentioning

confidence: 80%

HIV self-testing among female sex workers in Zambia: A cluster randomized controlled trial

Chanda¹,

Ortblad

Mwale³

et al. 2017

PLoS Med

122

173

View full text Add to dashboard Cite

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“…A key concern with self‐testing is whether self‐testers would seek HIV treatment . This study demonstrated a noteworthy 100% linkage to HIV treatment; the national linkage rate is 31% .…”

Section: Discussionmentioning

confidence: 99%

Uptake of HIV self‐testing and linkage to treatment among men who have sex with men (MSM) in Nigeria: A pilot programme using key opinion leaders to reach MSM

et al. 2018

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Introduction HIV self‐testing (HIVST) offers an alternative to facility‐based HIV testing services, particularly for populations such as men who have sex with men (MSM) who may fear accessing testing due to stigma, discrimination and criminalization. Innovative HIV testing approaches are needed to meet the goal of 90% of people living with HIV being diagnosed. This study piloted an intervention to distribute oral HIVST kits to MSM through key opinion leaders (KOLs) in Lagos, Nigeria and assessed the feasibility, acceptability, uptake of HIVST and linkage to HIV treatment.MethodsA cohort study was conducted (May through September 2017) with 319 participants who were recruited by 12 KOLs through their networks. A baseline survey was conducted at the time of the oral HIVST kit (OraQuick® HIV antibody test) distribution to eligible MSM followed by a 3‐month follow‐up survey to assess usage of and experience with the HIVST kits. Each participant was given two kits.ResultsThe median age of the participants was 25 years, 88.7% were literate and 17.9% were first‐time testers. Of the 257 participants (80.7% retention) who completed the three‐month follow‐up interview, 97.7% reported using the HIVST kit and 14 (5.6%) self‐reported an HIV positive result. A quarter (22.7%) tested themselves the same day they received the kit, and 49.4% tested within one week. Almost all participants reported that the HIVST kit instructions were easy or somewhat easy to understand (99.6%) and perform the test (98.0%). The most common reasons they liked the test were ease of use (87.3%), confidentiality/privacy (82.1%), convenience (74.1%) and absence of needle pricks (64.9%). All 14 participants who tested positive had sought confirmatory testing and initiated HIV treatment by the time of the three‐month survey.ConclusionsHIVST distribution through KOLs was feasible and oral self‐testing was highly acceptable among this urban MSM population. Despite concerns about linkage to treatment when implementing self‐testing, this study showed that linkage to treatment can be achieved with active follow‐up and access to a trusted MSM‐friendly community clinic that offers HIV treatment. HIVST should be considered as an additional option to standard HIV testing models for MSM.

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“…The goal of increasing the number of people who get tested for HIV is to be able to get people under treatment and to ultimately have PLHIV with undetectable viral load. Ensuring linkage to care should then be a condition for selftesting to be effective, in addition to post-test counseling for behavioral change in the case of a negative HIV test (Bain et al, 2016). Linkage to care is limited in WCAR, with a weak health system and a lack of policies on HIVST.…”

Section: Fourth Challenge: Linkage To Hiv Prevention and Care Services/facilitiesmentioning

confidence: 99%

HIV self-testing: The key to unlock the first 90 in West and Central Africa

Ekouévi

Bitty-Anderson

Gbeasor-Komlanvi

et al. 2020

International Journal of Infectious Diseases

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The West and Central African region (WCAR) still registers some of the highest rates of new HIV infections worldwide (16%) despite a low prevalence of HIV (1.9%). In this region, only 48% of people living with HIV are aware of their HIV status. To fill this gap, HIV Self testing (HIVST) could potentially be an additional approach to overcome the barriers to diagnose HIV infected patients, therefore being one of the keys to unlock the first 90 as recommended by the World Health Organization (WHO) since 2016. However, many challenges remain for the adoption of HIVST in routine clinical practice in low prevalence settings and need to be contextualized to WCAR settings. We report in this paper some of the challenges and discuss opportunities for a successful implementation of HIVST in the WCAR.

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Ethical implications of HIV self-testing: the game is far from being over

Cited by 6 publications

References 9 publications

HIV self-testing among female sex workers in Zambia: A cluster randomized controlled trial

HIV self-testing among female sex workers in Zambia: A cluster randomized controlled trial

Uptake of HIV self‐testing and linkage to treatment among men who have sex with men (MSM) in Nigeria: A pilot programme using key opinion leaders to reach MSM

HIV self-testing: The key to unlock the first 90 in West and Central Africa

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