Feasibility of supervised self-testing using an oral fluid-based HIV rapid testing method: a cross-sectional, mixed method study among pregnant women in rural India.

Archana Sarkar,Surendra Kumar Mishra,Sunil Mehra,Gitau Mburu,Fiona Campbell,Ritu Dargan,Jagannath Behera,Poonam Varma Shivkumar,Pankhuri Sharma

doi:10.7448/ias.19.1.20993

Abstract

IntroductionHIV self-testing can increase coverage of essential HIV services. This study aimed to establish the acceptability, concordance and feasibility of supervised HIV self-testing among pregnant women in rural India.MethodsA cross-sectional, mixed methods study was conducted among 202 consenting pregnant women in a rural Indian hospital between August 2014 and January 2015. Participants were provided with instructions on how to self-test using OraQuick® HIV antibody test, and subsequently asked to self-test under supervision of a community health worker. Test results were confirmed at a government-run integrated counselling and testing centre. A questionnaire was used to obtain information on patient demographics and the ease, acceptability and difficulties of self-testing. In-depth interviews were conducted with a sub-sample of 35 participants to understand their experiences.ResultsIn total, 202 participants performed the non-invasive, oral fluid-based, rapid test under supervision for HIV screening. Acceptance rate was 100%. Motivators for self-testing included: ease of testing (43.4%), quick results (27.3%) and non-invasive procedure (23.2%). Sensitivity and specificity were 100% for 201 tests, and one test was invalid. Concordance of test result interpretation between community health workers and participants was 98.5% with a Cohen's Kappa (k) value of k=0.566 with p<0.001 for inter-rater agreement. Although 92.6% participants reported that the instructions for the test were easy to understand, 18.7% required the assistance of a supervisor to self-test. Major themes that emerged from the qualitative interviews indicated the importance of the following factors in influencing acceptability of self-testing: clarity and accessibility of test instructions; time-efficiency and convenience of testing; non-invasiveness of the test; and fear of incorrect results. Overall, 96.5% of the participants recommended that the OraQuick® test kits should become publicly available.ConclusionsSelf-testing for HIV status using an oral fluid-based rapid test under the supervision of a community health worker was acceptable and feasible among pregnant women in rural India. Participants were supportive of making self-testing publicly available. Policy guidelines and implementation research are required to advance HIV self-testing for larger populations at scale.

Highlights

HIV self-testing can increase coverage of essential HIV services
This study aimed to explore the acceptability, concordance and feasibility of supervised HIV self-testing among pregnant women attending an antenatal clinic in the outpatient department of a rural hospital, using a non-invasive rapid oral fluid-based HIV test
Our study demonstrates the successful use of supervised HIV self-testing among a sample of pregnant women attending antenatal services in a rural Indian hospital

Summary

Introduction

This study aimed to establish the acceptability, concordance and feasibility of supervised HIV self-testing among pregnant women in rural India. Major themes that emerged from the qualitative interviews indicated the importance of the following factors in influencing acceptability of self-testing: clarity and accessibility of test instructions; time-efficiency and convenience of testing; non-invasiveness of the test; and fear of incorrect results. Conclusions: Self-testing for HIV status using an oral fluid-based rapid test under the supervision of a community health worker was acceptable and feasible among pregnant women in rural India. In India, these include low awareness of HIV testing services, poor understanding of ways to prevent mother-to-child transmission of HIV, poor perception of HIV risk, social and cultural barriers (such as low partner support), and fear of stigma and discrimination following disclosure [5,6]. Access to HIV testing and retention in care is further obstructed by factors related to the Indian health system, such as a lack of trained healthcare workers for antenatal HIV counselling [6], long distances to HIV testing

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