Rapid HIV Self-Testing

Abstract


 Self-testing has become recognizable to most people in Canada as a way to reduce the spread of infections. HIV self-testing has recently become available in Canada and is an approach to HIV screening intended to complement existing HIV testing currently offered in medical and community settings. Self-test kits can be used in the home, alone or in the presence of another person, and they may help overcome barriers to HIV diagnosis, and help Canada achieve its commitments to end the HIV and AIDS epidemics by 2030.
 HIV self-testing is recommended by the WHO, used in countries worldwide. The INSTI HIV-1/2 Antibody Self Test is the first HIV self-test available in Canada. It is a single-use HIV test kit that detects HIV-1 and HIV-2 antibodies from a drop of blood collected by a fingerstick. In 50% of people, the test can detect HIV infection about 22 days after exposure, and in 99% of people can detect HIV infection 12 weeks (3 months) after infection.
 As the INSTI HIV-1/2 Antibody Self Test is intended as a screening test, a positive result must be confirmed with a laboratory-based test. If the result is negative, no further action is required unless the tester has had a potential HIV exposure in the previous 3 months. In this case, a person should self-test at a later date or seek a laboratory-based HIV test that is able to detect HIV in a shorter window of time since potential exposure.
 While the comparability of the INSTI HIV-1/2 Antibody Self Test with traditional lab testing has already been established, when used in real-world settings in Canada, there is a higher than-expected rate of invalid test results (that is, when the test does not produce a result and therefore another test must be taken). Improvements to the content, design, or delivery of the test instructions and other resource materials provided to testers have been offered as possible solutions.
 This report outlines information related to the INSTI HIV-1/2 Antibody Self Test use in Canada and issues for consideration when implementing an HIV self-testing program including cost, support for testers, and providing test access to groups who have historically had lower testing rates.