Will an Unsupervised Self-Testing Strategy Be Feasible to Operationalize in Canada? Results from a Pilot Study in Students of a Large Canadian University

Abstract

Background. A convenient, private, and accessible HIV self-testing strategy stands to complement facility-based conventional testing. Over-the-counter oral HIV self-tests are approved and available in the United States, but not yet in Canada. Canadian data on self-testing is nonexistent. We investigated the feasibility of offering an unsupervised self-testing strategy to Canadian students. Methods. Between September 2011 and May 2012, we recruited 145 students from a student health clinic of a large Canadian university. Feasibility of operationalization (i.e., self-test conduct, acceptability, convenience, and willingness to pay) was evaluated. Self-test conduct was computed with agreement between the self-test performed by the student and the test repeated by a healthcare professional. Other metrics were measured on a survey. Results. Participants were young (median age: 22 years), unmarried (97%), and 47% were out of province or international students. Approximately 52% self-reported a history of unprotected casual sex and sex with multiple partners. Self-test conduct agreement was high (100%), so were acceptability (81%), convenience (99%), and willingness to pay (74%) for self-tests. Concerns included accuracy of self-tests and availability of expedited linkages. Conclusion. An unsupervised self-testing strategy was found to be feasible in Canadian students. Findings call for studies in at-risk populations to inform Canadian policy.

‘I will choose when to test, where I want to test’

“…Previous studies have largely reported that oral-fluid tests were appealing because they were easy to use, painless and did not require a blood sample [15,16,31]; although a study in Tanzania reported dislike for this method due to lack of familiarity [32]. Our study pointed to concerns by young people around accuracy of oral-fluid tests, a finding that has previously been cited in the United States [17,18].…”

HIV testing preferences among pregnant women attending antenatal care and their male partners: a discrete choice experiment in Uganda

“…These results are not discordant with the findings from a previous DCE study among long distance truck drivers in Kenya (Strauss, George, Lansdell, et al, 2018;, in which there was a slight (but not statistically significant) preference for nurse-administered testing. However, our results stand in contrast to a number of previously published studies' findings that self-testing was Figure 1: Stratified conditional logit models for sex and HIV testing history broadly preferred to clinic-based testing (Carballo-Diéguez, Frasca, Balan, Ibitoye, & Dolezal, 2012;Choko et al, 2015;Gaydos et al, 2011Gaydos et al, , 2013Kalibala et al, 2014;Kurth et al, 2016;Lippman et al, 2016;Marley et al, 2014;Nour et al, 2012;Pant Pai et al, 2014;Peck et al, 2014;Stevens, Vrana, Dlin, & Korte, 2018). This apparent contradiction may reflect the fact that by using the DCE, we were able to separate this attribute (self-testing versus nurse-administered testing) from other attributes that in practice are usually grouped together.…”

Is it Feasible to Use an Oral-Fluid Based Rapid Test Facilitated by Frontline Workers to Improve HIV Screening of Pregnant Women in Indian Rural Settings?

“…They are from the communities and can easily reach pregnant women in remote settings. Our results clearly indicates towards the acceptance of pregnant women in rural settings for this test with uptake as 95%, which is higher than reported in other studies on oral fluid based rapid tests (83-85%) [20]. This concord with other studies conducted among rural women indicating for the preference of oral fluid-based tests over blood-based tests [21].…”