By Kristen Little, HIV/TB Research Advisor, PSI
How do we do a better job reaching those most affected by the HIV epidemic? PSI’s answer: bring HIV services closer to consumers. A key piece of this strategy is PSI’s new project leveraging the private sector to increase access to and uptake of HIV self-testing (HIVST) among populations at high risk of HIV infection in Kenya, including adolescents.
Launched in March 2017, the two-year $2 million-dollar grant from the Children’s Investment Fund Foundation (CIFF) is being implemented by PSI in partnership with in-country independent network member, Population Services Kenya. The project aims to demonstrate the potential of Kenya’s private sector to generate informed consumer demand for HIVST.
While HIV testing has traditionally been driven by the public sector, in many countries private providers represent a major and growing – if not preferred – source of health services. Engaging with and strengthening the private sector (e.g., private clinics, pharmacies, drug vendors) is essential to ensure greater access to innovations like HIVST.
Lucy Maikweki, PS Kenya’s director for HIV/TB, agrees: “The environment in Kenya is ripe for the roll-out of private sector HIVST. Implementation guidelines have been launched by the Ministry of Health to support HIVST scale-up, and there is a big focus on reducing stigma and discrimination, especially among youth, and increasing testing and treatment coverage.” HIV self-testing transcends many of the common barriers to HIV testing, such as fear of stigma and discrimination, lack of privacy, lack of time, and distance and cost of transportation to the nearest health facilities. To this end, the project will particularly target groups that have been historically hard to reach with conventional testing approaches, including adolescents, young women and adult men.
More than 80,000 HIV self-test kits will be distributed over the life of the project through 120 private sector pharmacies and small franchised health clinics in Nairobi and Mombasa counties. The kits will allow individuals to test themselves, at the time and location of their choosing, using an oral fluid- or blood-based rapid diagnostic test.
OraSure Technologies’ OraQuick HIV Self-Test and bioLytical Laboratories’ INSTI HIV Self Test – both registered with the Kenyan Pharmaceuticals and Poisons Board and the Kenyan Medical Laboratory Technicians and Technologists Board – were selected for the research to be conducted by this project. The first uses a simple oral fluid swab and provides results in 20 minutes, while the second is a blood-based test that gives results in under a minute.
This project will generate important insights into consumer preferences, willingness to pay for self-tests, demand creation approaches, and test operation and linkage support strategies for private sector HIVST. It will also explore subsidy levels and targeting required to generate demand among youth and adolescents, building upon the leadership of the National AIDS and STI Control Program (NASCOP) and the recent launch of national guidelines for HIV self-testing.
While HIV self-tests are available in several sub-Saharan African countries, this project is one of the first efforts to use private sector distribution of HIVST to reach public health goals. “There is a growing body of evidence on the acceptability and feasibility of HIV self-testing,” said Petra Stankard, PSI’s senior technical advisor for HIV/TB. “But most of the investment in HIVST so far has been largely public-sector focused. CIFF’s investment in private sector HIVST distribution is strategic, and promises to generate important and timely evidence for the field.”
Project findings will inform national guidelines and contribute to efforts by the Ministry of Health to ensure broad access to HIVST in Kenya. “We have an opportunity to meaningfully contribute to achieving the first of the 90-90-90 targets in Kenya,” concluded Joyce Wanderi, PS Kenya’s chief operating officer, referring to the UNAIDS goal of having 90% of people living with HIV knowing their status by 2020. “Private sector HIVST can help us to reach people that our other testing approaches haven’t.”
Banner photo: © Population Services International / Banner Photo by: Eric Gauss