HIV SELF-TESTING : FREE TO KNOW YOUR STATUS

FAQ

 

HIV self-testing *

* Source OMS

What is HIV self-testing?

HIV self-testing is a process in which a person collects their own specimen (either oral or blood, via a fingertip prick), performs a test and interprets the result themselves. If the result is positive, the person asks to be re-tested in a facility to confirm or deny the result. If the result is negative, no further action is required unless the person has had a probable exposure to HIV or has a high ongoing risk of HIV infection.
The World Health Organization (WHO) recommends HIV self-testing as a safe and effective way to increase access to and use of HIV testing services.
Some people may want to do the self-test alone, in private. Others may prefer to use it with someone they trust, such as a friend or sexual partner, or while waiting to be seen at a health care facility.
HIV self-tests detect HIV antibodies, which are produced by a person’s body when they become infected with HIV. Antibodies are present in many body fluids, including oral fluid, blood, urine and breast milk (although HIV antibodies are present in oral fluid if a person is HIV-positive, HIV cannot be transmitted through oral fluid/saliva).
No HIV test can detect HIV infection immediately after exposure. There is usually a “window” of one to three months after exposure before HIV antibodies can be detected. In the case of self-testing, this is usually three months.

Why is HIV self-testing proposed and promoted?

Although many people have been tested for HIV in clinics and communities, it is estimated that 36 percent of HIV-positive people in West and Central Africa and 21 percent worldwide do not know their status and, therefore, are unable to obtain treatment. Self-testing is a complementary solution to access knowledge of one’s HIV status and, depending on the result, to access treatment and prevention services.
Self-tests are as accurate as tests performed in clinics. They are also easy for most people to perform, and they make it possible to test when and where one wants to. Many people find self-testing for HIV convenient and empowering.
Others, however, prefer to be tested by trained health workers or peer educators. HIV self-testing is not a substitute for these options. On the contrary, it offers an additional choice.

Why are communities important in making HIV self-testing safe, acceptable and effective?

The availability of HIV self-testing is increasing. As of September 2020, 77 countries have adopted policies supporting HIV self-testing.

Some community-based organizations, particularly in sub-Saharan Africa, have accumulated a great deal of expertise in integrating HIV self-testing into outreach services, as well as in creating demand for HIV treatment and/or prevention. The community-based approach is leading to a marked increase in the use of HIV self-testing, especially for populations that are untested, hidden and/or difficult to reach.

It is essential, at a minimum, that community organizations provide accurate messages to the community about HIV self-testing so that all people can understand and learn how to use it. They can also use their power of influence to shape community norms encouraging the use of HIV self-testing.

Community organizations can significantly shape the norms to support HIV self-testing and its appropriate use.

Another important role for community organizations includes distributing HIV self-test kits and providing support, counseling, and follow-up. Those with nonreactive results need information and referral to HIV prevention services. For those with reactive self-test results, community-based organizations can refer people to a site for confirmatory testing and, where appropriate, management, including access to treatment.

What types of tests are available?

HIV self-test kits are available in two forms:

  • Oral self-tests: the person passes a spatula over the upper and lower gums to collect oral fluid, puts the swab into a test tube and a few minutes later gets the result.
  • Blood self-tests: the person takes a drop of blood from his or her finger and places it on a device to which a reagent is added to obtain the result.

The WHO has approved a number of tests. This process is dynamic and subject to change, so it is advisable to regularly consult the list of approved self-screening kits*. To date, one oral self-test and three blood self-tests have been prequalified. In some unregulated countries, HIV self-test kits are available in pharmacies or through the Internet. The quality of these tests is unknown, so the reliability of their results is not guaranteed. It is therefore essential that all stakeholders raise awareness among potential users on the need to turn only to products approved by national authorities and identified as such.

* https://www.who.int/diagnostics_laboratory/evaluations/pq-list/self-testing_public-report/en/

What are the key messages for anyone using HIV self-testing ?
  1. A positive (reactive) HIV self-test result is not equivalent to a diagnosis of HIV seropositivity. All positive HIV self-test results should be followed by an additional test by a trained provider to confirm HIV status, starting with the first test in the national testing algorithm.
  2. However, if a person reports frequent exposure to HIV, it is important to provide information, refer them to prevention services, provide them with condoms, and recommend re-testing after 3-6 months, depending on national recommendations. Finally, a person who reports a potential exposure to HIV in the last six weeks should be encouraged to test again after three months.
  3. People who obtain an invalid HIV self-test result should be re-tested with a new HIV self-test kit or ask to be tested by a trained provider. Anyone who is unsure of his or her HIV self-test result should be referred for testing by a trained provider.
How long after a potential exposure to HIV should someone be tested?

