HIV Self-testing:key to controlling the global epidemic

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HIV Self-testing:key to controlling the global epidemic

A new international study has confirmed that self-testing for HIV is effective and could be the answer to controlling the global epidemic. This major systematic review, led by the Research Institute of the 香蕉视频 Health Centre (RI-MUHC), shows HIV self-testing removes much of the fear and stigma associated with being tested for the disease. This study, which is published in PLoS Medicine is the first of its kind and could pave the way for early detection and treatment around the world, thereby reducing transmission.

Published: 4 April 2013

According to UNAIDS*, 50 per cent of people living with HIV worldwide are unaware of their HIV status and about 2.5 million people become infected every year. Dr. Pant Pai firmly believes that access to an HIV self-test linked to expedited counselling systems will help expand access to screening and reduce judgement and perceived attitudes around HIV testing. Self-tests are performed in oral fluid samples from the gum lining of the mouth in the privacy of one鈥檚 home. They are non-invasive, convenient, ensure confidentiality and can provide results within 20 minutes. The results are self-interpreted however, and require confirmation at a medical clinic if positive.

There is a lot of global momentum in favour of HIV self-testing with several countries and health networks advocating their use. Several studies have been conducted to determine the best methods of making a self-test with linked counselling and referral services available in various African, North American and European settings. Dr. Pant Pai and her colleagues decided to look at the global evidence on self-testing strategies based on acceptability, feasibility and accuracy and success with linkages to care.

They examined 21 worldwide studies and found that two distinct self-testing strategies have been tried: 聽supervised self-testing (self-testing and counselling aided by a health-care professional), and unsupervised self-testing (self-testing performed without any help but with counselling available by phone or internet). Most of the data came from studies carried out in high-income settings including the United States, Canada, Spain and the Netherlands, as well as Kenya, Singapore, Malawi and India.

Across the various studies, researchers observed that acceptability (defined as the number of people who self-tested divided by the number who consented to self-test) was very high for both self-testing strategies. They also found evidence that people preferred self-testing to facility-based testing and oral self-testing to blood-based self-testing. 鈥淭he preference was largely driven by the fact the oral self-tests are non-invasive, convenient, easy to swab and do not involve a finger stick or blood from your arm for a preliminary screen,鈥� explains Dr. Pant Pai. 鈥淎 lot of people also wanted to take the oral self-test home to test their partners.鈥�

Dr. Pant Pai鈥檚 project is supported by a Stars in Global Health award from Grand Challenges Canada, which is funded by the Government of Canada. 鈥淐anada has a deep pool of talent dedicated to pursuing bold ideas that can have big impact in the developing world,鈥� adds Dr. Peter A. Singer, CEO of Grand Challenges Canada. 鈥淕rand Challenges Canada is proud to support innovators like Dr. Pant Pai because they will make a difference to many lives.鈥�

Dr. Pant Pai and colleagues urge policy makers everywhere to look at the proven results of supervised and unsupervised self-testing, and think how best to put these strategies into practice in their own countries. 鈥淲e have, as a society, made great progress with biomedical tools, drugs and strategies, but we haven鈥檛 conquered HIV-related stigma and perceived discrimination. The time is now right to tailor strategies to suit the preferences and lifestyles of patients with a view to expand access.鈥�

* Human immunodeficiency virus (HIV)

*2012 UNAIDS Report on the Global AIDS Epidemic

About this study

This work was supported by funds from Grand Challenges Canada (GCC). Dr. Nitika Pant Pai鈥檚 project is supported by a Stars in Global Health award from Grand Challenges Canada, which is funded by the Government of Canada.

The study entitled 鈥�Supervised and Unsupervised Self-Testing for HIV in High- and Low-Risk Populations: A Systematic Review鈥� was coauthored by Nitika Pant Pai (Division of Clinical Epidemiology,RI-MUHC and Department of Medicine, 香蕉视频, Montreal, Canada); Sushmita Shivkumar, Sabrina Pillay, Caroline Vadnais (Division of Clinical Epidemiology ,RI-MUHC, Montreal, Canada); Jigyasa Sharma and Lawrence Joseph (Department of Epidemiology, Biostatistics and Occupational Health, 香蕉视频, Montreal, Canada); Keertan Dheda (Division of Pulmonology and UCT Lung Institute, Department of Medicine and Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa); and Rosanna Peeling (London School of Hygiene and Tropical Medicine, London, UK).

Link to the study:

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