Reaching Beyond 90-90-90: A Paradigm Shift for HIV Prevention, Treatment and Care

On this year’s World AIDS Day, the Self-Care Trailblazer Group (SCTG) kicks off our 12 Days of Universal Health Coverage (UHC) from 1 to 12 December 2020 . The connection between ending the HIV/AIDS epidemic and ensuring health for all are inextricably linked. Join the SCTG as we celebrate UHC Day to promote health for all. Throughout our 12 Days of UHC series, SCTG members and partners share insights and lessons from their organizations on how self-care is part of the solution to achieving our goal — build a safer and healthier future and health systems that serve and protect us all.

By Karin Hatzold, Associate Director HIV/TB and STAR Initiative Project Director, Population Services International

HIV self-testing (HIVST) has shifted the paradigm for HIV testing, the first step in the treatment cascade. This approach to self-care allows people to test when, where and with whom they want – with or without the support of a health provider or counselor – and  will link the person to  treatment and prevention services.

When the Unitaid-funded HIV Self-Testing Africa (STAR) Initiative project launched in 2015, globally three out of 10 people living with HIV did not know they were infected with the virus. Six years, three phases and thirteen countries later, the project has catalysed the market for HIVST. STAR has demonstrated a critical role for HIVST in reaching populations poorly served by traditional testing modalities, including men, adolescents and key populations – and ensure that HIV treatment and care services are available for everyone who needs them.

HIVST is now a standard approach to HIV diagnosis in many high burden countries with lessons for other disease control efforts and the wider universal health coverage agenda by showing that self-care is a successful approach that can help ensure health for all. HIVST has also moved from its initial focus and purpose on identifying the remaining people living with HIV who do not know their status to also becoming  a demand creation tool and entry point for effective HIV prevention services, such as starting pre-exposure prophylaxis and/or  voluntary medical male circumcision (VMMC). HIVST could become the norm for HIV screening and serve as an entry point to the larger health system. 

STAR’s HIVST programme has developed new entry points for accessing health care in low- and middle-income countries through community health care, community pharmacies, retail networks and other public/private partnerships. There they can distribute, supervise and support HIVST, and facilitate follow-up and linkage to care and prevention.

There is potential to replicate the experience from HIVST for other disease management and health areas, such as COVID-19 testing, tracing and supporting community management. STAR serves as a roadmap for other diagnostics and self-care options and provides the needed evidence-base to support policy change and rapid scale-up of other health services, products and diagnostics.

Prevention services can be delivered more broadly by  building on efforts to shift diagnostics away from health care facilities, sustainable systems for community-based delivery and expanding access to person-centred treatment. HIVST has engaged communities and generated a demand for self-care; creating potential benefits beyond the HIV epidemic to shift the perceptions of self-testing amongst healthcare workers and contributing to health system strengthening at primary health care level, which is instrumental if we will achieve UHC and health for all.