HIV self-testing could "revolutionize testing in South Africa, but it has got to be done properly": perceptions of key stakeholders.

Tawanda Makusha,Miriam Taegtmeyer,Roger Peck,Jeanette Lim,Olivia Tulloch,Heidi van Rooyen,Adlai Davids,Lucia Knight,Susan Marie Graham

doi:10.1371/journal.pone.0122783

Abstract

South Africa bears the world’s largest burden of HIV with over 6.4 million people living with the virus. The South African government’s response to HIV has yielded remarkable results in recent years; over 13 million South Africans tested in a 2012 campaign and over 2 million people are on antiretroviral treatment. However, with an HIV & AIDS and STI National Strategic Plan aiming to get 80 percent of the population to know their HIV status by 2016, activists and public health policy makers argue that non-invasive HIV self-testing should be incorporated into the country HIV Counseling and Testing [HCT] portfolios. In-depth qualitative interviews (N = 12) with key stakeholders were conducted from June to July 2013 in South Africa. These included two government officials, four non-governmental stakeholders, two donors, three academic researchers, and one international stakeholder. All stakeholders were involved in HIV prevention and treatment and influenced HCT policy and research in South Africa and beyond. The interviews explored: interest in HIV self-testing; potential distribution channels for HIV self-tests to target groups; perception of requirements for diagnostic technologies that would be most amenable to HIV self-testing and opinions on barriers and opportunities for HIV-linkage to care after receiving positive test results. While there is currently no HIV self-testing policy in South Africa, and several barriers exist, participants in the study expressed enthusiasm and willingness for scale-up and urgent need for further research, planning, establishment of HIV Self-testing policy and programming to complement existing facility-based and community-based HIV testing systems. Introduction of HIV self-testing could have far-reaching positive effects on holistic HIV testing uptake, giving people autonomy to decide which approach they want to use for HIV testing, early diagnosis, treatment and care for HIV particularly among hard-to reach groups, including men.

Highlights

South Africa bears the world’s largest burden of HIV with over 6.4 million people living with the virus [1]
While HIV counseling and testing (HCT) coverage has increased in the country there is a need for continued expansion of HCT, coupled with linkage to care, as only 31% of known HIV positive persons were on antiretroviral treatment (ART) [1]
Levels of enthusiasm for HIV self-testing (HIVST) were high amongst stakeholders with the view that: “. . . it [could] revolutionize testing in South Africa” (Academic 2); it was timely: “This is something that is long overdue” (Academic 3) and that it could be used to achieve universal testing: “Every South African should be tested at least once a year. . .we need to have various approaches of reaching people, innovative and yet user friendly” (Government representative 1)

Summary

Introduction

South Africa bears the world’s largest burden of HIV with over 6.4 million people living with the virus [1]. People living with HIV (PLHIV) are often diagnosed late, resulting in avoidable morbidity, mortality, and transmission of the virus [2,3,4]. Effective control of the HIV epidemic in South Africa requires high coverage of HIV testing and linkage to treatment amongst all groups [2, 3, 5, 6]. Despite improved testing coverage in the general population, hard-to-reach groups—such as men who have sex with men (MSM), commercial sex workers (CSW), adolescents, and all men—are underserved, with poor access to testing and treatment services, high levels of stigma and discrimination and poor integration into health systems [7]

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Discussion

Conclusion