This is piece originally ran on AIDS Map.
“With the right policies, regulations, and technical guidance,” the volume of HIV self-testing kits sold in Uganda was multiplied by twenty, Fosca Tumushabe from Population Services International told the 22nd International Conference on AIDS and STIs in Africa (ICASA 2023) last week in Harare, Zimbabwe. In addition, the volume of non-approved kits sold more than halved, while close to two million people were reached with HIV self-testing information through digital channels.
Uganda has achieved the second UNAIDS target and is on track for the third, with a score of 81:96:92. However, it’s far behind in achieving the first target, which addresses the proportion of people with HIV who know their status. To improve this, the Ministry of Health introduced HIV self-testing in 2016. Existing guidelines and policies were reviewed so as to create a supportive environment for HIV self-testing, which was rolled out to the private sector in 2020.
However, the National Drug Authority lacked clear guidelines on the sale of HIV self-testing (HIVST) kits through platforms such as e-commerce, supermarkets and drug shops (small shops selling over-the-counter medicines). Instead, the market was flooded with non-approved kits sold at exorbitant prices.
To address this issue, the Ministry of Health partnered with Population Services International (PSI) in 2021 to form an advisory board. The board comprised approved kit distributors, pharmacy representatives, implementing partners, and the National Drug Authority. Together, they developed a joint work plan to empower pharmacies, increase awareness through digital channels, distribute approved products, and introduce support tools.
Geofrrey Taasi from the Ministry of Health Uganda shared that the country reduced the registration process time for approved kits from one year to three to six months. He also added that the protocol for kits entering the country had been simplified to a few steps: the product must first be approved (“prequalified”) by the World Health Organization, after which in-country laboratory validation is done to ensure that they meet the minimum inclusion criteria. It is then evaluated in the field, and then finally approved.
To increase visibility, in 2022, PSI engaged social influencers to support demand creation and increase access to information. They also sold self-testing kits with other sexual and reproductive (SRH) products like condoms and family planning, thereby linking them with SRH and HIV prevention.
Tumushabe said they worked with around 40 pharmacies and agreed on a price point for the kits, ranging between US$1.50 to $3. A WhatsApp chatbot supported clients before, during, and after testing. The chatbot phone number and a toll-free helpline were included on kit packaging.
18,004 HIV self-testing kits were sold between April 2022 and May 2023, representing a 20 times growth in volumes sold compared to the baseline volumes, while there was a 56% reduction in volumes of non-approved kits sold. An estimated 1,805,764 people were reached with HIV self-testing information through digital channels.
Dennis Aizobu from Society for Family Health in Nigeria told a side-event organised by PSI that his country has an estimated 2 million people living with HIV. Out of these, only 1.89 million know their status, leaving over 100,000 people unidentified. To improve access to HIV testing services among undertested populations, the country has rolled out self-testing, with the first Ministry of Health guidelines published in 2019.
In 2022, market research in Lagos, Kano, and Olecha revealed that people didn’t know they could get an HIV test from the private sector. They had separated HIV testing from other medical tests, such as pregnancy tests, which they knew they could obtain from privately. However, HIV messaging and programming have been centred on the public sector, so few people looked to the private sector for HIV testing services.
The programme utilised various marketing strategies to create demand. These strategies included social media campaigns, community events, selling kits through e-commerce and online pharmacies, and bundling the product with PrEP, PEP and condoms. Moreover, the programme is collaborating with the Pharmacist Council of Nigeria to develop training modules that incorporate HIV self-testing, which will begin in 2024. In Nigeria, pharmacists have to take module examinations every year to maintain their certification, and this new module will become a part of it, making it scalable across the country.
An enabling policy environment by governments to engage the private sector in healthcare is driving the success of HIV self-testing in countries like Uganda, Nigeria, Kenya, and Ghana.
However, given the private nature of self testing, measuring or monitoring linkage to HIV care (having obtained a confirmatory HIV test with a healthcare provider and, if confirmed as HIV positive, starting ART) and linkage to psychosocial support have been raised as an issue of concern in the region.