{"id":63128,"date":"2024-10-04T14:48:38","date_gmt":"2024-10-04T18:48:38","guid":{"rendered":"https:\/\/www.psi.org\/?post_type=news&p=63128"},"modified":"2024-10-07T14:57:41","modified_gmt":"2024-10-07T18:57:41","slug":"opinion-we-need-a-self-care-revolution-to-achieve-health-care-for-all","status":"publish","type":"news","link":"https:\/\/www.psi.org\/fr\/news\/opinion-we-need-a-self-care-revolution-to-achieve-health-care-for-all\/","title":{"rendered":"Opinion: We need a self-care revolution to achieve health care for all"},"content":{"rendered":"

This article was originally published in Devex<\/a>.<\/p>\n\n\n\n

Self-care technologies are key for improving health and well-being \u2014 and for reaching universal health coverage by 2030.<\/p>\n\n\n\n

Par\u00a0Dr. Karin Hatzold<\/a><\/em><\/p>\n\n\n\n

Today,\u00a0half of the world\u2019s population<\/a>\u00a0lacks access to essential health services, leaving billions without the care they need. Achieving universal health coverage by 2030 requires more than just strengthening existing systems \u2014 it demands a fundamental shift in how health care is delivered.<\/p>\n\n\n\n

Self-care plays a critical role in this shift by expanding access to services, easing the burden on overwhelmed health systems, and empowering individuals to take control of their health.<\/p>\n\n\n\n

Innovations in self-care encompass many aspects of care. New diagnostics, devices, drugs, and digital health tools are transforming the way people interact with the health system. Technologies such as  self-testing for HIV, COVID-19, and hepatitis C are among the most promising innovations for improving health and well-being \u2014 both from an individual perspective and a health systems perspective.<\/p>\n\n\n\n

By making self-testing more accessible, acceptable, and affordable, these tools offer individuals greater choice and autonomy, foster self-determination, and promote deeper engagement in managing their health.<\/p>\n\n\n\n

Closing diagnostic gaps with self-testing <\/h2>\n\n\n\n

Self-testing and self-sampling are bridging diagnostic gaps, offering alternatives to conventional provider-led testing.<\/p>\n\n\n\n

The introduction of HIV self-testing, or HIVST, in low- and middle-income countries marked a pivotal moment in global health, laying the groundwork for a self-care revolution.\u00a0HIVST first gained momentum with the\u00a0Unitaid-funded Self-Testing Africa, or STAR, initiative<\/a>\u00a0in\u00a02015<\/a>\u00a0and was endorsed by the\u00a0Organisation mondiale de la sant\u00e9<\/a>\u00a0a year later.<\/a>\u00a0The contribution of HIV self-testing has been instrumental in increasing the percentage of people living with HIV who know their status. In 2015,\u00a0an estimated 67%<\/a>\u00a0of people living with HIV globally were aware of their HIV status. By 2023, this figure had increased to\u00a086\u00a0%<\/a>.<\/p>\n\n\n\n

Before 2015, the number of HIV tests conducted annually was increasing, yet those at highest risk \u2014 such as men who have sex with men, sex workers, and people who inject drugs \u2014 were being missed by traditional testing methods. This realization, along with the push to meet the\u00a0United Nations<\/a>‘ 90-90-90 targets by 2020, highlighted the need for more effective and targeted testing.<\/p>\n\n\n\n

HIVST emerged as a transformative solution to increasing testing uptake, providing autonomy and discretion, particularly among populations who had previously been hesitant to test. In southern and eastern Africa, the scale-up of HIVST was accelerated by\u00a0Unitaid<\/a>‘s catalytic investment in the STAR initiative, with additional support from major donors like\u00a0The U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR<\/a>, le\u00a0Global Fund\u00a0to Fight AIDS, Tuberculosis and Malaria<\/a>, le\u00a0Children’s Investment Fund Foundation<\/a>, le\u00a0Gates Foundation<\/a>, and governments\u2019 own investments.<\/p>\n\n\n\n