HIV self-test kits detect antibodies that develop after one has contracted HIV. As with any form of HIV testing, a self-test will detect antibodies approximately six weeks after exposure to HIV.

Therefore, to ensure the accuracy of the result, the HIV self-test should be performed three months after a potential exposure to HIV.

I am HIV-positive I am on antiretroviral treatment. Can I use an HIV self-test kit?

A person who is HIV-positive and on antiretroviral therapy will have a decrease in HIV antibodies. Since the test looks for these antibodies, a person on treatment may test negative when performing a self-test. Conversion to seronegativity is not currently possible, so an HIV self-test is not necessary if a person has already been diagnosed HIV positive.

I am on pre-exposure prophylaxis (PrEP), can I use an HIV self-test kit?

A person on pre-exposure prophylaxis (PrEP) to prevent HIV may want to self-test in addition to HIV testing at a health care facility every three months. Self-testing should not and cannot replace quarterly testing in health care facilities, which allows for early detection and rapid treatment if necessary.

Should self-testing be offered to partners/peers?

Offering a self-test kit and encouraging a sexual partner, friend, or adult family member to take an HIV self-test is often an excellent way to help people learn their HIV status. But it is still important not to force them and to assess the risks of that person’s reaction in order to avoid harmful consequences and violence. The decision to take an HIV test should remain personal.

Should parents or guardians test their babies or children?

WHO does not recommend that parents or guardians use self-screening kits for babies or children. HIV self-test kits do not provide correct results in children under two years of age because the mother’s antibodies may still be present in the child.

If an adult is concerned that a child may have been exposed to HIV, he or she should consult a health care worker.

Can self-testing for HIV be harmful?

Thirty-two randomized controlled trials (RCTs) have shown that, compared to traditional institutional HIV testing :

  • HIV self-screening improves utilization of HIV testing services.
  • The proportion of people diagnosed and referred to care after HIV self-testing is similar to that observed after facility-based testing.
  • Cases of misuse of HIV self-testing and social harms associated with self-testing are rare. No suicides have been reported.
  • HIV self-testing does not increase the sexual risk behaviors of men who have sex with men.
  • A variety of service delivery models for HIV self-testing and support tools are proving effective.
  • Many people are willing and able to perform HIV self-testing with minimal support.
  • It is possible and acceptable to implement HIV self-testing in a variety of populations and settings.

Oraquick HIV self-test (delivered as part of the ATLAS project) *

* Source Orasure

Note: This information pertains only to the Oraquick HIV Self-Test Kit and was written by the manufacturer and translated by the ATLAS Project. The original version is available here: http://self-test.com/

What is the OraQuick® HIV Self-Test?

The OraQuick® HIV Self-Test is a tool for performing a safe and reliable HIV test in a private setting.

The OraQuick® HIV Self-Test uses oral fluid to detect the presence of HIV-1 and HIV-2 antibodies. It can give you results in 20 minutes, and if you follow the instructions carefully, the test can detect the virus in over 99% of HIV-infected people. As this is a “triage” test, it is essential, in case of reactivity, to perform a confirmatory test in a suitable setting.

The OraQuick® HIV Self-Test should only be used for HIV testing and should not be used for any other purpose. If you need to be tested for pregnancy or for a sexually transmitted disease (STD) or other infection, please contact your physician or healthcare provider. He or she can help you with the test.

How can the OraQuick® HIV Self-Test use an oral fluid for HIV testing when HIV cannot be transmitted through saliva?

HIV is not transmitted through saliva. The OraQuick® test detects antibodies produced in response to HIV infection, not the virus itself.

How accurate is the HIV test using oral fluid?

Oral HIV tests are very accurate. In studies, the OraQuick® HIV self-test detected 100% of HIV-infected people and 99.1% of non-HIV-infected people.

What are the benefits of rapid oral HIV tests?

Rapid HIV tests that use oral fluid are safe and accurate, and they provide rapid results. They are an alternative to conventional testing. OraQuick® HIV Self-Test also offers advantages such as convenience and privacy.

What can cause false positives in an HIV test?

A false positive is when an HIV test shows that a person is HIV positive when they are not.

The conditions that can lead to a false positive HIV test are as follows:

  • Incorrectly reading the test as positive,
  • Do not follow the instructions for use carefully,
  • Do not wait 15 minutes after eating or drinking, or 30 minutes after using oral hygiene products, before taking the test.

How the test works: questions before taking the test

I am pregnant and/or breastfeeding. Can I use the test?

You can safely use the OraQuick® HIV Self-Test if you are pregnant and/or breastfeeding.

I wear braces. Can I still use the OraQuick® HIV Self-Test?

