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By Dr. Karin Hatzold, Associate Director, HIV and Tubercuolosis and Project Director, STAR, Population Services International
Self-testing is an essential part of universal health coverage (UHC) and avital tool to help people learn about their HIV status on their own, offering individuals a pathway to accessing HIV treatment and effective HIV prevention interventions. This is particularly relevant in low- and middle-income countries (LMICs), where concerns about stigma and difficulties in accessing healthcare can place significant barriers to HIV testing.
Adapting HIV self-testing (HIVST) to meet the specific needs of the individual client, currently not able or reluctant to take up testing services, is crucial to achieving health for all. Various HIVST delivery modes have been tested through which HIVST can be made widely available to everyone who needs it, when and where they chose to access it. Distribution can be through community based and facility-based distribution of self-test kits, through vending machines or over-the-counter sales at pharmacies. Other delivery options can be met through online distribution and home delivery and through secondary distribution, when an HIVST is distributed to one person for use by another through sexual and social networks.
Since July 2022, there are now six WHO prequalified HIV self-test kits contributing to market competition and resulting in substantial price reductions of the self-test kits, affordable for out-of-pocket purchase by individuals in LMIC.
HIVST can play an essential role in helping UHC. It can ease the burden on health facilities where healthcare workers are overstretched and not able to offer HIV testing to everyone who needs it. By reducing the unit price for HIVST kits, integration of HIVST with facility-based testing, and having clients perform HIVST in outpatient settings we can put HIVST within the reach of all who need it. Offering HIV self-testing as part of routine screening, just like blood pressure and body temperature checks, health care workers could focus more on linking clients with positive self-test results to confirmative testing and HIV treatment and offering counselling and referral to clients who test negative for accessing effective HIV prevention interventions, such as pre-exposure prophylaxis (PrEP) or medical male circumcision for men. HIVST can significantly increase efficiency of services through task-shifting and reduce costs to the health delivery system, which is an essential part of ensuring we achieve UHC and a healthy future for all.
In the HIV prevention world, there is a growing recognition that diverse service delivery models can help reach populations not engaged in traditional care models. With the new WHO guidance on Differentiated and simplified pre-exposure prophylaxis (PrEP) for HIV prevention, there now exists the opportunity to further differentiate PrEP delivery with HIVST for initiation and monitoring of oral PrEP.
HIVST can enable individuals taking PrEP to test routinely, which could potentially increase access and adherence to PrEP services. Additionally, HIVST could enable greater differentiated service delivery for PrEP initiation and continuation in new settings beyond the bounds of traditional healthcare facilities, such as at private pharmacies, during at-home visits and through online ordering and distribution. Countries could consider integrating HIVST into PrEP delivery to potentially increase the resilience of service delivery and patient-centred care during an era of pandemics and achieve and maintain global HIV prevention targets.
Lessons learned from the introduction of HIVST can also be applied across self-testing for other health and disease areas as a way to help us advance progress towards UHC. The achievements provided a foundation from which the potential of other self-testing and self-care approaches can now be more readily realized, as people-centred options in UHC, including for sexually transmitted infections, Hepatitis, and COVID-19.