Largest global HIV self-testing study takes off

Delegates at the just concluded 21st International AIDS Conference 2016 heard that there is a strong demand for HIV self-testing in rural areas of Africa according to a study done in Zimbabwe.

The largest global HIV Self-Testing Africa (STAR) research project also studied whether the same self-testing kits would help male partners of women undergoing antenatal services to test and whether such a procedure would sometimes be coercive.

HIV self-testing has been proposed as an additional approach to help countries expand access to HIV testing services.  World Health Organization (WHO) defines HIV self-testing as a process in which a person, who wants to know his or her HIV status, collects a specimen, performs a test and interprets his or her test result, often in private.

There are many models for implementing HIV self-testing, which vary in the level of support provided and how and where HIV self-testing kits are distributed.  Approaches include support from health workers, distribution or sale in the community or a health facility, as well as sale in pharmacies, kiosks, vending machines and through the Internet.

The conference heard that the four-year STAR project aims to generate evidence from the study communities on the acceptability, feasibility, scalability, costs and cost-effectiveness of the various methods.

The first phase of the study is from 2015 - 2017 and over 730,000 self-testing kits will have been distributed across Zambia, Zimbabwe and Malawi. The second phase which will be from 2017 - 2019 will be done in South Africa and will provide more two million self-testing kits.

"Community-based distribution of HIV Self-testing is acceptable and results in high testing coverage, particularly among men and young people. The high testing yield suggests participation by high risk individuals with unknown status, although we cannot exclude use of kits to confirm known HIV+ve status. More precise estimates of uptake and linkage based on household surveys are currently being analyzed," Euphemia Lindelwe Sibanda of the Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe, said while presenting at the conference.

Self-testing to support male partner testing

In Uganda as in most other countries, women are tested for HIV during pregnancy but men do not always get tested. Many tricks have been employed to get men to be tested during the time when their partners are undergoing antenatal care but the results have not been good.

So Anthony Gichangi of Jhpiego Kenya led a study to find out whether male partners could be tested during their partner's antenatal and found out that men who got tested during their partner's antenatal tripled.

His presentation was titled ‘Provision of oral HIV self-test Kits triples uptake of HIV testing among male partners of antenatal care clients: results of a randomized trial in Kenya'.

In a three-arm randomized controlled study in 14 antenatal care sites in Eastern and Central Kenya,  1410 consenting women at first antenatal were randomized with an overall aim of the study being to increase men's testing rates.

At the time of analysis, 756 were followed up and 669 men responded to the survey (623 couples). Of the 669 men surveyed, in Group 3, 83% of men reported having taken the HIV test, compared to 28% in Group 1 and 36% in Group 2.  Most men testing for HIV indicated testing together with their partner regardless of the study group, information that was corroborated by the female partners. Of the men using HIV self-test kits, over 90% reported it was very easy to take a swab and read the test results.

Preliminary results from the trial indicate that the antenatal care platform offers a unique opportunity to increase HIV testing among men using oral self-test kit. By increasing male partner testing, the potential exists to reduce mother-to-child-transmission and other new infections among adults.

Coercion

In many countries where HIV self-testing is already an approved HIV prevention intervention, the rate of gender based violence is high with many people reporting being forced to test.

Therefore a study done in Blantyre, Malawi wanted to find out whether it would be alright and safe to provide self-testing kits in situations like these.

The study led by Wezzie Lora of Malawi Liverpool Wellcome Trust, Blantyre, told the conference that data on coercion was collected using mixed methods ‘But the focus in this paper is on 60 serial biographical interviews (15 men, 15 women and 15 couples) collected at two time points with individuals aged 16-49 years who collected the HIV Self-testing  kit in Blantyre'

The results showed that HIV self-testing kit was an empowering tool especially for women by bringing test kits into the household.

Coercive testing was considered acceptable in some contexts where people were in a stable relationship or had a history of infidelity and had never disclosed HIV status.

Coercive testing was often considered as a beneficent act that helped people to control their future. In other cases, coercion was viewed as an infringement of human rights but actual impacts of coercive testing did not reflect perceived impacts of coercive testing.

"In cases where coercion was considered acceptable actual realities of coercion were not considered unethical. The impact of methodological approaches needs to be understood in researching complex concepts such as coercion," Lora concluded.