You can safely use the OraQuick® HIV Self-Test if you wear braces or retainers.

Will antibiotics (or other non-HIV drugs) affect my test result?

To date, there is no evidence that the use of antibiotics or drugs (other than antiretrovirals) can affect test results. Please proceed with the test as instructed.

Take the test

I have opened my test and there is no liquid in the tube. What should I do?

If there was no liquid in the tube when you opened the kit, the kit is defective. We apologize for this inconvenience. Please discard the test kit.

You can dispose of the test with your regular garbage; no additional precautions are necessary.

What should I do if I (or a third party) accidentally drank the reagent liquid?

The ingredients contained in the test liquid are non-toxic and pose no known health risks in the amount provided in the vial. If you or someone you know has swallowed some of the liquid and you are concerned, please contact your doctor. If you were unable to perform the test, please obtain a new test kit.

What should I do if I received reagent in the eye?

The ingredients in the test liquid are non-toxic. If you have received liquid from the test tube into your eye, immediately rinse the eye with water.

There is a small pocket of absorbent material inside the package that contains the test stick. Do I need to do anything with it?

The small pouch inside the test stick package is designed to prevent moisture from affecting the test stick during storage. It should not be used to perform the OraQuick® test and can be discarded in the trash.

I mistakenly/accidentally removed the spatula (or it fell off) before the required 20 minutes. Will my results be valid?

If you have removed the spatula, or if it has fallen out, before 20 minutes of immersion, the test result is not valid even if you have immediately replaced the spatula in the tube. The spatula must remain in the tube for at least 20 minutes, as described in the instructions. Therefore, do not consider your result as an accurate indication of your HIV status.

You can dispose of the test with your regular waste; no additional precautions are necessary. Please repeat the OraQuick® test procedure with a new test kit.

I left the spatula in the reagent tube for more than 40 minutes. Will the results be accurate?

If you read the test more than 40 minutes after the spatula has been placed in the vial, the test result is invalid. Do not take the result as an indication of your HIV status.

You can dispose of the test with your regular garbage; no additional precautions are necessary.

Please repeat the OraQuick® test procedure with a new test kit and follow all instructions carefully. Please read the instructions before starting the test and make sure you understand how to collect your sample. Place the spatula in the reagent for at least 20 minutes and no more than 40 minutes before reading the test.

What do I have to do with the material after performing the test?

You can dispose of the test with your regular garbage; no additional precautions are necessary.

Understanding your results

What do the letters "C" and "T" on the spatula mean?

The letter “C” on the spatula means “control”. A line should appear next to the letter “C” if you have followed the instructions carefully and waited 20 minutes after placing your spatula in the reagent. This line means that your test is working. If NO line appears next to the letter “C”, it means that your test is not working and you will need to obtain a new one.

The letter “T” on the spatula means “test”. A line next to the letter “T”, even if the line is weak, and a line next to the letter “C”, means that you have a reactive result and that you may have HIV. You will need a second test to confirm your result. A “T” line, even if the line is weak, and no “C” line means that the test is not working and you need to be retested.

If you have a positive result, you will need a second test to confirm your result. Please go to an HIV testing site for a confirmatory test in a medical setting.

When I read my test result, there were no marks or discoloration on the spatula. What does this mean?

If there were no lines on the test stick when you read your result, your test did not work. Therefore, do not take the result as a valid indication of your HIV status.

You can throw the test away with your regular garbage; no additional precautions are necessary.

Please repeat the OraQuick® test procedure with a new test kit and carefully follow all handling and testing instructions.

My test does not have a "C" line, but a "T" line. What does this mean?

If your test has a line next to the letter “T”, but no line next to the letter “C”, it means your test did not work. For a test to work, a line MUST appear next to the area marked “C”. Therefore, do not consider the result you get as a valid indication of your HIV status.

You can throw the test away with your regular garbage; no additional precautions are necessary.

My test has a line at "C" and a very weak line at "T". What does this mean?

Any line next to the letter “T” on the spatula, regardless of its color or hue, means that you have a reactive result. You will need a second test to confirm your result. Please consult your doctor or health care provider for follow-up testing in a medical setting. Until your test result is confirmed, please take precautions to avoid the risk of spreading HIV.

My test has a line at the "C" and a very dark red line at the "T". Why is this line so dark? What does it mean?

If your test result shows a line next to the letter “C” and a line next to the letter “T”, your test is reactive. This result indicates that there is a possibility that you may be infected with HIV. However, the intensity of the lines on the test key does not correspond to the stage of the disease or the potential for infection.

You will need a second test to confirm your result. Please consult your doctor or health care provider for follow-up testing in a medical setting. Until your test result is confirmed, please take precautions to avoid the risk of spreading HIV.

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