Abstract
BackgroundIn South Africa, stigma, discrimination, social visibility and fear of loss of confidentiality impede health facility-based HIV testing. With 50% of adults having ever tested for HIV in their lifetime, private, alternative testing options are urgently needed. Non-invasive, oral self-tests offer a potential for a confidential, unsupervised HIV self-testing option, but global data are limited.MethodsA pilot cross-sectional study was conducted from January to June 2012 in health care workers based at the University of Cape Town, South Africa. An innovative, unsupervised, self-testing strategy was evaluated for feasibility; defined as completion of self-testing process (i.e., self test conduct, interpretation and linkage). An oral point-of-care HIV test, an Internet and paper-based self-test HIV applications, and mobile phones were synergized to create an unsupervised strategy. Self-tests were additionally confirmed with rapid tests on site and laboratory tests. Of 270 health care workers (18 years and above, of unknown HIV status approached), 251 consented for participation.FindingsOverall, about 91% participants rated a positive experience with the strategy. Of 251 participants, 126 evaluated the Internet and 125 the paper-based application successfully; completion rate of 99.2%. All sero-positives were linked to treatment (completion rate:100% (95% CI, 66.0–100). About half of sero-negatives were offered counselling on mobile phones; completion rate: 44.6% (95% CI, 38.0–51.0). A majority of participants (78.1%) were females, aged 18–24 years (61.4%). Nine participants were found sero-positive after confirmatory tests (prevalence 3.6% 95% CI, 1.8–6.9). Six of nine positive self-tests were accurately interpreted; sensitivity: 66.7% (95% CI, 30.9–91.0); specificity:100% (95% CI, 98.1–100).InterpretationOur unsupervised self-testing strategy was feasible to operationalize in health care workers in South Africa. Linkages were successfully operationalized with mobile phones in all sero-positives and about half of the sero-negatives sought post-test counselling. Controlled trials and implementation research studies are needed before a scale-up is considered.
Highlights
A vast proportion of HIV infected individuals worldwide (6/10) do not know their serostatus [1]. This is because HIV testing in health care facilities are impeded by long wait times, lack of privacy and fear of loss of confidentiality of test results, and stigma and discrimination associated with an HIV diagnosis [2,3,4]
There is an urgent need to arrange for private and confidential alternatives to facility-based testing. To address this public health need, we developed an innovative, synergistic, HIV self-testing strategy that can be performed with oral HIV tests, and in future, in the comforts of one’s own home. We evaluated this strategy in a population of health care workers (HCW) from the University of Cape Town
Of 270 participants that were approached for study participation, 251 (93.0%) consented, of which 126 completed the internetbased application, and about 125 completed paper-based application (Figure 2)
Summary
A vast proportion of HIV infected individuals worldwide (6/10) do not know their serostatus [1]. This is because HIV testing in health care facilities are impeded by long wait times, lack of privacy and fear of loss of confidentiality of test results, and stigma and discrimination associated with an HIV diagnosis [2,3,4]. A selftesting strategy for HIV offers a private and confidential alternative to facility-based tests, but evidence on feasibility of self-testing from South Africa remains limited. In South Africa, stigma, discrimination, social visibility and fear of loss of confidentiality impede health facilitybased HIV testing. Non-invasive, oral self-tests offer a potential for a confidential, unsupervised HIV self-testing option, but global data are limited
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