Self-testing, an innovative and efficient tool for screening
HIV self-testing is a process by which the person takes the sample (oral fluid or blood), performs the HIV test, and then interprets the result, often in a private setting, alone or with a trusted person.
The HIV self-test is an innovative tool that empowers the patient, allows more people to be diagnosed HIV-positive and helps to achieve the first of the United Nations 90-90-90 targets : to ensure that, by 2020, 90% of people living with HIV know their HIV status. Expanding the use of ADVIH contributes to these global goals by first encouraging those who are being tested for the first time, but also undiagnosed HIV-positive people and those at constant risk (who must be tested regularly).
WHO has formally recommended that HIV self-testing should be offered as an additional approach to HIV testing services.
ADVIH thus complements the traditional screening offers. As a result, it makes it possible to reach populations that previously had no access to screening due to barriers to health access such as discrimination, stigma, distance or cost.
The guide developed by WHO in 2016 highlights the following elements from the different experiences :
For many users, HIVST promotes discretion and enjoys high acceptability, particularly among key populations, including men, youth, caregivers, pregnant women and their male partners, couples and the general population;
HIVST represents a step forward in increasing patient autonomy, decentralizing services and creating demand for HIV testing among populations without access to existing services;
HIVST can provide results as reliable as when used by a trained provider, provided that the products used meet quality, safety and performance standards (as is the case with the OraQuick oral test and the INSTI blood test, pre-qualified by WHO). In-person demonstrations and the provision of other information resources, such as videos, can also contribute to better performance of HIV self-tests.
HIV self-tests can be distributed in different ways in the public and private sectors, including at the community level, in health facilities or via Internet. Users can also sometimes choose between an oral or blood HIV self-test. As a result, different populations can benefit from a wide range of HIV self-test options.
In addition, experience shows that ADVIH :
more than doubles the use of HIV testing among men who have sex with men, male partners of pregnant women and women who have recently given birth ;
increases the use of HIV testing by couples, especially male partners of pregnant women or postpartum women ;
almost doubles the frequency of HIV testing for men who have sex with men ;
can identify an equivalent or higher percentage of HIV-positive people ;
does not reinforce risky behaviours (such as anal intercourse without a condom) or the number of bacterial sexually transmitted infections (STIs) ;
does not reduce the use or frequency of STI screening ;
does not increase negative social consequences, adverse events or behaviours ;
performs as well as an HIV TOR used and interpreted by a skilled health worker.
HIV self-tests do not provide a definitive diagnosis. It is a diagnostic-oriented rapid test for triage purposes, which means that people with reactive results must undergo additional tests, performed by a provider trained according to a nationally validated screening strategy.
The HIV self-test can be performed with direct (human) assistance or without assistance. Additional strategies (free telephone line, demonstration video, website, information brochures) can be used to support the user in both cases.
Information, support and guidance are essential so that the user is referred to appropriate services based on the result obtained, particularly when he or she is reactive positive, so that he or she can confirm his or her status and have access to care if necessary.
Whichever approach is chosen, people who test themselves must be provided with clear information on how to test, how to interpret the result correctly, and where and how to access HIV prevention, treatment, care and support services. In particular, they must be aware of the following aspects :
a reactive result is not a positive diagnosis for HIV and must be confirmed with additional screening. If the result is confirmed, the person concerned must be explained where and how to access treatment and care.
a non-reactive result is assumed to be negative. Users who are exposed to a high or constant risk of HIV, or who may have been exposed to HIV within the previous six weeks, should be re-tested and referred to an appropriate HIV prevention service (e. g. post-exposure prophylaxis or pre-exposure, voluntary medical circumcision).
an invalid result (impossible to interpret) requires the user to repeat the test again either with a new ADVIH kit or by going to the screening centre.
The various existing self-tests
At present, two HIV self-assessment devices, one oral and one blood, have been pre-qualified by the World Health Organization.
Oral self-test
The oral HIV self-assessment device consists of a spatula and a reagent. After pressing the spatula on the upper and lower gums, the device is immersed in the reagent for twenty minutes. If the result is reactive, it is advisable to go to an HIV testing centre for a confirmation test. If the result is negative, it is advisable to find out about preventive measures to remain HIV-negative and/or to repeat the test within three months if a risk has been taken.
This test detects antibodies that the body develops when infected with HIV (HIV-1 or 2). It does not detect viral particles.
Blood self-test
The blood HIV self-test device works by taking a drop of blood from the fingertip, placed in one of the test windows, and adding reagent to another window. Within a few minutes, the result appears. If the result is reactive, it is advisable to go to an HIV testing centre for a conformation test. If the result is negative, it is advisable to find out about preventive measures to remain HIV-negative and/or to repeat the test within three months if a risk has been taken.