by Sandy Garçon, Senior Advocacy Manager, PSI
Interventions that were previously available in the developing world only through health clinics are increasingly being found in the Global South on the shelves of pharmacies, at health kiosks or through community health workers bringing product and services to consumers’ front doors. Self-care, as it’s been deemed, is shifting the center of gravity for many diagnostics, drugs and devices from a clinical setting to individuals self- administering at home or in their workplaces. This takes the notion of task-shifting in health to a whole new level.
Since 2016, PSI has been leading the implementation of the Unitaid-funded HIV Self-Testing Africa (STAR) initiative to catalyze and shape the global market for HIV self-testing (HIVST). The aim is to help reach the goal of 95 percent of HIV positive individuals knowing their status by improving the uptake and frequency of testing among those who are reluctant or have limited access. This often includes men, adolescents and key populations. Nearly 5 million HIVST kits will be distributed across Eswatini, Malawi, Lesotho, South Africa, Zambia and Zimbabwe by 2020, enabling an unprecedented number of individuals to learn their status in a stigma-free private space.
We wanted to know what the health workers on the frontline of the fight against HIV/AIDS think about placing this kind of power in consumers’ hands. So, we asked them.
Nurses Genevieve Weimers and Sharon Murundi-Manganye (both working at public sector healthcare facilities in South Africa), Manqosa Khang (HIV Testing Services Coordinator in Lesotho’s Leribe District) and Lungowe Musonda (sister in-charge at Mapalo Health Facility in Lesotho’s Copperbelt Province) answered a series of interview questions to help us understand how HIVST self-care turned skeptics into advocates.
What was your initial view on HIVST before it came to your area?
Genevieve Weimers: My initial view was that it may disrupt the normal HIV testing services (HTS) program, which is already implemented in the facility. My concern was that a lot of programs are introduced in a very short space of time.
Sharon Murundi-Manganye: Initially, I didn’t understand the program and was very skeptical regarding how the community would receive new test types and how it would affect HTS and traditional testing.
Manqosa Khang: Initially, I thought HIVST was a strategy to retrench counselors because I thought conventional testing was not going to be used anymore.
Lungowe Musonda: I had a negative opinion because I thought people would not be able to test themselves at home.
How has HIVST been received by the people and populations that you serve?
GW: Since the introduction of HIVST in the facility where I am working, I have noticed that a lot of clients are interested in using a new method of HIV testing. More clients are reached daily. Those who were never interested in the facility are now testing.
LM: Most people are accessing the tests, are able to test and to share the results with the health practitioners.
How have you integrated HIVST into the services you offer at your healthcare center? How has HIVST impacted HIV service delivery?
SMM: We included patient navigators and case managers to assist clients that screened positive to be navigated for confirmation.
MK: I had to introduce it to the district authorities and create awareness at work places—mostly at construction sites, government ministries and banks. It has doubled counselors’ efforts to convince the client for testing, hence, my sites always meet their target.
As a provider, what challenges has HIVST helped you surpass?
MK: I have been able to surpass zero-positive reporting and the challenge of testing many people unnecessarily with a conventional test because HIVST is a screening tool before a conventional test can be done.
LM: Congestion in HIV counseling and testing rooms has reduced and more patients are testing, thereby increasing the number of people knowing their status.
How has HIVST impacted patient behaviors?
SMM: Those that opted for [a self-test] have returned with their partners, as well as family members, advocating for the test. They are also sticking to the window period notice.
MK: Basotho males have changed attitudes and behavior toward health services, which they previously considered as services for females and children.
What challenges do you see with HIVST service delivery and distribution?
MK: The main challenge is that, due to the fact that it is new in Lesotho, most people get tempted to re-test for HIV to see if it can reveal the results they already know. The challenge can be overcome by capacitating counselors more and more to be able to probe further and dig for necessary information before giving out HIVST [kits].
LM: Some opt to test at home because there is insufficient room to test at the health facility.
Where does more work need to be done?
GW: Making sure all stakeholders are on the same page with regard to newly approved guidelines.
LM: More work needs to be done in maternal and child health for secondary distribution, where male involvement is poor.
Do you think that HIVST should replace conventional testing?
GW: Both HIVST and traditional [testing] can be implemented simultaneously. Clients should be allowed to choose which method they prefer
SMM: It is important that both HTS and HIVST are offered to the client as options. Test kits should be made freely available to all interested or opting to test. Those returning with a positive result should be linked to care immediately.
This article appears in PSI’s Impact magazine, released in tandem with Women Deliver 2019, as part of an ongoing conversation about putting #PowerInHerHands.
Banner Image: © Unitaid/Eric Gauss