Unitaid welcomes new WHO guidelines that recommend the use of HIV self-testing to help get millions of people who do not know they are infected with HIV diagnosed and put on treatment.
The guidelines are borne out by preliminary results from the world’s largest evaluation of HIV self-testing, funded by Unitaid in Malawi, Zambia and Zimbabwe. The results show that HIV self-tests can reach those who have never tested before for HIV and that self-tests are popular among people who are less likely to test such as young people and men.
Today almost 14 million people – 40 percent of all people with HIV – are unaware that they are living with HIV. The “90-90-90” fast-track targets for 2020 call for: 90 percent of all people living with HIV to know their status; 90 percent of those diagnosed with HIV infection to be on antiretroviral therapy; and for 90 percent of all people on treatment to have viral suppression.
Several groups of people, including men, young people and vulnerable groups, have made limited use of conventional testing services because they fear that having direct dealings with health workers may put them at risk of stigma and discrimination.
Preliminary results from Unitaid’s Self-testing Africa (STAR) project, in partnership with Population Services International (PSI), support WHO’s view that self-testing could substantially boost the number of people getting tested for the first time, and reach people missed by conventional testing approaches.
Data from the STAR project show that between 21-31 percent of people who used an HIV self-test did so for the first time, with high numbers of men self-testing. The majority of HIV self-test users were between 15 to 24 years of age in the three countries – an age group that is normally hard to reach. Among self-testers, 44 to 50 percent were men in Zimbabwe and Zambia – a group with historically low testing rates.
“The WHO Guidelines and these results show that HIV self-testing can efficiently bring testing services to people in the privacy of their homes,” said Lelio Marmora, Unitaid Executive Director. “Diagnosis is the gateway for treatment. With such a powerful tool, we can reach the missing 14 million who don’t know their status and meet global treatment targets.”
“The evidence presented in the WHO guidelines shows that HIV self-testing can double the uptake of testing among men and key populations – both of which are groups at risk for HIV but who are less likely to be tested,” said Dr Parirenyatwa, Zimbabwean Minister of Health and Child Care.
Under the STAR project, 603 trained workers from local communities distributed more than 125, 000 self-test kits over the last four months in Malawi, Zambia and Zimbabwe. Demand for self-testing has been unprecedented and people who tested positive were put in touch with care and treatment services.
“We welcome the STAR project, supported by Unitaid, which is promoting self-testing and helping countries to close the HIV testing gap,” said Dr Gottfried Hirnschall, Director of WHO’s Department of HIV and Global Hepatitis Programme.
An HIV self-test allows for complete confidentiality and can be done using an oral swab or a finger prick. Results are available within 20 minutes. The self-test also saves people the time and money that they would spend in going to a health facility.
“We have evidence now that demand and acceptability of HIV self-test kit use is high when offered at the community and facility level and that we are reaching people, who would otherwise not access HIV testing services,” said Dr Karin Hatzold, Project Director, Population Services International (PSI).
WHO is now urging countries to use HIV self-testing in addition to their conventional HIV testing services. “In Zimbabwe we plan to adopt this newly recommended approach as a way to achieve to reach those who are unable or reluctant to test, and achieve the first 90 goal by 2020,” added Dr Parirenyatwa.
Based on these encouraging early results, and new WHO guidelines, Unitaid remains optimistic about the promise of self testing.
