Accuracy and Acceptability of Oral Fluid HIV Self-Testing in a General Adult Population in Kenya.

Ann E Kurth,Edwin Were,John E Sidle,Charles M Cleland,Nok Chhun,Wilfred Emonyi,Violet Naanyu,Stephen M Macharia,Edwin Sang,Abraham M Siika

doi:10.1007/s10461-015-1213-9

Ann E Kurth, Edwin Were + Show 8 more

Open Access

https://doi.org/10.1007/s10461-015-1213-9

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Abstract

We evaluated performance, accuracy, and acceptability parameters of unsupervised oral fluid (OF) HIV self-testing (HIVST) in a general population in western Kenya. In a prospective validation design, we enrolled 240 adults to perform rapid OF HIVST and compared results to staff administered OF and rapid fingerstick tests. All reactive, discrepant, and a proportion of negative results were confirmed with lab ELISA. Twenty participants were video-recorded conducting self-testing. All participants completed a staff administered survey before and after HIVST to assess attitudes towards OF HIVST acceptability. HIV prevalence was 14.6 %. Thirty-six of the 239 HIVSTs were invalid (15.1 %; 95 % CI 11.1–20.1 %), with males twice as likely to have invalid results as females. HIVST sensitivity was 89.7 % (95 % CI 73–98 %) and specificity was 98 % (95 % CI 89–99 %). Although sensitivity was somewhat lower than expected, there is clear interest in, and high acceptability (94 %) of OF HIV self-testing.

Highlights

Knowledge of HIV status is key to earlier access to HIV treatment and prevention services
We evaluated performance, accuracy, and acceptability parameters of unsupervised oral fluid (OF) HIV self-testing (HIVST) in a general population in western Kenya
Our objective is to evaluate the performance and accuracy parameters of unsupervised oral fluid HIV self-testing among adult lay users in the general population of Kenya

Summary

Introduction

Knowledge of HIV status is key to earlier access to HIV treatment and prevention services. As an HIV prevention strategy, HIV testing is cost effective, estimated to cost US$249 per HIV-1 infection averted in Kenya [1, 2]. It is the fundamental entry point to an effective seek, test, treat and retain (STTR) paradigm, which has the potential to bend the curve of the HIV pandemic [3]. Health seeking behavior among undiagnosed persons living with HIV (PLWH), especially men, and an overemphasis on facility based approaches to HIV testing services [4].

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