Abstract
Stigma, discrimination, lack of privacy, and long waiting times partly explain why six out of ten individuals living with HIV do not access facility-based testing. By circumventing these barriers, self-testing offers potential for more people to know their sero-status. Recent approval of an in-home HIV self test in the US has sparked self-testing initiatives, yet data on acceptability, feasibility, and linkages to care are limited. We systematically reviewed evidence on supervised (self-testing and counselling aided by a health care professional) and unsupervised (performed by self-tester with access to phone/internet counselling) self-testing strategies. Seven databases (Medline [via PubMed], Biosis, PsycINFO, Cinahl, African Medicus, LILACS, and EMBASE) and conference abstracts of six major HIV/sexually transmitted infections conferences were searched from 1st January 2000-30th October 2012. 1,221 citations were identified and 21 studies included for review. Seven studies evaluated an unsupervised strategy and 14 evaluated a supervised strategy. For both strategies, data on acceptability (range: 74%-96%), preference (range: 61%-91%), and partner self-testing (range: 80%-97%) were high. A high specificity (range: 99.8%-100%) was observed for both strategies, while a lower sensitivity was reported in the unsupervised (range: 92.9%-100%; one study) versus supervised (range: 97.4%-97.9%; three studies) strategy. Regarding feasibility of linkage to counselling and care, 96% (n = 102/106) of individuals testing positive for HIV stated they would seek post-test counselling (unsupervised strategy, one study). No extreme adverse events were noted. The majority of data (n = 11,019/12,402 individuals, 89%) were from high-income settings and 71% (n = 15/21) of studies were cross-sectional in design, thus limiting our analysis. Both supervised and unsupervised testing strategies were highly acceptable, preferred, and more likely to result in partner self-testing. However, no studies evaluated post-test linkage with counselling and treatment outcomes and reporting quality was poor. Thus, controlled trials of high quality from diverse settings are warranted to confirm and extend these findings. Please see later in the article for the Editors' Summary.
Highlights
On July 3, 2012 the US Food and Drug Administration (FDA) approved an oral point-of-care (POC) HIV self test, OraQuick, for over-the-counter (OTC) sale on the basis of a positive recommendation from their Blood Product Advisory Committee (FDABPAC) [1]
Both supervised and unsupervised testing strategies were highly acceptable, preferred, and more likely to result in partner self-testing
A total of 1,207 studies were identified from databases and bibliography searches and 14 abstracts retrieved from conferences for a total of 1,221 citations
Summary
On July 3, 2012 the US Food and Drug Administration (FDA) approved an oral point-of-care (POC) HIV self test, OraQuick, for over-the-counter (OTC) sale on the basis of a positive recommendation from their Blood Product Advisory Committee (FDABPAC) [1] This decision, the first for a self test for an infectious disease, is an important step towards normalizing the process of receiving an HIV diagnosis, currently beset with stigma and discrimination. Discrimination, lack of privacy, and long waiting times partly explain why six out of ten individuals living with HIV do not access facility-based testing By circumventing these barriers, self-testing offers potential for more people to know their sero-status. HIV infection can be controlled but not cured by taking a daily cocktail of powerful antiretroviral drugs throughout life
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