Self-testing for HIV with rapid diagnostic tests is as reliable and accurate as testing by health care workers, according to a new review and meta-analysis.
“HIV self-testing is just an additional approach for people to learn their HIV status, particularly for individuals who are reluctant or unable to access existing HIV testing services because of concerns about privacy, stigma, discrimination, and, in some contexts, criminalisation,” Dr. Carmen Figueroa of the World Health Organization in Geneva, the first author of the new study, told Reuters Health by email. The findings were published online April 24.
From 35% to 44% of people with HIV worldwide do not know that they are HIV positive. In order to help reach the United Nations goal of 90% of HIV-positive individuals knowing their status by 2020, the World Health Organization has strongly endorsed HIV self-testing.
To inform the recommendation, Dr. Figueroa and her colleagues analyzed 25 studies, including 13 of unassisted HIV self-testing, 11 of directly assisted HIV self-testing and one study of both approaches.
Raw proportion of agreement for assisted and unassisted testing ranged from 85.4% to 100%. “Overall, our estimates of pooled agreement across studies were almost perfect for both types of approaches,” the authors write. “Pooled estimates according to whether HIV self-testing was observed or not also had almost perfect agreement.”
Sensitivity for self-testing ranged from 80% to 100%, while specificity was 95%-100%.
“In case of a reactive result, doctors as usual should offer further testing and treatment if confirmed positive and in case of a non-reactive result advise individuals to retest as needed and advise linkage to relevant HIV prevention services,” Dr. Figueroa said. “People living with HIV aware of their status and taking antiretrovirals should not use (HIV self-testing), as they can obtain a false-negative result.”
She added: “Available evidence from different settings and populations shows that linkage to care after HIV self-testing is variable, ranging from 10.2% to 100%. We still need to explore how much time people will need to process a reactive result and link to care and explore the effect of distribution models and the role of type of assistance in linkage to care.”
Because HIV testing efforts typically focus on pregnant women, women have “much better” access to testing than men do, said Dr. Jeffrey D. Klausner of the University of California, Los Angeles, who co-authored an editorial accompanying the study.
“I think this HIV home self-testing is a real breakthrough, because it allows men in particular to test privately, to test at home, and not have to take off work potentially or travel some place to get tested,” he told Reuters Health by phone. “If it’s effectively promoted it has the potential to make a big difference.”
The HIV Self-testing Africa (STAR) Initiative, funded by Unitaid, is aiming to distribute 4.8 million HIV self-test kits across the continent by 2020. In an approach being evaluated in Malawi, pregnant women are given self-test kits to pass along to their male partners, Dr. Klausner noted.
“In China they’re putting them in vending machines; we’ve had them in the United States in vending machines in sex clubs, and they have been very popular,” he said. “Those are new strategies that need to be scaled up and evaluated.”
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Lancet HIV 2018.
By Anne Harding