The importance of HIVST became even more evident during the COVID-19 pandemic, when access to traditional health services was restricted by lockdowns. HIVST kits were distributed through online pharmacies and integrated with digital technologies to facilitate the testing process and reporting by users. This ensured continued access to lifesaving antiretroviral therapy for those who tested positive, while also supporting prevention services like preexposure prophylaxis.<\/p>\n\n\n\n

As a result of the STAR initiative, demand for HIVST kits saw a dramatic increase from 500,000 to over 30 million<\/a> in the procurement pipeline between 2019 and 2024. The increasing demand attracted more manufacturers, leading to a wider range of available products. Today, there are six WHO-prequalified HIVST products in the market<\/a> along with one additional product approved by the Global Fund Expert Review Panel for Diagnostics, and several more in the pipeline. This market expansion provides clients with more choices and fosters market competition, resulting in lower HIVST kit prices.<\/p>\n\n\n\n

The STAR initiative and other research have explored additional use cases for HIVST, leading to the 2023 WHO recommendation<\/a> to expand HIVST use for preexposure prophylaxis initiation, continuation, and reinitiation, promoting HIVST through sexual and social networks (for example, encouraging people to share self-testing kits with their sexual partners, family members, or friends), and offer HIVST at facilities to improve service delivery efficiency.  <\/p>\n\n\n\n

A road map for other self-testing interventions<\/h2>\n\n\n\n

The introduction and scale-up of HIVST provided the infrastructure for self-testing of other infectious diseases. During the COVID-19 pandemic, only 20.4%<\/a> of global tests were conducted in low- and middle-income countries, even though they account for over half of the world\u2019s population. This underscored the urgent need for alternatives to costly, labor-intensive polymerase chain reaction, or PCR, testing. Self-sampling and self-testing quickly emerged as effective solutions, particularly when used at home, reducing transmission risk and exposure.<\/p>\n\n\n\n

A\u00a0catalytic investment<\/a>\u00a0from Unitaid and FIND in 2021, implemented in seven countries across three continents, contributed to WHO’s guidance on COVID-19 self-testing and led to the registration of three low-cost self-tests. Thanks to early insights gained from HIVST, the timeline to receive WHO guidance for COVID-19 products was significantly shortened\u00a0.<\/p>\n\n\n\n

The testing gap for hepatitis C is even wider than HIV, with only\u00a026%<\/a>\u00a0of people living with chronic hepatitis aware of their status. Stigma and discrimination as well as extremely low access to testing services \u2014 particularly among people who inject drugs \u2014 are the major barriers to testing uptake. Hepatitis C self-testing, or HCVST, offers a solution. In 2021, HCVST was\u00a0integrated into the STAR initiative<\/a>\u00a0and implemented in five countries across Africa and Asia.<\/p>\n\n\n\n

Self-testing is the future<\/h2>\n\n\n\n

The STAR initiative’s pioneering work in self-testing continues to catalyze the introduction of newer technologies, such as multiplex self-test kits, which have the potential to further revolutionize health care.<\/p>\n\n\n\n

By combining multiple tests into a single kit, multiplex self-testing provides users with a more affordable and accessible option. Additionally, by simplifying procurement and distribution, multiplex kits benefit health programs and governments while supporting a more integrated response, especially in regions with overlapping disease burdens. For example, offering multiplex self-tests to pregnant women in areas with high rates of HIV and syphilis co-infection can optimize the identification and management of these diseases, reducing mother-to-child transmission and improving health outcomes.<\/p>\n\n\n\n

Join the self-care revolution <\/h2>\n\n\n\n

Self-testing has transformed health care by expanding access and easing the strain on health systems. As we aim for universal health coverage by 2030, self-testing must be a core strategy. The success of HIV self-testing provides a powerful road map for addressing other infectious diseases, including hepatitis C, hepatitis B, STIs, and COVID-19. It also highlights the potential of multiplex self-tests to address multiple health issues at once.<\/p>\n\n\n\n

Now is the time to invest in self-care and self-testing, integrating them into public health policies and programs. We must continue to innovate, broaden access, and ensure self-testing is affordable and available to all. By doing so, we can close diagnostic gaps, improve individual health, and bring quality care to those who need it most. Let\u2019s harness the full potential of self-testing to achieve universal health coverage by 2030, building a future where everyone can take control of their health.<\/p>\n\n\n\n

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