Improving HIV Prevention for Mother and Child

HIV Self-Testing to Prevent Mother-to-Child Transmission

South Africa has one of the largest burdens of HIV in the world with 7.9 million people living with HIV. 

Despite high uptake of antiretroviral therapy among HIV-positive pregnant and breastfeeding women to prevent mother-to-child transmission, an estimated 6,000 babies are born with HIV in South Africa every year.

Most transmissions to the infant occur when the mother gets infected during pregnancy from her sexual partner. Male partner HIV testing and early linkage to treatment can prevent transmission to the pregnant woman and the infant.

Rethabile has plenty to be happy about. She recently found out that she is pregnant. 

Like many expectant mothers, she visited her local antenatal clinic to register and get tested for HIV. 

Her husband Njabulo is at work and cannot accompany her. He might also not feel comfortable being the only man among all the women and babies.

In facilities like Esselen Primary Health Care Clinic in Johannesburg’s suburb of Hillbrow, providers administer routine antenatal services and blood tests, including for HIV. 

Rethabile is also asked about her partner’s HIV status, but she does not know. They never got tested for HIV together and she is unaware whether he has ever tested on his own.

Nurse Mondli Ntuli shows Rethabile how to use the HIV self-test kit. The test is easy to perform oneself–just a quick finger prick and the result will be available in just 1 minute.

In South Africa, the National Department of Health is distributing HIV self-test kits at clinics and hospitals throughout the country. Self-test kits are free of charge and pregnant women are encouraged to take the test home for their partners. Uptake of HIV self-testing among male partners is as high as 80-90%. 

Men often prefer to test in the privacy of their homes than at the clinic.  

On her way home, Rethabile wonders how she will tell her husband Njabulo about the self-test. Will he be willing to take the test?

Njabulo admits that he has never tested before for HIV. At first, he is hesitant, but Rethabile insists, “It’s important for the baby that we know if you are HIV positive. If you are positive, you can take treatment. It will reduce the risk of transmission to zero and you will not fall sick.”

Njabulo decides to self-test, using the easy-to-follow instructions. Within a few minutes the results are ready. Njabulo’s test is reactive.

He decides to go to the clinic to confirm the positive status the next day and wants to start on treatment if the test is confirmed positive.

With his status confirmed at the clinic, Njabulo has begun his antiretroviral treatment. 

Rethabile also started on pre-exposure prophylaxis to prevent infection during the first six months of Njabulo’s treatment. 

Their baby is now protected.

It is as easy as 1, 2, 3! 

Over 3 million people in South Africa have used HIV self-test kits so far, either as oral fluid or blood-based kits.  Many, like Njabulo, had never tested before and found out about their status and got to start on treatment.  The National Department of Health in collaboration with Unitaid and PSI’s STAR Initiative project will further scale up HIVST to make it available wherever people want to access it, including through vending machines and online ordering or through peer-to-peer distribution.

ABOUT THIS STORY

Over the past decade, great progress has been made in expanding HIV testing services. Yet in 2019, there were still 8.1 million people with HIV unaware of their HIV positive status. To meet the global 95-95-95 targets, there must be innovations in methods for testing.

HIV self-testing (HIVST) is a process whereby a person collects his or her own specimen using a simple rapid HIV test and then performs the test and interprets the results themselves.

HIV Self-Testing Africa (STAR) is a Unitaid-funded initiative, led by Population Services International, working to catalyze the global market for HIVST, generate evidence for decision-making and create an enabling environment for HIVST scale-up.

HIVST through the STAR Initiative has increased uptake and frequency of HIV testing among priority population groups previously not reached. HIV testing is the entry point to HIV prevention in case of a negative result and to care and treatment in the case of a positive result. Secondary distribution of HIVST kits to sexual partners of HIV negative pregnant and breastfeeding mothers has the potential to lead to earlier diagnosis and uptake of antiretroviral therapy among serodiscordant partners, thereby reducing HIV acquisition of the women and consequently reducing mother to child transmission.

HIVST through the STAR Initiative has increased uptake and frequency of HIV testing among priority population groups previously not reached. HIV testing is the entry point to HIV prevention in case of a negative result and to care and treatment in the case of a positive result. Linkage to confirmative testing and care and treatment after an HIV positive self-test is crucial.

Using an innovative WhatsApp interactive digital solution, support for consumers is bolstered by offering a platform to guide them through the HIVST experience with clear, concise and individualized instructions for how to properly administer the HIVST and accurately interpret the results. Based on the results, the WhatsApp platform informs the consumer of the appropriate next steps to link them to care and prevention services according to the outcome of their test.

These digital tools have been used in many countries that have received support through STAR with impressive results in linking self-test users to the care they need.